Municipal distribution of bladder cancer mortality in Spain: Possible role of mining and industry

Background: Spain shows the highest bladder cancer incidence rates in men among European countries. The most important risk factors are tobacco smoking and occupational exposure to a range of different chemical substances, such as aromatic amines. Methods: This paper describes the municipal distribution of bladder cancer mortality and attempts to adjust this spatial pattern for the prevalence of smokers, using the autoregressive spatial model proposed by Besag, York and Mollie, with relative risk of lung cancer mortality as a surrogate. Results: It has been possible to compile and ascertain the posterior distribution of relative risk for bladder cancer adjusted for lung cancer mortality, on the basis of a single Bayesian spatial model covering all of Spain's 8077 towns. Maps were plotted depicting smoothed relative risk (RR) estimates, and the distribution of the posterior probability of RR>1 by sex. Towns that registered the highest relative risks for both sexes were mostly located in the Provinces of Cadiz, Seville, Huelva, Barcelona and Almeria. The highest-risk area in Barcelona Province corresponded to very specific municipal areas in the Bages district, e. g., Sur a, Sallent, Balsareny, Manresa and Cardona. Conclusion: Mining/industrial pollution and the risk entailed in certain occupational exposures could in part be dictating the pattern of municipal bladder cancer mortality in Spain. Population exposure to arsenic is a matter that calls for attention. It would be of great interest if the relationship between the chemical quality of drinking water and the frequency of bladder cancer could be studied.