Trends and Spatial Patterns of Oral Cancer Mortality in Ecuador, 2001–2016

The aims of this study were to describe the temporal trend of OC from 2001 to 2016 and to analyze the space and space-time clusters of high mortality due to OC in Ecuador from 2011 to 2016. Methods. The present study is a mixed ecological study; the time trends were obtained using a Joinpoint regression model, space-time scan statistics was used to identify high-risk clusters, and Global Moran I index was calculated. Results. In Ecuador, between 2001 and 2016, OC caused a total of 1,025 deaths. Crude mortality rates significantly increased, with an APC (annual percentage change) of 2.7% (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mrow><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.009</mml:mn></mml:mrow></mml:math>). The age-standardized mortality rate did not significantly increase (APC: 1.73%; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mrow><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.08</mml:mn></mml:mrow></mml:math>). The most likely cluster was detected in 2015, included 20 cantons. The second cluster included 38 cantons, in the years 2014 to 2016. The Global Moran I index for the study period showed a negative spatial autocorrelation (−0.067; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mrow><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.37</mml:mn></mml:mrow></mml:math>). Conclusion. Mortality due to OC in Ecuador significantly increased over the 16-year study period, the young groups being the most affected. Ecuadorian provinces present high variability in types of OC and cancer rates.