{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:15:32Z","timestamp":1760145332588,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T00:00:00Z","timestamp":1720396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Applied Sciences"],"abstract":"<jats:p>Tracheal, bronchus, and lung cancer (TBLC) remains a major public health concern. Knowledge about geographic patterns and time trends in TBLC could give insights to better address this problem. This study aimed to evaluate the geographic patterns and time trends in mortality due to TBLC observed in Portugal. TBLC-related deaths and population estimates (2011\u20132021) were derived from the Instituto Nacional de Estat\u00edstica. Age-standardized mortality rates for people aged 50 or more (ASMR_50+) per 100,000 were obtained. Analyses were stratified by gender, geographic region, and level of urbanization. The time trends in ASMR_50+ were evaluated using joinpoint regression models, and the values for the annual percentage change (APC) and the respective 95% confidence interval (95% CI) were obtained. Differences in mortality due to TBLC between regions and levels of urbanization (2017\u20132021) were assessed through a standardized mortality ratio (SMR) and the respective 95% CI. In 2021, the ASMR_50+ per 100,000 inhabitants observed in mainland Portugal was 158.0 and 40.4 among men and women, respectively. According to the time-trend analysis, ASMR_50+ due to TBLC remained stable or described a downward trend among men, but there was an upward trend among women in suburban and urban regions. Observed deaths were significantly higher than the expected for men in urban areas (SMR = 125%; 95% CI: 121\u2013128 and SMR = 118%; 95% CI: 115\u2013122 in Norte and Lisboa, respectively), and women in Urban Norte (SMR = 125%; 95%CI: 119\u2013131). Lower mortality than expected was observed among men living in Rural Norte and Rural Centro, as well as, among women living in all the rural areas. In suburban areas, the observed deaths were lower, higher, or as expected depending on the geographic region and gender. A notable upward trend in mortality due to TBLC among women was observed. The geographic patterns observed suggest the effects of deleterious environmental factors and smoking habits, deserving attention from policymakers.<\/jats:p>","DOI":"10.3390\/app14135933","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T11:30:02Z","timestamp":1720438202000},"page":"5933","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Time Trends and Geographic Patterns of Mortality Due to Tracheal, Bronchus, and Lung Cancer in Portugal"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5194-5141","authenticated-orcid":false,"given":"Cristina","family":"Teixeira","sequence":"first","affiliation":[{"name":"Escola Superior de Sa\u00fade de Bragan\u00e7a, Instituto Polit\u00e9cnico de Bragan\u00e7a, 5300-121 Bragan\u00e7a, Portugal"},{"name":"EPIUnit, Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, 4050-600 Porto, Portugal"},{"name":"Laborat\u00f3rio para a Investiga\u00e7\u00e3o Integrativa e Translacional em Sa\u00fade Populacional (ITR), 4050-600 Porto, Portugal"}]},{"given":"Cristiana","family":"Fialho","sequence":"additional","affiliation":[{"name":"Escola Superior de Sa\u00fade de Bragan\u00e7a, Instituto Polit\u00e9cnico de Bragan\u00e7a, 5300-121 Bragan\u00e7a, Portugal"}]},{"given":"Joana","family":"Cunha","sequence":"additional","affiliation":[{"name":"Escola Superior de Sa\u00fade de Bragan\u00e7a, Instituto Polit\u00e9cnico de Bragan\u00e7a, 5300-121 Bragan\u00e7a, Portugal"}]},{"given":"Ana","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Escola Superior de Sa\u00fade de Bragan\u00e7a, Instituto Polit\u00e9cnico de Bragan\u00e7a, 5300-121 Bragan\u00e7a, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8858-1617","authenticated-orcid":false,"given":"Andrea F.","family":"Afonso","sequence":"additional","affiliation":[{"name":"Escola Superior de Sa\u00fade de Bragan\u00e7a, Instituto Polit\u00e9cnico de Bragan\u00e7a, 5300-121 Bragan\u00e7a, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8912-7355","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Escola Superior de Sa\u00fade de Bragan\u00e7a, Instituto Polit\u00e9cnico de Bragan\u00e7a, 5300-121 Bragan\u00e7a, Portugal"},{"name":"Centro de Investiga\u00e7\u00e3o de Montanha (CIMO), Instituto Polit\u00e9cnico de Bragan\u00e7a, Campus de Santa Apol\u00f3nia, 5300-253 Bragan\u00e7a, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.chest.2021.12.655","article-title":"Distribution, Risk Factors, and Temporal Trends for Lung Cancer Incidence and Mortality: A Global Analysis","volume":"161","author":"Huang","year":"2022","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s13045-020-00915-0","article-title":"Epidemiological trends of tracheal, bronchus, and lung cancer at the global, regional, and national levels: A population-based study","volume":"13","author":"Deng","year":"2020","journal-title":"J. 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