Comparing Cancer Mortality Estimates in Mexico By Using Two National Death Registries

Abstract 49 Background: Mexico has low cancer mortality compared with other Latin American countries and high-income economies. The National Institute of Geography and Statistics (INEGI) uses an automated coding system that has been adapted from the Centers for Disease Control system to process death certificates. In contrast, the System for Epidemiologic Death Statistics (SEED) relied on a standardized manual process. We hypothesized that the low cancer mortality could be explained by processing procedures. We undertook this work to compare cancer mortality rates from two national death registries that independently code and attribute cause of death from death certificates. Methods: We calculated age-standardized cancer mortality rates for all cancers and specific sites by sex for 2010 to 2014 by using data from INEGI and SEED. We calculated stroke mortality rates for comparison. We obtained age-adjusted mortality rates and 95% CIs by using direct method and World Population Prospects 2010 as a standard. Results: Age-standardized mortality rate per 100,000 women for all cancers was 74.8 (95% CI, 74.0 to 75.6) in INEGI and 74.1 (95% CI, 73.3 to 74.9) in SEED for 2010. In contrast, for men, cancer mortality rate was 69.0 (95% CI, 68.2 to 69.7) in INEGI and 68.4 (95% CI, 67.7 to 69.7) in SEED. We did not observe substantial differences across cancer sites and years; however, when analyzing cases with cancer as a contributing condition, INEGI reported approximately 50% more compared with SEED. In contrast, stroke mortality significantly differed between registries for all years. For women, in 2010, INEGI reported 29.4 (95% CI, 29.0 to 29.9) compared with 26.5 (95% CI, 26.0 to 26.9) in SEED. Corresponding estimates for men were 36.6 (95% CI, 36.0 to 37.1) and 33.0 (95% CI, 32.4 to 33.5), respectively. Conclusion: Cancer mortality estimates were minimally affected by use of distinct processing procedures. Death certification in Mexico should be further evaluated. Funding: AstraZeneca, GlaxoSmithKline, and Merck. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Susana Lozano-Esparza No relationship to disclose Dalia Stern No relationship to disclose Juan Eugenio Hernandez-Avila No relationship to disclose Evangelina Morales-Carmona No relationship to disclose Rafael Lozano No relationship to disclose Eduardo Lazcano-Ponce Consulting or Advisory Role: Merck Sharp & Dohme Research Funding: Roche, Roche (Inst), BD, Qiagen (Inst) Travel, Accommodations, Expenses: GlaxoSmithKline, Merck Sharp & Dohme, Qiagen Ruy Lopez-Ridaura Research Funding: AstraZeneca Martin Lajous Research Funding: AstraZeneca

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Stroke Mortality Trends in the Population of Klaipėda From 1994 to 2008

Medicina ◽

10.3390/medicina47090071 ◽

2011 ◽

Vol 47 (9) ◽

pp. 512 ◽

Cited By ~ 3

Author(s):

Henrikas Kazlauskas ◽

Nijolė Raškauskienė ◽

Rima Radžiuvienė ◽

Vinsas Janušonis

Keyword(s):

