se ha leído el artículo
array:20 [ "pii" => "13101089" "issn" => "02139111" "estado" => "S300" "fechaPublicacion" => "2006-12-31" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Gac Sanit. 2006;20 Supl 3:42-51" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3598 "formatos" => array:3 [ "EPUB" => 201 "HTML" => 2898 "PDF" => 499 ] ] "itemSiguiente" => array:16 [ "pii" => "13101090" "issn" => "02139111" "estado" => "S300" "fechaPublicacion" => "2006-12-31" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Gac Sanit. 2006;20 Supl 3:52-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9768 "formatos" => array:3 [ "EPUB" => 221 "HTML" => 8596 "PDF" => 951 ] ] "es" => array:11 [ "idiomaDefecto" => true "titulo" => "Guía de principios y métodos de las redes centinelas sanitarias en España" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "52" "paginaFinal" => "60" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Guide to the principles and methods of health sentinel networks in Spain" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Agustín Tomás Vega Alonso, Óscar Zurriaga Llorens, Antònia Galmés Truyols, José Eugenio Lozano Alonso, Laura Paisán Maestro, Milagros Gil Costa, Azucena Herrero Llorente, Julián Mauro Ramos Aceitero" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Agustín Tomás" "apellidos" => "Vega Alonso" ] 1 => array:2 [ "nombre" => "Óscar" "apellidos" => "Zurriaga Llorens" ] 2 => array:2 [ "nombre" => "Antònia" "apellidos" => "Galmés Truyols" ] 3 => array:2 [ "nombre" => "José Eugenio" "apellidos" => "Lozano Alonso" ] 4 => array:2 [ "nombre" => "Laura" "apellidos" => "Paisán Maestro" ] 5 => array:2 [ "nombre" => "Milagros" "apellidos" => "Gil Costa" ] 6 => array:2 [ "nombre" => "Azucena" "apellidos" => "Herrero Llorente" ] 7 => array:2 [ "nombre" => "Julián Mauro" "apellidos" => "Ramos Aceitero" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13101090?idApp=WGSE" "url" => "/02139111/00000020000000S3/v0_201307171022/13101090/v0_201307171024/es/main.assets" ] "itemAnterior" => array:16 [ "pii" => "13101088" "issn" => "02139111" "estado" => "S300" "fechaPublicacion" => "2006-12-31" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Gac Sanit. 2006;20 Supl 3:33-41" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4007 "formatos" => array:3 [ "EPUB" => 188 "HTML" => 3266 "PDF" => 553 ] ] "es" => array:11 [ "idiomaDefecto" => true "titulo" => "Utilización de un impuesto sobre ventas de tabaco en la fase minorista destinado a la financiación de la farmacoterapia para la deshabituación tabáquica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "33" "paginaFinal" => "41" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Use of a retail sales tax on tobacco to fund drug therapy for smoking cessation" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fernando Antoñanzas Villar, Roberto Rodríguez Ibeas, Carmelo Juárez Castelló, Manuel Ramírez Esquibel, Reyes Lorente Antoñanzas, Jaime Ginestal Gómez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Fernando" "apellidos" => "Antoñanzas Villar" ] 1 => array:2 [ "nombre" => "Roberto" "apellidos" => "Rodríguez Ibeas" ] 2 => array:2 [ "nombre" => "Carmelo" "apellidos" => "Juárez Castelló" ] 3 => array:2 [ "nombre" => "Manuel" "apellidos" => "Ramírez Esquibel" ] 4 => array:2 [ "nombre" => "Reyes" "apellidos" => "Lorente Antoñanzas" ] 5 => array:2 [ "nombre" => "Jaime" "apellidos" => "Ginestal Gómez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13101088?idApp=WGSE" "url" => "/02139111/00000020000000S3/v0_201307171022/13101088/v0_201307171023/es/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "titulo" => "Accuracy of cancer death certificates in Spain: a summary of available information" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "51" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Beatriz Pérez-Gómez, Nuria Aragonés, Marina Pollán, Berta Suárez, Virginia Lope, Alicia Llácer, Gonzalo López-Abente" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Pérez-Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Nuria" "apellidos" => "Aragonés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Marina" "apellidos" => "Pollán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Berta" "apellidos" => "Suárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Virginia" "apellidos" => "Lope" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Alicia" "apellidos" => "Llácer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 6 => array:3 [ "nombre" => "Gonzalo" "apellidos" => "López-Abente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Área de Epidemiología Ambiental y Cáncer. Centro Nacional de Epidemiología. Instituto de Salud Carlos III. Madrid. España." