Cancer mortality in Serbia, 1991-2015: an age-period-cohort and joinpoint regression analysis

Background: As the result of dramatic political changes, civil wars, and a long-term refugee crisis from the end of the last to beginning of this century, the population of Serbia has experienced significant health problems. The aim of this study was to assess cancer mortality trends in Serbia. Methods: This nationwide study was carried out to analyze cancer mortality in Serbia during 1991-2015 using official data. The age-standardized mortality rates (per 100,000) were calculated by direct standardization, using the world standard population by Segi. The average annual percent change (AAPC) and corresponding 95% confidence interval (CI) were computed using joinpoint regression analysis. Age-period-cohort analysis was performed to address the possible underlying reasons for the observed temporal trends. Results: Over the 25-year study period, there were 466,075 cancer deaths (266,043 males and 200,032 females) in Serbia. Overall cancer mortality increased between 1991 and 2009 in both males (by + 0.9% per year) and females (by + 0.8% per year) and has been decreasing since then, by -0.9% annually in both sexes. For almost all major cancers except stomach cancer, cancer mortality in Serbia demonstrated upward trends during the study period. The largest increases were noted in lung cancer among females (AAPC = +3.7, 95% CI 3.5-3.9) and prostate cancer in males (AAPC = +1.9, 95% CI 1.4-2.3). \Conclusions: After two decades of increase, cancer mortality rates are finally declining in Serbia. Despite this, these rates place Serbia among the countries with the highest cancer mortality in the world.