28 July 2010
The Department of Health Information and Research has a unique reporting role as regards the health of the Maltese population. One means of assessing our population health is by maintenance of registries on birth and deaths and a number of conditions. The National Mortality Registry deals with mortality statistics whose data comes almost exclusively from the death certificate. Since it is legal requirement for a death certificate to be completed by the certifying doctor after each death, the data coverage is considered to be practically 100%. The accuracy and detail of the certification is further improved by the Department through validation with the deceased medical records carried out by trained medical professionals, cross linking with other registers such as the Malta National Cancer Registry, and, where necessary, discussion with certifying doctor as well as with pathologists and police, particularly regarding deaths from external causes.
The Malta National Cancer Registry has been collecting data from hospitals, laboratories, clinics both public and private in the MalteseIslands since 1991. This register covers all cancer diagnoses resulting in around 1,200 new diagnoses yearly (excluding rare non-melanocytic skin cancers). The function of this register is to collect data as regards the cancer burden in the community, and follow up diagnosed cases. It provides a surveillance tool to examine trends for cancer by age and gender, cancer type, over time at a national level.
For the following analysis incidence data was extracted by gender, five year age groups and region of residence allowing computation of age and gender standardised rate for the six different regions of the MalteseIslands for the years 2000-2007 separately. Due to small numbers, an average for the periods 2000-2003 and 2004-2007 are being presented, rather than numbers for single years. Similarly, information regarding mortality were extracted from the national mortality registry for the years 2000-2008. Data was extracted by gender, five year age groups and region of residence.
Results:
Over incidence and mortality rates resulting from all cancers are higher amongst males when compared to females for all regions in both time periods being investigated.
Males
Between the period of 2000 and 2003 the highest cancer incidence rates amongst males were in the Southern Harbour and the South East region. This is followed by the Western, Northern and NorthernHarbourregions. The lowest cancer incidence rate between 2000 and 2003 was in Gozo. One should however note that the difference between the highest rate and the lowest rate is of only 35 cases per 100,000 in this period. Cancer incidence rates amongst males have increased from the period between 2000 and 2003 to the period between 2004 and 2007 in all regions but these increases are not significant in the North. In fact, between 2004 and 2007 the Northern region and Gozo remain with the lowest cancer incidence rates amongst males. The South East region no longer has the highest cancer incidence rate amongst males for the period of 2004 to 2007 but comes second to the SouthHarbour and the Western regions, which show the highest incidence rates amongst males.
Table 1 All Cancer Incidence (excluding non-melanoma skin cancers) - Males
Average age-standardised rate per 100,000 populationDistrict / 2000 - 2003 / 2004 – 2007
Rate / 95% Confidence Int. / Rate / 95% Confidence Int.
Southern Harbour / 315.96 / (310.84 , / 321.04) / 373.09 / (367.45 , / 378.73)
Northern Harbour / 291.92 / (287.84 , / 295.99) / 340.69 / (336.01 , / 345.37)
South Eastern / 317.47 / (310.36 , / 324.58) / 357.98 / (350.59 , / 365.37)
Western / 304.18 / (297.14 , / 310.98) / 363.35 / (355.82 , / 370.88)
Northern / 299.08 / (292.28 , / 305.87) / 303.04 / (296.61 , / 309.48)
Gozo & Comino / 280.30 / (272.33 , / 288.26) / 293.53 / (285.57 , / 301.48)
Between 2000 and 2004 the highest mortality rate for all cancers amongst males was in the Southern Harbour region. One notes a significant decreasing trend in the following order: the Western Region, the Northern Harbour Region and the South East region, respectively. Gozo and the Northern region show similar mortality rates and have the lowest rates for this time period amongst the 6 regions. The difference between the highest and lowest rates is of 63 deaths per 100,000. Similar to incidence rates amongst males, mortality rates have also increased from the period of 2000 to 2004 and the period of 2005 to 2008. The SouthHarbour region remains the region with the highest mortality rate. This is followed by the West and South Eastern with similar mortality rates. The NorthHarbour and Northern regions have the third highest rates while Gozo remains the region with the lowest cancer mortality rate amongst males.