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Área de Análisis Epidemiológico y Situación de Salud. Centro Nacional de Epidemiología. Instituto de Salud Carlos III. Madrid. España." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold"> Background</span></p><p class="elsevierStylePara">One of the most usual approaches to studying the situation of cancer worldwide is to analyse the geographic distribution of mortality rates and their trends. Information on the quality of cancer mortality data is thus essential for interpreting differences in mortality statistics.</p><p class="elsevierStylePara">In Spain, mortality represents the only comprehensive and homogeneous source of information on cancer for the whole country. The source of mortality statistics is the medical death certificate (DC), a compulsory administrative document completed by the practitioner who certifies the death. This certificate is subsequently transcribed onto a second document, the Statistical Bulletin of Death (SBD), and both are sent to the Municipal Civil Registry. Usually, the Civil Registry forwards the SBDs to the regional offices of the National Statistic Institute (Instituto Nacional de Estadística [INE]) on a monthly basis, where all items except cause of death are digitally recorded. When the data have been duly screened to detect errors and ensure quality control, the underlying causes of death (Causa básica de defunción) are coded at the Regional Authority Mortality Registries by trained teams, applying common criteria in accordance with International Classification of Diseases (ICD) guidelines. National coding protocols have been established to guarantee homogeneity of data<span class="elsevierStyleSup">1</span>, while specific methods have also been implemented to validate accuracy systematically. Digital data files are then sent to the INE head office, which releases them once they have been rendered anonymous.</p><p class="elsevierStylePara">Quantitative data that would enable to asses the quality of cancer death certificates in Spain are relatively scarce. Several studies have addressed this topic, but all refer to areas of the country or to specific populations, and some have been published in local epidemiological bulletins or in symposium proceedings, which are not easily accessible. In this paper, we sought to synthesize information derived from these studies and to complement such data with a short description of the temporal distribution of the proportion of deaths due to ill-defined tumours in Spain, as an indirect indicator of the quality of cancer death certification.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> Methods</span></p><p class="elsevierStylePara">For review purposes, DC and SBD were deemed to be death certificates, as a very high concordance between both documents has been reported<span class="elsevierStyleSup">2</span>. Studies into the quality of cancer death certification in Spain were identified through: <span class="elsevierStyleItalic">1)</span> a MEDLINE and EMBASE search using broad search criteria (January 1966 to January 2006); <span class="elsevierStyleItalic">2)</span> a similar search in Spanish bibliographical databases, the Spanish Medical Index (<span class="elsevierStyleItalic">Índice Médico Español</span> [IME]), and IBECS; and <span class="elsevierStyleItalic">3)</span> references in identified papers. In two studies<span class="elsevierStyleSup">3,4</span>, only abstracts of poster presentations at scientific meetings were published. In these cases, quality-indicator data presented in the poster were specifically searched for.</p><p class="elsevierStylePara">Studies were considered eligible if they reported quantitative estimates of the accuracy of death certificates containing any mention of cancer. In these studies, cancer death certificates were compared against a second source of information, mainly comprising clinical or anatomo-pathological reports (which were taken as the «gold standard»). Agreement between both sources was measured using detection and confirmation rates.</p><p class="elsevierStylePara">According to Percy et al<span class="elsevierStyleSup">5</span>, the detection rate (DR) or sensitivity for a specific site is defined as the proportion of hospital diagnoses (available clinical/anatomo-pathological information) with cancer of a certain site, with a death certificate where this disease is considered to be the basic cause of death, whereas the confirmation rate (CR) or positive predictive value is the proportion of cancer deaths in which the underlying cause specified in the death certificate is confirmed by hospital diagnosis.