Facchini U, Camnasio M, Cantaboni A, Decarli A, La Vecchia C
Int J Epidemiol. 1985 Dec;14(4):538-48. doi: 10.1093/ije/14.4.538.
The distribution of death certification rates from various cancers or groups of cancers in broad Italian geographical areas (north/centre/south) was analysed. In both sexes, total cancer mortality was considerably elevated in the north of the country compared to southern regions (around 70% for males and 30% for females in the truncated 35-64 rate), and generally intermediate in central areas. Northern mortality rates were higher for respiratory cancers and other tobacco related neoplasms (excluding bladder), with a north/south ratio ranging from 1.5 for lung and most respiratory sites to about 4.0 for oesophageal cancer in males. There was little tendency towards a leveling of these differences in younger (40-49 year old) males. Northern areas showed higher death certification rates for cancers of the stomach, large bowel, liver and most other digestive sites. The lower gastric cancer mortality registered in southern Italy is curious, since this is the poorest part of the country. Death certification rates from all other common neoplasms (uterus apart) were also elevated in the north. The geographical variation, however, appeared more limited for non-epithelial neoplasms. The substantial differences in cancer mortality between various Italian geographical areas can hardly be dismissed as due to lower death certification accuracy in the south. Some of the differences can be explained in terms of available knowledge of the causes of cancer (eg reproductive factors for breast and ovarian neoplasms, alcohol plus tobacco for oesophageal cancer). However, the lower mortality from respiratory cancers in southern areas can only with some difficulty be totally explained in terms of tobacco consumption. Likewise, the north/south variation cannot be related to non-specific consequences of industrialization, since cancer mortality was similarly elevated in highly industrialized and chiefly rural northern areas. It is conceivable that dietary factors may also explain some of the differences. However, at present, there is no obvious general explanation for this quite peculiar geographical distribution of cancer mortality within a single country.
分析了意大利主要地理区域（北部/中部/南部）各类癌症或癌症组的死亡证明率分布情况。在男性和女性中，该国北部的癌症总死亡率相比南部地区大幅升高（在截断的35 - 64岁死亡率中，男性约高70%，女性约高30%），中部地区的死亡率通常处于中间水平。北部地区呼吸道癌症和其他与烟草相关的肿瘤（不包括膀胱癌）的死亡率较高，男性中，从肺癌和大多数呼吸道部位的1.5到食管癌的约4.0，南北死亡率之比不等。在较年轻（40 - 49岁）男性中，这些差异几乎没有趋于平稳的趋势。北部地区胃癌、大肠癌、肝癌和大多数其他消化部位癌症的死亡证明率较高。意大利南部胃癌死亡率较低令人好奇，因为这是该国最贫困的地区。除子宫癌外，所有其他常见肿瘤的死亡证明率在北部也较高。然而，非上皮性肿瘤的地理差异似乎更为有限。意大利不同地理区域之间癌症死亡率的巨大差异很难被认为是由于南部死亡证明准确性较低所致。部分差异可以根据对癌症病因的现有认识来解释（例如乳腺癌和卵巢癌的生殖因素、食管癌的酒精加烟草因素）。然而，南部地区呼吸道癌症死亡率较低仅靠烟草消费很难完全解释。同样，南北差异与工业化的非特定后果无关，因为在高度工业化且主要是农村的北部地区，癌症死亡率同样升高。可以想象饮食因素也可能解释部分差异。然而，目前对于一个国家内这种非常特殊的癌症死亡率地理分布，尚无明显的总体解释。