Mortality Rate ◽

Mortality Rates ◽

Mortality Data ◽

World Population ◽

Stroke Mortality ◽

Middle Aged ◽

Elderly Men ◽

Men And Women ◽

Specific Mortality ◽

Permanent Residents

The objective of the study was to evaluate the trends in stroke mortality in the population of Klaipėda aged 35–79 years from 1994 to 2008. Material and Methods. Mortality data on all permanent residents of Klaipėda aged 35–79 years who died from stroke in 1994–2008 were gathered for the study. All death certificates of permanent residents of Klaipėda aged 35–79 years who died during 1994–2008 were examined in this study. The International Classification of Diseases (ICD-9 codes 430–436, and ICD-10 codes I60–I64) was used. Sex-specific mortality rates were standardized according to the Segi’s world population; all the mortality rates were calculated per 100 000 population per year. Trends in stroke mortality were estimated using log-linear regression models. Sex-specific mortality rates and trends were calculated for 3 age groups (35–79, 35–64, and 65–79 years). Results. During the entire study period (1994–2008), a marked decline in stroke mortality with a clear slowdown after 2002 was observed. The average annual percent changes in mortality rates for men and women aged 35–79 years were –4.6% (P=0.041) and –6.5% (P=0.002), respectively. From 1994 to 2002, the stroke mortality rate decreased consistently among both Klaipėda men and women aged 35–64 years (20.4% per year, P=0.002, and 14.7% per year, P=0.006, respectively) and in the elderly population aged 65–79 years (13.8% per year, P=0.005; and 12% per year, P=0.019). During 2003–2008, stroke mortality increased by 16.3% per year in middle-aged men (35–64 years), whereas among women (aged 35–64 and 65–79 years) and elderly men (aged 65–79 years), the age-adjusted mortality rate remained relatively unchanged. Conclusions. Among both men and women, the mortality rates from stroke sharply declined between 1994 and 2008 with a clear slowdown in the decline after 2002. Stroke mortality increased significantly among middle-aged men from 2003, while it remained without significant changes among women of the same age and both elderly men and women.

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Age-Standardized Mortality Rates in the Caribbean: One Source, Three Different Interpretations

Journal of Global Oncology ◽

10.1200/jgo.18.19000 ◽

2018 ◽

Vol 4 (Supplement 1) ◽

pp. 26s-26s

Author(s):

Nicholas G. Wolf ◽

Camille Morgan ◽

John S. Flanigan

Keyword(s):

Cancer Mortality ◽

The United States ◽

Mortality Rates ◽

Virgin Islands ◽

International Agency ◽

World Population ◽

Us Virgin Islands ◽

The Caribbean ◽

Mortality Estimates

Abstract 74 Purpose A recent publication in the Morbidity and Mortality Weekly Report (MMWR) provided the opportunity to calculate differences in published cancer mortality estimates for Caribbean jurisdictions from three organizations, MMWR, the International Agency for Research on Cancer, and the Institute for Health Metrics and Evaluation. This comparison study serves to educate end users of these data. Methods We downloaded the publicly available cancer mortality estimates for 15 jurisdictions and the United States from the three organizations. We compared reported age-standardized mortality rates for each jurisdiction, and calculated the range among the estimates for each jurisdiction. We repeated this analysis after applying the same world population standard to all estimates. Results For males, ranges of Caribbean estimates were between 49% (Grenada and Trinidad) and 201% (US Virgin Islands) of the MMWR value, with an average of 88%. For females, ranges were between 15% (Trinidad) and 171% (US Virgin Islands) of the MMWR value, with an average of 64%. After all estimates were compared using the same population standard, ranges of Caribbean estimates for males were between 6% (Grenada) and 111% (US Virgin Islands) of the MMWR value, with an average of 34%. For females, ranges were between 7% (Grenada) and 97% (US Virgin Islands), with an average of 28%. Conclusion The use of different standard populations complicates comparisons across organizations. Data modeling does not completely compensate for the quality of source data, as our analysis has demonstrated by the differences in mortality rates despite the good quality of the vital registration in the Caribbean. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

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ESOPHAGEAL CANCER MORTALITY IN BRAZIL: A TIME-SERIES ANALYSIS FROM THE GLOBAL BURDEN OF DISEASE STUDY

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.202100000-17 ◽

2021 ◽

Vol 58 (1) ◽

pp. 100-106

Author(s):

Max Moura de OLIVEIRA ◽

Igor Pereira Bertoncini SILVA ◽

Renato TEIXEIRA ◽

Deborah Carvalho MALTA ◽

Betine Pinto Moehlecke ISER

Keyword(s):

