THE DISTRIBUTION OF MORTALITY BY CERVICAL -CANCER IN SPAIN FROM 1981 TO 1986 - AN ECOLOGICAL STUDY

BACKGROUND: The aim of the present study was to analyze the geographic distribution of mortality by cervical cancer in Spain from 1981-1986 and to examine the relationship with a group of variables such as per capita income, the occurrence of sexually transmitted diseases, the nu mber of hotel rooms, and the prescriptions of oral contraceptives at a provincial level. METHODS: The causes standardized of death for cervi cal cancer in each Spanish province during the period from 1981 to 198 6 were estimated. Multivariate analysis by Poisson regression was perf ormed to determine the relationship between mortality and the variable s collected. To do so the provinces were classified into four categori es according to quartile distribution of each independent variable con sidered with the relative risk for each category created being estimat ed. RESULTS: A characteristic mortality pattern was observed in cervic al cancer with the greatest mortality being found in the island and so me coastal provinces and the lowest mortality in the peninsular Inland provinces. Upon simple analysis of the relationship of mortality with the ecologic variables an important positive association was found wi th the number of hotel rooms and, to a lesser degree, with the oral co ntraceptive prescriptions, provincial per capita income, the percentag e of urban population and the rate of illiteracy. CONCLUSIONS: A distr ibution Of mortality by cervical cancer which appears to correspond to a certain leisure-turism pattern, in addition to greater urban and le sser cultural development is reported. This may be in agreement with t he hypothesis that cervical cancer is more frequent in more urban area s in which women demonstrate greater promiscuity and relaxation of sex ual behaviours, together with the persistence of a low education level .