</p><p class="elsevierStylePara">DRs and CRs can be computed as: <span class="elsevierStyleItalic">a)</span> site-specific cancer rates at three digits of the ICD, that is considering an indicator per cancer-site; <span class="elsevierStyleItalic">b)</span> all-site three-digit rates, an overall indicator for cancer where the rates' numerator contains all cancer cases (ICD-9 codes 140-208) in which the site specified in the death certificate and clinical information agree; and <span class="elsevierStyleItalic">c)</span> all-tumour rates, also an overall indicator where the rates' numerator includes all cases that just mention «cancer» in both the death certificate and gold standard, even though there might be site misclassification. These figures are logically expected to be higher than overall comparisons at a three-digit level. A graphical scheme that might help understand these concepts is shown in figure 1.</p><p class="elsevierStylePara"><img src="138v20nSupl.3-13101089tab01.gif"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1. Cross-tabulation of cause of death according to clinical diagnoses and medical death certificates and quality-indicator formulae.</span></p><p class="elsevierStylePara">Identified papers were classified into three main categories:</p><p class="elsevierStylePara">I. <span class="elsevierStyleItalic">Studies focusing on all-cause death certificates</span>, which provide accurate detection and confirmation rates (fig. 1).</p><p class="elsevierStylePara">II. <span class="elsevierStyleItalic"> Studies based solely on death certificates that mention cancer</span>. These could be subdivided into two groups:</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">a.</span> Studies with an additional source of information on c<span class="elsevierStyleInf">g</span> or b<span class="elsevierStyleInf">g</span> (fig. 1) that allows them to estimate accurate detection and confirmation rates. In some cases, these data<span class="elsevierStyleSup">6</span> were not considered for the purpose of calculating site-specific cancer rates, thereby leading to overestimated rates.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">b.</span> Studies without information on cancer deaths not certified as such, or on non-cancer cases erroneously certified as cancer (c<span class="elsevierStyleInf">g</span> or b<span class="elsevierStyleInf">g).</span> This rules out the possibility of computing all-tumour or three-digit agreement detection rates, and means that site-specific detection rates and confirmation rates are likely to be overestimated (fig. 1). In some cases<span class="elsevierStyleSup">4,7,8</span>, it was possible to find information on global false positives within the text of the paper. We used these data to calculate unbiased all-tumour confirmation rates.</p><p class="elsevierStylePara">III. <span class="elsevierStyleItalic"> Necropsy-based studies.</span> Since necropsies are relatively scarce in this country<span class="elsevierStyleSup">9</span>, the main problem with these studies is external validity, as they tend to focus on very specific populations.</p><p class="elsevierStylePara">Many of the detection and /or confirmation rates offered in the summary tables were directly taken from the selected studies, though, where possible, the tables were completed by computing DRs and CRs using data provided in the papers.</p><p class="elsevierStylePara">In a second stage, a pooled CR and DR was calculated for each specific cancer location using data from all studies that had covered that location, and then all main cancer sites were classified according to Percy's criteria, the bench-mark for these types of studies<span class="elsevierStyleSup">5</span>. Finally, as a complementary approach, we calculated the percentage of deaths due to ill-defined tumour versus all-tumour deaths and the percentage of deaths of ill-defined conditions versus all-cause deaths for the period 1980-2002, using whole country mortality figures supplied by the INE.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> Results</span></p><p class="elsevierStylePara">Published studies on quality of cancer death certificates in Spain</p><p class="elsevierStylePara">A total of 14 studies providing quantitative data on quality of cancer death certification in Spain were found. The main characteristics of these studies, their classification according to the above criteria and, where available, all-tumour (ICD-9 codes 140-208) and all-site three-digit detection and confirmation rates are shown in table 1. In addition, figure 2 depicts the geographical location of the respective study populations.