final presentation (national burden of cns tumors in iran)

7/29/2019 Final Presentation (National Burden of CNS Tumors in Iran)

1/26


2/26

National burden of CNSTumors in Iran

Abbass Entezari M.DMPH

Assistant Professor of Community & Preventive medicine


3/26

Clinical Data

Information

Knowledge

Appropriate

Decision Making

Improve Outcomes

For Patient

(clinical benefits)

Improve Use of

Resources

(economic Benefits)

Community

Health Promotion

Individual

Health PromotionHealth

Promotion

Service

Research

education


4/26

Necessity of priority setting

When resources are scarce and they always are

we need methods to define what is most

important.


5/26

Two public health questions:

1. What is the total impact of disease and injury in

the population?

2. How do we compare the impacts of different

diseases, risk factors, and interventions that

affect different populations?


6/26

Simple Measures

1. Death

2. New Case counting


7/26

Death Caused by CNS Tumors(Death Registration System 2004)

All(percent)

All

DeathMale

(percent)

Male

(Death)

female

(percent)

female

(Death)Site23.50764424.59489421.772750Stomach

12.58409214.18282110.061271Lung

9.5631099.3618639.871246

Hematologic

system

9.1229678.6217159.911252

Liver & Biliary

system

7.6124767.3214578.071019Brain & CNS

100325301001990010012630

All Cancer

Mortality


8/26

Death Caused by CNS Tumors(Death Registration System)

0

1000

2000

3000

4000

5000

6000

7000

8000

StomachLu

ng

Hema

tologic

syste

Liver&

Biliary

syste

Brain&

CNS

Colorectal

Esopha

gus

Reprod

uctive

syste

m

Endo

crinesyste

m

B

reast

Lary

nx

Bladder

Lymph

Nod

e

Pancre

asSk

in

Lip&

OralCa

vity

Kidn

ey

M (Death)

F (Death)


9/26

All New Cancers (Cancer Registration system 2005)

All

(percent)All(Count)Male(percent)M(Count)Female(percent)Female(Count)Site17.07848318.96532114.623162Skin112.3961560.6217527.665981Breast212.35613616.0845127.511624Stomach310.16504911.4932248.441825Reproductive sys4

8.1640568.0322558.331801Colorectal53.6017874.6413032.24484Lung102.7413601.273564.641004Endocrine sys112.5312572.717612.29496Brain & CNS121.829032.035691.54334Kidney13

100496921002806710021625All Cancer


10/26

All New Cancers (Cancer Registration system 2005)

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Skin

Brea

st

Stom

ach

Reproductives

ystem

Colorectal

Bladder

Esophagus

Hema

tolog

icsyste

LymphN

odeLu

ng

Endocri

nesy

stem

Brain&

CNS

Kidney

Larynx

Lip&

OralC

avity

Liver&

Bili

arysyste

Pancreas

M (Count)

F (Count)


11/26

New CNS Cancers in Provinces (Female)

Female

ASR/100,000F (Count)Provice

2.509Charmahal

2.30120Tehran

2.067Zanjan

0.231Yasuj

0.000E.Azarbayjan

0.000Hormozgan


12/26

New CNS Cancers in Provinces (Male)

Male

ASR/100,000

Male

(Count)Provice

3.4211Bushehr

3.41178Tehran

2.965Khorasan - S

0.322Hormozgan

0.281Semnan

0.251Yasuj


13/26

New CNS Cancers in Provinces (Both Sex)All (ASR/100000)ProviceAll (ASR/100000)Provice

1.48Qom2.86Tehran

1.48Markazi2.27Isfahan

1.42Ghazvin2.24W.Azarbayjan

1.41Mazandaran2.20Bushehr

1.35Khorasan - N2.19Zanjan

1.35Gilan2.18Hamadan

1.31Loresan2.04Kerman

1.28Kordestan1.97Khozestan

0.91Ardabil1.90Fars

0.78Ilam1.86Yazd

0.58Semnan1.83Kermanshah

0.53Sistan1.83Khorasan - Razavi

0.24Yasuj1.63Charmahal

0.19E.Azarbayjan1.61Khorasan - S

0.16Hormozgan1.60Golestan


14/26

New CNS Cancers in Provinces (Both Sex)

