Impact of war on central nervous system tumors incidence: a 15-year retrospective study in Istria County, Croatia

Telarović, Srđana and Telarović, Siniša and Relja, Maja and Franinović-Marković, Julijana (2006) Impact of war on central nervous system tumors incidence: a 15-year retrospective study in Istria County, Croatia. Collegium Antropologicum, 30 (1). pp. 149-155. ISSN 0350-6134

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Abstract

The aim of study was to analyze epidemiological features of central nervous system (CNS) tumors diagnosed in Istria County, Croatia, with a particular emphasis on incidence dynamics during the wartime (1991-1995). The data were extracted from the medical records of patients with CNS tumors admitted to the Department of Neurology of Pula General Hospital in the period from the 1st January 1986 to the 31st December 2000, N = 364. For calculation of rates, we used data from the 2001 Croatian consensus http://www.dzs.hr/Eng/Census/census2001.htm. Data are presented as counts and incidence rates (IRs) per 100,000 persons-years in the case of annual rates. Annual incidence rates are shown as "raw" incidence rates and smoothed 5-year rolling average rates. The examined patient-related variables were: sex, age, occupation, premorbidity and comorbidity, with a particular emphasis on psychosomatic disorders and negative habits. The analyzed tumor-related variables included clinical manifestation, localization, and applied diagnostic and therapeutic methods. Primary tumors were separated from the metastatic, and the latter were analysed with respect to their site of origin. The lowest incidence of CNS tumors (10 patients) was reported in 1990, and the highest (42 patients) in 1993. The incidence dynamics of CNS tumors showed a rapidly progressive increase over the 1991-1995 period, followed by the return to average values. The access to a better and more readily available diagnostics may only partially explain this phenomenon. Therefore, we analyzed other factors that may have contributed towards the rapid increase in the number of CNS tumors, such as its coincidence with the war or psychotrauma. The results confirm the observational clinical hypothesis of an extreme increase in the number of CNS tumors during the period under consideration.

Abstract in Croatian

Cilj studije je epidemiološka analiza bolesnika sa dijagnosticiranim tumorom središnjeg živčanog sustava (SŽS) u Istarskoj županiji, Hrvatska, s posebnim osvrtom na dinamiku incidencije tijekom ratnih godina (1991–1995). Podaci su prikupljeni analizom medicinske dokumentacije bolesnika liječenih na Odjelu za neurologiju Opće bolnice Pula u razdoblju od 1. siječnja 1986.g. do 31. prosinca 2000.g., N=364. Za demografsku analizu korišteni su podaci Državnog zavoda za statistiku – http://www.dzs.hr/Eng/Census/census2001.htm1 te je uz deskriptivnu statistiku odgovarajućim statističkim metodama izračunata godišnja stopa incidencije tumora na 100.000 osoba. Analizirane su osobine bolesnika u odnosu na spol, dob i zanimanje, te premorbiditet i komorbiditet s posebnim osvrtom na psihosomatske bolesti i negativne navike. Prikazane su karakteristike ekspanzivnih procesa u odnosu na kliničku manifestaciju i lokalizaciju te dijagnostičke metode i postupke terapije. Također su izdvojeni primarni tumori od metastatskih kod kojih je analizirano ishodišno sijelo. Najniža incidencija zabilježena je 1990. godine – 10, a najviša 1993.godine – 42 tumora. Istraživanjem dinamike incidencije prikazan je rapidno progresivni porast u godinama od 1991. do 1995., a nakon toga pad prema prosječnim vrijednostima. Respektirajući bolju i dostupniju dijagnostiku koje samo djelomično mogu utjecati na navedeni prikaz, analizirani su i drugi čimbenici naglog povećanja broja tumora SŽS, posebice koincidiranje s neposrednim ratnim godinama i psihotraumom. Rezultati istraživanja također potvrđuju empirijsku kliničku pretpostavku o ekstremnom povećanju ekspanzivnih procesa SŽS u navedenom razdoblju.

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