</p><p class="elsevierStylePara"><img src="138v20nSupl.3-13101089tab02.gif"></img></p><p class="elsevierStylePara"><img src="138v20nSupl.3-13101089tab03.gif"></img></p><p class="elsevierStylePara"><img src="138v20nSupl.3-13101089tab04.gif"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 2. Geographical location of published studies furnishing data on quality of cancer death certification in Spain.</span></p><p class="elsevierStylePara">Six of these studies belonged to categories I and II(a)<span class="elsevierStyleSup">3,6,10-14</span>, those furnishing the most accurate estimators, with detection rates ranging from 75.2-100% for all tumours as a whole and 64.8-100% for all-site three-digit rates. On average, confirmation rates were higher than detection rates, ranging from 91.5-99.3% for all-tumour and 68.2-80.8% for all-site three-digit rates.</p><p class="elsevierStylePara">Another five studies were classified as category II(b)<span class="elsevierStyleSup">7,8,15-18</span>. In general, they supplied data on all-tumour and all-site three-digit confirmation rates. Yet, with two exceptions<span class="elsevierStyleSup">4,8</span>, these studies failed to consider global false positives when estimating three-digit confirmation rates, an approach that implies a certain overestimation of the agreement. Where possible, therefore, we calculated a corrected confirmation rate by including global false positives in the denominator. Only one study<span class="elsevierStyleSup">8</span> had adopted this approach and, in this case, the «biased» confirmation rate (excluding global false positives) was reckoned for comparison purposes. Both «biased» ­denoted by <span class="elsevierStyleSup">«</span>*<span class="elsevierStyleSup">»</span>­ and corrected confirmation rates are shown in table 1. On average, biased confirmation rates were three points higher than corrected rates. In these studies, all-tumour and corrected all-site three-digit confirmation rates were comparable to those obtained for categories I and II(a).</p><p class="elsevierStylePara">Only two papers came within category III (necropsy-based studies)<span class="elsevierStyleSup">9,19</span>. Their results were slightly worse than others, but it should be borne in mind here that in Spain most autopsies are restricted to cases with uncertain diagnosis.</p><p class="elsevierStylePara">Table 2 summarises available information in Spain on detection and confirmation rates for malignant neoplasms by the main specific locations. The data, sorted by the period analysed, revealed that in the interim between the early 1980's and the most recent study (1992 data), the quality of certification had improved. Highest indices were found for cancer of the stomach, colon and rectum, pancreas, lung, melanoma, female breast, brain and haematological tumours. In contrast, other sites, such as ill-defined tumours and non-melanoma skin cancer, displayed lower rates of agreement.</p><p class="elsevierStylePara"><img src="138v20nSupl.3-13101089tab05.gif"></img></p><p class="elsevierStylePara">Furthermore, in order to have a brief overview of the quality of cancer certification for specific sites, pooled estimators were calculated to classify the accuracy of death certification for specific cancers according to Percy's criteria<span class="elsevierStyleSup">5</span>, which depend on detection and confirmation rates (table 3).</p><p class="elsevierStylePara"><img src="138v20nSupl.3-13101089tab06.gif"></img></p><p class="elsevierStylePara">Ill-defined tumours and ill-defined causes</p><p class="elsevierStylePara">Figure 3 shows the trend in the percentage which ill-defined tumours and ill-defined causes represent of all-cancer and all-cause deaths, respectively, over the calendar period 1980-2002, in both sexes. During the 1980's, Regional Mortality Registries became responsible for the coding process. This change led to an improvement in the quality of the information, which is reflected in the downward trend in the proportion of ill-defined causes. The initial decline in the percentage of ill-defined causes was accompanied by an increase in the proportion of ill-defined tumours, which registered a less clear pattern. Nevertheless, it should be noted that, coinciding with the introduction of ICD-10 in Spain, 1999 witnessed an increase in these indicators, with the percentage of ill defined causes and ill defined tumours rising by 31% and 10% respectively over the previous year's figures, followed by an apparent levelling-off. Interestingly, women registered higher values for these two indicators of bad certification, in all cases. When proportional mortality was computed using adjusted rates, women continued to have worse results (data not shown).