Progress and challenges in laryngeal cancer mortality in Spain, 1999-2023.

BACKGROUND AND OBJECTIVE Laryngeal cancer remains a significant public health concern, with pronounced sex- and age-related disparities in mortality. In Spain, recent national analyses are scarce. This study provides a comprehensive assessment of laryngeal cancer mortality trends from 1999 to 2023 and disentangles the contributions of age, period, and cohort effects.

METHODS We conducted a population-based time-series analysis of laryngeal cancer mortality in Spain over a 25-year period (1999-2023). Age-standardised mortality rates (ASMRs) were calculated, and Joinpoint Regression identified temporal trends. Age-Period-Cohort (A-P-C) modelling (for ages 35-84) decomposes changes into effects attributable to age, period (reflecting clinical management), and birth cohort (reflecting generational risk factor exposure).

RESULTS A total of 36,598 deaths were recorded, 94% among men. Male ASMRs fell sharply from 12.10 to 4.76 per 100,000, with an annual percentage change (APC) of -4.0%. Female ASMRs remained largely stable. APC modelling for men showed a strong negative net drift (-6.27%), driven by a pronounced negative cohort effect, with rate ratios declining from the 1919 to 1984 birth cohort. In women, APC analysis revealed an age-dependent reversal: mortality declined in younger women but increased significantly in those aged 55 and over (e.g., APC +4.13% at ages 60-64).

CONCLUSION Male laryngeal cancer mortality in Spain has declined markedly, primarily due to decreasing smoking-related cohort risks. The rising mortality in older women reflects the delayed impact of past smoking uptake. Continued, gender-sensitive tobacco control strategies are essential.