Table 2: All cancer mortality - Males
Average age-standardised rate per 100,000 populationDistrict / 2000 - 2004 / 2005 - 2008
Rate / 95% Confidence Int. / Rate / 95% Confidence Int.
Southern Harbour / 213.30 / (209.14 , / 217.46) / 229.33 / (224.88 , / 233.78)
Northern Harbour / 180.50 / (177.29 , / 183.71) / 201.78 / (197.98 , / 205.09)
South Eastern / 170.19 / (165.03 , / 175.36) / 215.76 / (209.97 , / 221.56)
Western / 202.75 / (197.04 , / 208.47) / 216.57 / (210.67 , / 222.46)
Northern / 151.89 / (147.08 , / 156.71) / 196.05 / (190.07 , / 202.03)
Gozo & Comino / 149.64 / (144.08 , / 155.20) / 171.21 / (164.98 , / 177.43)
Females
Between 2000 and 2003 the highest cancer incidence rate amongst females was in the South Eastern District. This is followed by the Southern Harbour, NorthernHarbour and North Districts which share similar rates. The lowest incidence rates were in the Northern Region and Gozo, similar to males during the same time period. The difference between the lowest and highest rates is of 39 cases per 100,000. An increase in cancer incidence within all regions was also noted amongst females from the period of 2000 to 2003 and 2004 to 2007 with the exception of the South Eastern Region. Between 2004 and 2007 the highest incidence rate is in the Northern Harbour Region followed by the Western Region. The South Eastern Region and Gozo show similar rates and are placed below the NorthHarbour and West. The Northern region shares the lowest cancer incidence rate amongst women with the Southern Harbour region.
Table 3: All cancer incidence (excluding non-melanoma skin cancers) - Females
Average age-standardised rate per 100,000 populationDistrict / 2000 - 2003 / 2004 - 2007
Rate / 95% Confidence Int. / Rate / 95% Confidence Int.
Southern Harbour / 262.72 / (258.21 , / 267.22) / 278.09 / (273.32 , / 282.86)
Northern Harbour / 263.53 / (259.86 , / 267.21) / 321.40 / (317.35 , / 325.45)
South Eastern / 283.66 / (277.38 , / 289.94) / 285.63 / (279.42 , / 291.85)
Western / 265.82 / (260.09 , / 271.55) / 302.44 / (296.31 , / 308.58)
Northern / 245.36 / (239.33 , / 251.39) / 279.69 / (273.70 , / 285.67)
Gozo & Comino / 247.54 / (240.42 , / 254.65) / 284.42 / (276.68 , / 292.15)
Between 2000 and 2004 the highest cancer mortality rate amongst females was in the SouthHarbour and South Eastern regions which share similar rates. These are closely followed by the NorthernHarbour region. The lowest cancer mortality rates amongst females for this time period were in Gozo, the West and North. However, the difference between the highest and lowest rates is of just 16 deaths per 100,000. Mortality rates have increased in all regions from the period of 2000 to 2004 and 2005 to 2008 however these increases are not significant for the West. On the other hand, the highest mortality rates for the period of 2005 to 2008 are in Gozo, the NorthHarbour and South Eastern Regions while the lowest rates are within the Southern Harbour, Western and Northern Regions. Once again, the difference between the highest and the lowest is quite low – just 22 deaths per 100000 population.
Table 4: All cancer mortality - Females
Average age-standardised rate per 100,000 populationDistrict / 2000 - 2004 / 2005 - 2008
Rate / 95% Confidence Int. / Rate / 95% Confidence Int.
Southern Harbour / 129.36 / (126.44 , / 132.29) / 121.15 / (118.24 , / 124.05)
Northern Harbour / 120.52 / (118.15 , / 122.89) / 137.62 / (135.07 , / 140.15)
South Eastern / 127.10 / (122.91 , / 131.28) / 137.97 / (133.65 , / 142.30)
Western / 113.44 / (109.91 , / 116.97) / 116.07 / (112.41 , / 119.73)
Northern / 114.60 / (110.57 , / 118.63) / 119.42 / (115.66 , / 123.18)
Gozo & Comino / 113.27 / (108.73 , / 117.81) / 138.81 / (133.37 , / 144.25)