Time Series ◽

Esophageal Cancer ◽

Mortality Rate ◽

Burden Of Disease ◽

Cancer Mortality ◽

Mortality Rates ◽

Global Burden Of Disease ◽

Global Burden ◽

World Population ◽

Standardized Mortality Rate

ABSTRACT BACKGROUND: In the world, around 450,000 new cases of esophageal cancer are diagnosed each year. OBJECTIVE: To evaluate the trend of esophageal cancer mortality rates in Brazil between 1990-2017. METHODS: A time series study using data on mortality from esophageal cancer in residents ≥30 years in Brazil from 1990 to 2017. Data was estimated by the Global Burden of Disease (GBD) study and analyzed according to sex, age group and federal unit of Brazil. The standardized rates according to age were calculated by the direct method using the standard GBD world population. Annual average percentage change and 95% confidence interval (95% CI) were calculated for mortality by Joinpoint regression. RESULTS: The age-standardized mortality rate in males was 20.6 in 1990 and 17.6/100,000 in 2017, increasing according to age, being 62.4 (1990) and 54.7 (2017) for ≥70 years. In women, the age-standardized mortality rate was 5.9 in 1990 and 4.2/100,000 in 2017. There was a reduction in mortality rates in all age groups and both sexes with great variation among the states. CONCLUSION: Despite the high mortality rates for esophageal cancer in Brazil, the trend was decreasing, but with regional differences. Mortality was around four times higher in men.

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Age-Standardized Mortality Rates in the Caribbean: One Source, Three Different Interpretations

Journal of Global Oncology ◽

10.1200/jgo.18.00010 ◽

2018 ◽

pp. 1-10

Author(s):

Nicholas G. Wolf ◽

Camille Morgan ◽

John S. Flanigan

Keyword(s):

Cancer Mortality ◽

The United States ◽

Mortality Rates ◽

Virgin Islands ◽

International Agency ◽

World Population ◽

Us Virgin Islands ◽

The Caribbean ◽

Mortality Estimates

Purpose A recent publication in Morbidity and Mortality Weekly Report ( MMWR) provided the opportunity to calculate differences in published cancer mortality estimates for Caribbean jurisdictions from three organizations: MMWR, the International Agency for Research on Cancer, and the Institute for Health Metrics and Evaluation. This comparison study serves to educate end users of these data. Methods We downloaded the publicly available cancer mortality estimates for 15 jurisdictions and the United States from the three organizations. We compared reported age-standardized mortality rates for each jurisdiction and calculated the range among estimates for each jurisdiction. We repeated this analysis after applying the same world population standard to all estimates. Results For males, the ranges of the Caribbean estimates were between 49% (Grenada and Trinidad) and 201% (US Virgin Islands) of the MMWR value, with an average of 88%. For females, the ranges were between 15% (Trinidad) and 171% (US Virgin Islands) of the MMWR value, with an average of 64%. After all estimates were compared using the same population standard, the ranges of the Caribbean estimates for males were between 6% (Grenada) and 111% (US Virgin Islands) of the MMWR value, with an average of 34%. For females, the ranges were between 7% (Grenada) and 97% (US Virgin Islands), with an average of 28%. Conclusion The use of different standard populations complicates comparisons across organizations. Data modeling does not completely compensate for quality of source data, as our analysis demonstrated by the differences in mortality rates despite the good quality of the vital registration in the Caribbean.

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Mortality rate of lip, oral cavity and pharynx malignant tumors in Serbia within a period 1991-2009

Vojnosanitetski pregled ◽

10.2298/vsp1302189i ◽

2013 ◽

Vol 70 (2) ◽

pp. 189-194

Author(s):

Milena Ilic ◽

Svetlana Radevic ◽

Vladimir Stefanovic ◽

Tatjana Cirkovic ◽

Tamara Zurovac ◽

...

Keyword(s):

