Mapping regional disparities in testicular cancer mortality across Spain (2004–2023)

Abstract

Introduction

This study investigates testicular cancer (TC) mortality trends and spatial patterns in Spain, utilizing provincial-level spatial analysis to identify high-risk clusters.

Methods

An ecological study was conducted using TC mortality data (ICD-10 code C62) from the Spanish National Institute of Statistics (2004–2023). Age-standardized mortality rates (ASMRs) were calculated using the direct method. Temporal trends were analyzed with joinpoint regression. Spatial patterns were assessed using standardized mortality ratios (SMR), smoothed relative risk (RR), and posterior probabilities (PP) through Bayesian hierarchical models. Spatial clustering was examined with Tango’s test and Kulldorff’s likelihood ratio test.

Results

A total of 909 TC deaths were recorded, with ASMRs ranging from 0.14 to 0.26 per 1,000,000 inhabitants. No significant temporal trends were observed. Age-specific mortality showed a bimodal distribution, peaking at ages 35–39 and 85+. The highest SMRs were found in Zamora (2.58), Segovia (2.64), and Soria (2.39), while the lowest were in Madrid (0.66) and Barcelona (0.55). Bayesian spatial analysis identified elevated relative risk in Badajoz (RR 1.6), Huelva (RR 1.47), and Sevilla (RR 1.4). Kulldorff’s analysis revealed a high-mortality cluster in southwestern Spain (Huelva, Sevilla, Badajoz), with a secondary cluster extending to neighbouring provinces.

Conclusions

While TC mortality in Spain remained stable, significant regional disparities exist. High-risk provinces and mortality clusters highlight potential inequalities in healthcare access, socioeconomic conditions, and environmental exposures.