</p><p class="elsevierStylePara"><img src="138v20nSupl.3-13101089tab07.gif"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 3. Percentages of deaths due to ill-defined tumours and ill-defined conditions versus all-tumour and all-cause mortality. Trends for the period 1980-2002 by sex and for both sexes.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> Discussion</span></p><p class="elsevierStylePara">Though quality at a national level has not been studied, available data suggest that, overall, cancer death certificates in Spain possess an accuracy comparable to that reported for other industrialised countries<span class="elsevierStyleSup">5,20,21</span>. Indirect estimations such as the proportion of ill-defined causes in Spain show similar percentages to those registered by other developed countries<span class="elsevierStyleSup">22</span>.</p><p class="elsevierStylePara">The first Spanish study to address death certificate reliability was published in 1981<span class="elsevierStyleSup">15</span>. Specifically focused on cancer death certificates, this study solely covered the Barcelona metropolitan area. Several authors subsequently studied the quality of death certificates in other parts of the country. In this paper, we summarised all available information to provide a global view of the quality of Spanish cancer-mortality statistics.</p><p class="elsevierStylePara">In Spain, published quality estimators are basically drawn from regional studies, many of which are sponsored or undertaken by Cancer Registries. Accordingly, it should be borne in mind that, despite the existence of national coding protocols, inferring quality indicators for the country, such as our pooled estimators, might also be problematic, since decentralisation of the coding process could cause inter-regional variability, and there are huge areas of the country where death certification quality studies have not been conducted (fig. 2). Only Giménez et al<span class="elsevierStyleSup">3</span>, in their study on a toxic-oil poisoned cohort, provide national data, though their results could also be misleading as they refer to a cohort of sick people, subjected to a thorough follow-up over time. The progressive increase in the number of Cancer Registries in the country might go some way towards having more representative data about quality of cancer death certification in Spain in the future. Nevertheless, results from the different studies were quite similar for most cancer sites.</p><p class="elsevierStylePara">Compared to other causes of death, cancer (ICD 140-208) seems to be well certified in Spain, with detection rates being as much as 9 points higher for all tumours than for all causes together, and confirmation rates over 20 points higher than for all causes<span class="elsevierStyleSup">11,12</span>, which could be due to the fact that cancer is usually a well-characterised diagnosis, and in most cases has histological confirmation.</p><p class="elsevierStylePara">All-tumour detection rates ranged from 79.9 to 100 and the CRs exceeded 90%. Depending upon their results, some studies have classified this broad category as well-certified<span class="elsevierStyleSup">3,11,13</span>, while others have viewed tumours as being slightly underreported<span class="elsevierStyleSup">3,12</span>. However, the percentage of underreporting in Spain, as estimated by García-Benavides et al<span class="elsevierStyleSup">11</span> and Cáffaro et al<span class="elsevierStyleSup">6</span>, seems to be around 5-6%, which is comparable to international figures<span class="elsevierStyleSup">20,23,24</span>. Hence, global cancer mortality figures can be considered accurate and useful for estimating the burden of this group of diseases.</p><p class="elsevierStylePara">As expected, when site misclassification was taken into account, agreement estimates were lower. All-site three-digit detection rates from categories I and II(a) studies range from 64.8 to 100 and confirmation rates from 68.2 to 80.8. Based on these indicators, cancer could be deemed to be ill-certified according to Percy's criteria. It is remarkable that, in general, Ruiz-Liso et al<span class="elsevierStyleSup">13</span> obtained better results than other studies. The CR range in category II(b) studies was similar (64.4-81%). The design used in such studies excludes global false positives, thus slightly overestimating this indicator. According to three studies<span class="elsevierStyleSup">6-8</span>, in which both correct and biased estimators were available, biased data were on average three points higher. In the USA<span class="elsevierStyleSup">5</span> and France<span class="elsevierStyleSup">20</span>, CRs were slightly higher than in Spain (82.7 and 86%, respectively). Nevertheless, it should be noted that those studies belong to category II(b) and are also biased.