Mortality Rate ◽

Oral Cavity ◽

Cancer Mortality ◽

Malignant Tumors ◽

Mortality Rates ◽

World Population ◽

Annual Percent Change ◽

Female Population ◽

Percent Change ◽

Pharynx Cancer

Background/Aim. Lip, oral cavity and pharynx malignant tumors account for 3.7% of all cancer deaths worldwide, with significant geographic variations in frequency and distribution. The aim of this descriptive epidemiologic study was to analyze the mortality rate of lip, oral cavity and pharynx malignant tumors in Serbia proper within a period 1991-2009. Methods. Mortality rates standardized directly using the world population as the standard were used in data analysis. Linear trend and regression analyses were used to analyze rate trends in mortality. Results. The Serbian population demonstrated an increase in the mortality of lip, oral cavity and pharynx malignant tumors (y = 3.32 + 0.03?; p = 0.002; average annual percent change = + 0.8). The male population showed a significant increase in mortality trend (y = 5.90 + 0.03?; p = 0.020; % change = + 0.9), while the female population did not show a significant increase in mortality. The male/female cancer mortality ratio was 5.5:1. Mortality rates for lip, oral cavity and pharynx cancer increased with age in both genders, with rates being the highest in the population aged 85 and older. Increasing trends of lip, oral cavity and pharynx cancer mortality were observed in males aged 50-54; the average annual percent change was + 7.4 % (95% CI, 6.2-9.0). The population of both genders aged 55-59 demonstrated an increase in lip, oral cavity and pharynx cancer mortality, the increase being + 1.8% (95% CI, 1.4-2.2) in men and + 34.3% (95% CI, 28.4-40.2) in women. Conclusion. The increasing trend in lip, oral cavity and pharynx cancer mortality points to the necessity to investigate etiology and improve primary and secondary prevention measures.

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USE OF CODED MORTALITY DATA TO ASSESS AREA CANCER RATES: IMPACT OF RESIDENCE REPORTING AND CODING ERRORS

American Journal of Epidemiology ◽

10.1093/oxfordjournals.aje.a115780 ◽

1990 ◽

Vol 132 (supp1) ◽

pp. 178-182 ◽

Cited By ~ 8

Author(s):

ALLAN N. WILLIAMS ◽

REBECCA A. JOHNSON ◽

ALAN P. BENDER

Keyword(s):

Rural Areas ◽

Cancer Mortality ◽

Mortality Rates ◽

Mortality Data ◽

Standardized Mortality Ratio ◽

Death Certificates ◽

Total Cancer ◽

Mortality Ratio ◽

Cancer Rates ◽

Standardized Mortality Ratios

Abstract In spite of their limitations, mortality data are used in many epidemiologic and public health settings. In this investigation, the authors examined the extent to which community cancer mortality rates were affected by incorrect reporting or coding of residence on death certificates. Observed and expected cancer mortality for two adjacent communities in northern rural Minnesota for the periods 1970–1974 and 1980–1984 were obtained from computerized state mortality data. Using statewide rates to obtain expected values, standardized mortality ratios for total cancers for both periods combined were 138 for men (101 observed deaths) and 148 for women (86 observed deaths). These excesses were statistically significant (p < 0.05). However, after review of data from the actual death certificates, city maps, and information from city officials, 44 of the 187 total cancer deaths (24%) were found to have had an incorrectly reported or coded residence status. After removal of these cases, the standardized mortality ratio for total cancers for males went from 138 to 107, and for females the standardized mortality ratio went from 148 to 111. No standardized mortality ratios remained statistically significant These findings may have implications for those who use mortality data for assessing cancer rates in communities in rural areas.

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An age-period-cohort analysis of mortality rates for stomach, colorectal, liver, and lung cancer among prefectures in Japan, 1999–2018

Environmental Health and Preventive Medicine ◽

10.1186/s12199-020-00922-0 ◽

2020 ◽

Vol 25 (1) ◽

Author(s):

Tasuku Okui

Keyword(s):

Lung Cancer ◽

Mortality Rate ◽

Liver Cancer ◽

Cancer Mortality ◽

Cohort Effect ◽

Mortality Rates ◽

The Other ◽

Cohort Effects ◽

Other Hand ◽

Cancer Types

Abstract Background Although change in the birth cohort effect on cancer mortality rates is known to be highly associated with the decreasing rates of age-standardized cancer mortality rates in Japan, the differences in the trends of cohort effect for representative cancer types among the prefectures remain unknown. This study aimed to investigate the differences in the decreasing rate of cohort effects among the prefectures for representative cancer types using age-period-cohort (APC) analysis. Methods Data on stomach, colorectal, liver, and lung cancer mortality for each prefecture and the population data from 1999 to 2018 were obtained from the Vital Statistics in Japan. Mortality data for individuals aged 50 to 79 years grouped in 5-year increments were used, and corresponding birth cohorts born 1920–1924 through 1964–1978 were used for analysis. We estimated the effects of age, period, and cohort on each type of mortality rate for each prefecture by sex. Then, we calculated the decreasing rates of cohort effects for each prefecture. We also calculated the mortality rate ratio of each prefecture compared with all of Japan for cohorts using the estimates. Results As a result of APC analysis, we found that the decreasing rates of period effects were small and that there was a little difference in the decreasing rates among prefectures for all types of cancer among both sexes. On the other hand, there was a large difference in the decreasing rates of cohort effects for stomach and liver cancer mortality rates among prefectures, particularly for men. For men, the decreasing rates of cohort effects in cohorts born between 1920–1924 and 1964–1978 varied among prefectures, ranging from 4.1 to 84.0% for stomach cancer and from 20.2 to 92.4% for liver cancers, respectively. On the other hand, the differences in the decreasing rates of cohort effects among prefectures for colorectal and lung cancer were relatively smaller. Conclusions The decreasing rates of cohort effects for stomach and liver cancer varied widely among prefectures. It is possible that this will influence cancer mortality rates in each prefecture in the future.

