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Trends and Patterns of Ovarian Cancer Mortality in Belgrade, Serbia: A Joinpoint Regression Analysis
  1. Darija Kisic Tepavcevic, MD, PhD*,
  2. Bojana Matejic, MD, PhD,
  3. Tatjana Gazibara, MD* and
  4. Tatjana Pekmezovic, MD, PhD*
  1. *Institutes of Epidemiology and
  2. Institutes of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
  1. Address correspondence and reprint requests to Tatjana Pekmezovic, MD, PhD, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade 11000, Serbia. E-mail: pekmezovic{at}


Objective: Ovarian cancer (OC) represents the leading cause of gynecological cancer deaths. The aim of our study was to estimate the patterns and trends in OC mortality in the population of Belgrade (Serbia) during the period 1976 to 2007.

Methods: Mortality data (official death certificates) for OC have been gathered from the Municipal Institute of Statistics in Belgrade. Mortality rates with corresponding 95% confidence intervals were adjusted by the European standard population. Trends in age-adjusted and age-specific mortality rates were calculated using joinpoint regression, according to the method of Kim et al. An annual percent of changes in mortality rates for each line segment was estimated by fitting a regression line to the natural logarithm of the rates using calendar years as a regressor variable.

Results: The average age-adjusted OC mortality rate during the period 1976-2007 was 5.4/100,000 (95% confidence interval, 4.8-6.1). For total women population, no joinpoint is found, whereas significantly increasing mortality trend was observed during the whole study period (+3.6% annually; P < 0.001). In the group age 55 to 64 years, one joinpoint was detected with a significant increase in OC mortality trend between 1976 and 1990 (+9.8% annually; P < 0.001) and with nonsignificant decreasing tendency between 1990 and 2007 (−1.0% annually; P = 0.773). In the two oldest age groups, statistically significantly increasing tendency in OC mortality was evident during the overall calendar period with no apparent change in linear trends.

Conclusions: Mortality due to the OC in Belgrade has continued to increase, suggesting that this malignancy is becoming an increasing public health problem in our country.

  • Ovarian cancer
  • Mortality
  • Joinpoint

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  • This work was supported by the Ministry of Science and Education of Republic of Serbia (grant 175087).