Tehr

an

Isfah

an

W.Azarbayjan

Bush

ehr

Zanja

n

Hama

dan

Kerm

an

Khoz

esta

nFa

rsYa

zd

Kerm

ansh

ah

Khoras

an-Razavi

Charm

ahal

Kho

rasan

-S

Goles

tan

Markazi

Qom

Ghaz

vin

M

azan

daran Gi

lan

Kho

rasan

-N

Lores

an

Kordestan

Ardabil Ila

m

Semn

an

Sista

nYa

suj

E.Aza

rbayjan

H

ormo

zgan

Male

Female


15/26

Most common CNS Tumor Types

Total

CountMaleFemaleType343194149Astrocytoma NOS342227115Glioblastoma NOS794930Astrocytoma Anaplastic674126Medulobastoma NOS573720Oligodendroglioma NOS


16/26

Least common CNS Tumor Types

Total

CountMaleFemaleType101Fibrosarcoma

110Mixed Tumor Malignant NOS

101Atypical Teratoid/Rhabdoid Tumor

110Malignant Lymphoma Mixed

101Malignant Lymphoma Small cleaved


17/26

CNS Tumor Types

Astro

cytomaNOS

GlioblastomaNOS

Astro

cytomaAn

aplasti

c

Medulob

astomaNOS

Oligoden

droglio

maNOS

Epen

dimom

aNOS

Astro

cytomaFibrilar

y

Mixe

dGlioma

Astro

cytomaGe

mistocyti

Oligoden

droglio

maAn

aplastic

MalignantL

ymph

omaNOS

Neoplasm

/Malignant

Epen

dimom

aAna

plastic

Prim

itive

Neuroecto

derm

alTumor

Medulob

astomaDe

smoplastic

MalignantL

ymph

omaLa

rgeB-Cel

l

SmallCel

l

Astro

cytomaPr

otoplasmi

c

Phleom

orphicXa

nto-Astro

cytom

a

GlioblastomaGiantCel

l

Germinoma

Astro

belastoma

Gliosarcoma

GliomaM

alignant

Fibr

osar

coma

Mixe

dTu

mor

MalignantNOS

Atypica

lTeratoid/Rh

abdoid

Tumo

r

Maligna

ntLym

phom

aMi

xedsm

all&

Largece

l

MalignantL

ymph

omaSm

allcleave

d

Male

Female


18/26

Ultimate Measure of Ill-health?

Death is most common

Easy to determine

Commonly tabulated

Deaths + Illness = ?


19/26

Disability Adjusted Life Year (DALY)

DALY = YLL + YLD

Years of Lost Life (due to mortality)

Years Lost to Disability (due to injury & illness)

The only differences in the rating of a death or

disability should be due to age and sex, not to

income, culture, location, social class.

Everyone in the world has right to best life expectancy in world


20/26

Needs for DALY calculation

1. Prevalence of CNS Tumors

2. Incidence of CNS Tumors

3. Age of onset & Duration of CNS Tumors

4. Mortality of CNS Tumors

5. Remission rate of CNS Tumors

6. Case fatality of CNS Tumors

7. RR mortality plusTotal population of Iran

Total Mortality of iran


21/26

problem

There are no complete and

consistent data


22/26

WHO recommendation

Use of Disease Modeling concept and DISMOD

software for production of consistent data


23/26

YLL (due to Mortality) of All Cancers

YLLSite61793.4Stomach cancer

57608.4Leukaemia

45855.9CNS cancer

2901.8Cervix uteri cancer

2294.8Corpus uteri cancer

2005.3Ovary cancer


24/26

YLD (due to mortality) of All Cancers

YLDSite5474.0Breast cancer

4520.9Stomach cancer

3278.9Colon cancer3251.1Leukaemia

3063.8Respiratory Cancers

2863.9skin cancers

2632.1Bladder cancer

1978.5CNS cancer

5474.0Breast cancer


25/26

Highest Cancers DALYs In Iran

DALY %DALYSite100157117.0All Cancers

42.2166314.3Stomach cancer

38.7460859.5Leukaemia

30.4547834.4CNS cancer

23.8537476.1Respiratory Cancers

18.9029702.1Liver cancer


26/26

final presentation (national burden of cns tumors in iran)

Documents