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All-cause and cancer mortality in a private health plan in Brazil: Ten years retrospective analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e13610 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e13610-e13610

Author(s):

Joao Paulo Reis Neto ◽

Juliana Martinho Busch ◽

Stephen D. Stefani

Keyword(s):

Cause Of Death ◽

Health Plan ◽

Cancer Mortality ◽

Causes Of Death ◽

Direct Method ◽

Mortality Rates ◽

Years Of Life Lost ◽

Early Screening ◽

Cross Sectional ◽

Circulatory System Diseases

e13610 Background: Cancer is the second leading cause of death worldwide. From 2014 to 2015 Brazil estimated more than 500,000 new cases of cancer, which placed the country among those with the highest cancer incidence. This study evaluates the 10-year evolution of mortality rates due to all causes and cancer and to estimate the potential years of life lost (PYLL) in beneficiaries of health plan, according to sex, age and geographic region. Methods: Retrospective cross-sectional, descriptive study evaluated the causes of death, between 2008 and 2017, by sex and age groups, for all causes (AC) and cancer (CA) data from the health insurance system. The information on the death certificates (DC) was coded according to the ICD-10. Age was stratified into groups: up to 49 years, 50–59 years, 60–69 years, 70–79 years and 80 years or more. Data were analyzed by checking the proportions and mortality rates (MR), grouped into two five-year periods, 2008-2012 (P1) e 2013-2017 (P2). Annual MR per 100,000 population was estimated using the direct method and proportional mortality rates (PMR). To calculate the potential years of life lost (PYLL) the upper limit was 76 years old. The avoidable MR was also analyzed for individuals up to 75 years and cancer. Microsoft Excel v2010 and Qlik Sense v13.21 were used to analyze data and statistics. Results: 5,779 deaths were analyzed, 4,447 in men (77.0%, average 70.1 years) and 1,332 women (33%, 75.9 years). Cancer was the second leading cause of death (n = 953, PMR 16.5%), behind cardiovascular disease (n = 1,662 PMR 28.8%). The major crude death rate per 100,000 was due circulatory system diseases (347), followed by cancer (199) and respiratory system diseases (110). The highest cancer MR were in men, elderly and Brazilian regions with the lowest Human Development Index (HDI). Greatest number of deaths in men at P1 were from cancers of lung (CMP 19.8%), prostate (14.2%) and pancreas (8.0%). At P2, prostate (18.2%), lung (16.8%) and stomach (7.6%). In women, during P1, breast (20.2%), lung (13.1%) and pancreas (83%), and during P2, the same order, 22.5%, 14.6% and 9.3%, respectively. Cancer accounted for a total of 6,335 PYLL and 40.9% of causes of death were classified as avoidable. Conclusions: Cancer was one of the leading causes of mortality during the study. High pancreatic cancer MR differs from national statistics, requiring more analysis that involves possible occupational exposure. Although preventive actions for healthy life habits, early screening and diagnosis, Brazil presents high cancer mortality rates as showed in this analysis.

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Cervical cancer mortality in Peru: regional trend analysis from 2008–2017

BMC Public Health ◽

10.1186/s12889-021-10274-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

J. Smith Torres-Roman ◽

Luz Ronceros-Cardenas ◽

Bryan Valcarcel ◽

Miguel A. Arce-Huamani ◽

Janina Bazalar-Palacios ◽

...

