[The distribution of cervical cancer mortality in Spain (1981-1986). An ecological study]

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 number of hotel rooms, and the prescriptions of oral contraceptives at a provincial level.

The causes standardized of death for cervical cancer in each Spanish province during the period from 1981 to 1986 were estimated. Multivariate analysis by Poisson regression was performed to determine the relationship between mortality and the variables collected. To do so the provinces were classified into four categories according to quartile distribution of each independent variable considered with the relative risk for each category created being estimated.

A characteristic mortality pattern was observed in cervical cancer with the greatest mortality being found in the island and some 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 with the number of hotel rooms and, to a lesser degree, with the oral contraceptive prescriptions, provincial per capita income, the percentage of urban population and the rate of illiteracy.

A distribution of mortality by cervical cancer which appears to correspond to a certain leisure-tourism pattern, in addition to greater urban and lesser cultural development is reported. This may be in agreement with the hypothesis that cervical cancer is more frequent in more urban areas in which women demonstrate greater promiscuity and relaxation of sexual behaviours, together with the persistence of a low education level.