A comparison of the cancer-related mortality of France and Italy using the multiple cause-of-death approach

Aline Desesquelles, Institut National d'Études Démographiques (INED)
Antonio Salvatore, Università di Roma "La Sapienza"
Marilena Pappagallo, Istituto Nazionale di Statistica (ISTAT)
Luisa Frova, Istituto Nazionale di Statistica (ISTAT)
Monica Pace, Istituto Nazionale di Statistica (ISTAT)
France Meslé, Institut National d'Études Démographiques (INED)
Viviana Egidi, Università di Roma "La Sapienza"

In the literature, multiple cause-of-death (MCOD) data have been used in order to re-evaluate mortality levels attributed to a given condition, as well as to examine what are the most frequent/specific associations of causes involving this condition. We use this approach to analyse and compare cancer-related mortality of Italy and France. Though treatments have improved, cancer remains a very lethal disease. Thus it is expected that cancer often is selected as the underlying cause of the death but it may vary according to anatomic sites. Cancers with the best survival profiles may be considered as chronic conditions, and the presence of comorbid conditions among long-term cancer survivors is likely to become more frequent. Data for the two countries are for year 2003. They are based on all mentions reported on the death certificates by the certifying physicians. The similarity of the results for the two countries is very striking. We find that the re-evaluation of the mortality levels is modest for most anatomic sites. The impact of the MCOD approach is larger for malignant neoplasms of the skin and of the prostate. For all anatomic sites, the most frequent associations are with neoplasms, diseases of the circulatory system, and diseases of the respiratory system, but the picture is very different for the most specific associations. The simultaneous reporting of a neoplasm as underlying and contributing cause of the death is a feature of the cancer-related mortality. As far as we know from the medical state of the art, we are able to categorize all other associations according to five lines of interpretation (“degeneration of the contributing cause”, “risk factor for cancer”, “common cause”, “consequence / complication of cancer”, “symptom of cancer”).