Keyword(s):

Cervical Cancer ◽

Spatial Analysis ◽

Latin American ◽

Cancer Mortality ◽

Care Delivery ◽

Mortality Rates ◽

Mortality Trends ◽

Annual Percent Change ◽

North East ◽

Cervical Cancer Mortality

Abstract Background Cervical cancer is the third leading cause of cancer-related death among Latin American women. Peru has the sixth highest mortality rate for cervical cancer in the region with regional variations. We aimed to determine overall and regional cervical cancer mortality rates and trends in Peru between 2008 and 2017. Methods We performed an ecological study on the number of deaths by cervical cancer in Peru. Deaths were extracted from the Peruvian Ministry of Health mortality database. Age-standardized mortality rates (ASMR) were estimated per 100,000 women-years using the world standard Segi population. We computed mortality trends using the Joinpoint regression program, estimating the annual percent change (APC). For spatial analysis, GeoDA software was used. Results Peru showed downward trends in the last decade (from 11.62 in 2008 to 9.69 in 2017 (APC = − 2.2, 95% CI: − 4.3, − 0.1, p < 0.05). According to regional-specific analysis, the highest ASMR was in the rainforest region, although this declined from 34.16 in 2008 to 17.98 in 2017 (APC = − 4.3, 95% CI: − 7.2, − 1.3, p < 0.01). Concerning spatial analysis and clustering, the mortality rates from 2008 to 2017 showed a positive spatial autocorrelation and significant clustering (Moran’s I: 0.35, p < 0.001) predominantly in the neighboring North-East departments (Loreto, Ucayali, and San Martin). Conclusions Although mortality trends in the entire population are decreasing, mortality rates remain very high, mainly in the rainforest region. Our results encourage a need for further development and improvement of the current health care delivery system in Peru.

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Temporal trends in female breast cancer mortality in a state in Legal Amazon

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1331 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J C S Oliveira ◽

N D Galvão ◽

B S N Souza ◽

A M C S Andrade ◽

J F Cabral ◽

...

Keyword(s):

Breast Cancer ◽

Mortality Rate ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Temporal Trends ◽

Mortality Rates ◽

Female Breast Cancer ◽

Age Group ◽

Mato Grosso ◽

Annual Mortality

Abstract Background Breast cancer is the fifth most common cause of death from cancer in women worldwide. In Brazil, mortality rates are increasing. Therefore, the aim of this study is to analyze breast cancer mortality between 2000 and 2018 in Mato Grosso, a Brazilian state in Legal Amazon. Methods Ecological study analyzing temporal trends. Data were extracted from the Mortality Information System. The selected variables were: sex (female), cause of death (C-50, in the 10th revision of the International Classification of Diseases - ICD 10), age (less than 50 years-old, equal or older than 50 years-old) and year of death (2000-2018). Resident population data were obtained from the Ministry of Health's database (DATASUS) for calculation of breast cancer annual mortality rates. Temporal trends were estimated using linear regression. All analyses were done in the STATA 14.0. Results Between 2000 and 2018, 2,276 deaths from breast cancer were registered in women. Of these, 756 (33.2%) in the youngest age group and 1,520 (66.8%) in the oldest age group. A statistically significant increase in breast cancer mortality was found for both age groups (p < 0.001). In the annual mortality rates analysis, women in the youngest age group had the lowest rate in 2003 (1.98 deaths/100,000 women) and the highest rate in 2018 (7.88 deaths/100,000 women). The oldest age group had the lowest mortality rate in 2000 (21.48 death/100,000 women) and the highest rate in 2017 (47.09 deaths/100,000). The mean mortality rate was 5.69 for the youngest age group and 33.19 for the oldest age group. The annual percentage of change was 33.31 for the youngest group and 62.49 for the oldest group. Conclusions There is a statistically significant increase in female breast cancer mortality rate in Mato Grosso, one of the Brazilian states in Legal Amazon. It is imperative to invest in breast cancer screening to enable the reduction of the mortality rate of the disease. Key messages Our study presents information of breast cancer in a state from Legal Amazon that has increased death rates by the years 2000 to 2018. Besides breast cancer is relevant in Brazil, this is the first analysis from this specific data, potential to support improvement in disease control.

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