Revising Incidence and Mortality of Lung Cancer in Central Europe: An Epidemiology Review From Hungary

Abstract

Objective: While Hungary is often reported to have the highest incidence and mortality rates of lung cancer, until 2018 no nationwide epidemiology study was conducted to confirm these trends. The objective of this study was to estimate the occurrence of lung cancer in Hungary based on a retrospective review of the National Health Insurance Fund (NHIF) database. Methods: Our retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with lung cancer (ICD-10 C34) between 1 Jan 2011 and 31 Dec 2016. Age-standardized incidence and mortality rates were calculated using both the 1976 and 2013 European Standard Populations (ESP). Results: Between 2011 and 2016, 6,996 - 7,158 new lung cancer cases were recorded in the NHIF database annually, and 6,045 - 6,465 all-cause deaths occurred per year. Age-adjusted incidence rates were 115.7-101.6/100,000 person-years among men (ESP 1976: 84.7-72.6), showing a mean annual change of - 2.26% (p = 0.008). Incidence rates among women increased from 48.3 to 50.3/100,000 person-years (ESP 1976: 36.9-38.0), corresponding to a mean annual change of 1.23% (p = 0.028). Age-standardized mortality rates varied between 103.8 and 97.2/100,000 person-years (ESP 1976: 72.8-69.7) in men and between 38.3 and 42.7/100,000 person-years (ESP 1976: 27.8-29.3) in women. Conclusion: Age-standardized incidence and mortality rates of lung cancer in Hungary were found to be high compared to Western-European countries, but lower than those reported by previous publications. The incidence of lung cancer decreased in men, while there was an increase in incidence and mortality among female lung cancer patients.

Keywords: European standard population; Hungary; epidemiology; incidence; lung cancer; mortality.

Figure 1

Age-standardized incidence rates (standard: ESP 2013) of lung cancer by sex in Hungary between 2011 and 2016 (per 100,000 person-years; dotted lines represent 95% CI). CI, confidence interval.

Figure 2

Age-standardized mortality rates (standard: ESP 2013) of lung cancer by sex in Hungary between 2011 and 2016 (per 100,000 person-years; dotted lines represent the 95% CI). CI, confidence interval.

Figure 3

Age-standardized incidence and mortality rates per 100,000 person-years among male lung cancer patients in European countries and Hungary based on the NHIF survey in 2012 (using ESP 1976). Description: A dot in the graph shows age-standardized incidence and mortality rates together for a country. The Y axis represents the standardized mortality rate per 100,000 population, while the X axis represents the standardized incidence rate per 100,000 population.

Figure 4

Correlation between the age-standardized incidence rate of lung cancer in European countries in 2012 based on the report by Ferlay et al. (2) and the age-standardized prevalence (%) of tobacco smoking in the population aged ≥15 years in 1998–2002. Description: incidence rates of lung cancer are presented as a function of the prevalence of tobacco smoking. The X axis represents the age-standardized prevalence of smoking expressed in percentages in the population aged >15 years between 1998 and 2002 and the Y axis represents the age-standardized incidence rates of different European countries, thus merging these data in one dot.