</p><p class="elsevierStylePara">If some problematic categories are grouped (this is the case of cervical ­ICD 180­, corpus ­ICD 182­ and unspecified uterine cancer ­ICD 179­; or colon ­ICD 153­ and rectal neoplasms ­ICD 154­), all-site three-digit agreement rates improve. This can be seen in Cirera and Navarro<span class="elsevierStyleSup">7</span>, where the proportion of agreement using three-digit ICD was close on 80%, and aggregation of problematic locations raised it to 83%. A comparable increase was previously described in the USA<span class="elsevierStyleSup">5</span> (4%) and in Ontario<span class="elsevierStyleSup">21</span> (6%).</p><p class="elsevierStylePara">Analysis of specific anatomic locations shows that, in general, the main leading cancer sites are well certificated. Thus, lung, colon-rectum (ICD 153-154), prostate, stomach, pancreas, female breast, uterus (ICD 179-180,182) and brain cancer, as well as leukaemia, lymphomas, myeloma belong to this category. Together, they represented around 69% of all cancer deaths registered in Spain in 2002<span class="elsevierStyleSup">25</span>. Nonetheless, it should be noted that colon and rectal cancers are respectively ill and undercertified unless they are considered together, since mutual misclassification of the two sites has been reported<span class="elsevierStyleSup">7,21</span>. A similar situation can be observed with respect to uterus. Overall, this location has good accuracy rates, but cervix and corpus uterus are under ­and ill­ certified, respectively. Mortality due to uterus cancer in Spain registered a steady decrease since 1976, contrasting with the slightly increasing trend in cervix mortality<span class="elsevierStyleSup">26</span>, which has been explained mainly as a consequence of a reassignment of cases previously coded as «uterus non-specified»<span class="elsevierStyleSup">14</span>. Nevertheless, if uterus is regarded as a single category, its certification has improved with time and, in more recent studies, achieves acceptable figures.</p><p class="elsevierStylePara">Some other frequent locations, such as larynx, bladder or ovary, which rank among the ten leading causes of cancer death in Spain, evince problems in certification. A certain degree of overreporting has been described for laryngeal cancer, due to misclassification of head and neck tumours<span class="elsevierStyleSup">6,8,18</span>. Similarly, there is certain measure of overreporting for oesophageal cancer, mainly attributable to the inclusion of stomach cases<span class="elsevierStyleSup">6-8,18</span>, as well as for liver, largely due to misclassification of gallbladder and ill-defined neoplasms<span class="elsevierStyleSup">6-8,13,18</span>. Percy et al<span class="elsevierStyleSup">27</span> warned that inclusion in ICD-9 code 155 of liver cancer that was not specified as primary or secondary, was a possible cause of misclassification for these tumours, as it might lead to some coders registering secondary liver cancers under this category.</p><p class="elsevierStylePara">Furthermore, there have been reports of underestimation of urinary bladder cancer, erroneously certified as prostate neoplasm<span class="elsevierStyleSup">6-8,13,17,18</span>. It should, however, be noted that, even with this underestimation, Spain had the second highest bladder mortality rate within the European Union in 2000<span class="elsevierStyleSup">26</span>. In addition, some Spanish authors have reported undernotification of skin cancers due to lack of information on their anatomic location<span class="elsevierStyleSup">6</span>, thereby implying their inclusion as ill-defined and unspecified tumours (ICD-9 195, 199).</p><p class="elsevierStylePara">Accuracy of ovary-neoplasm certification seems to vary widely among studies, though it can be regarded as undercertified according to pooled estimators. While some reported cases of death due to ovarian cancer were really due to abdominal or uterine neoplasms, in some studies<span class="elsevierStyleSup">7,8,14</span>, «unspecified uterus tumours» would appear to include some ovarian cancers as well as tumours of the cervix and endometrium<span class="elsevierStyleSup">6,8,14,17,18</span>.</p><p class="elsevierStylePara">Ill-defined tumours were badly certified according to Percy's criteria. Cirera and Navarro<span class="elsevierStyleSup">7</span> reported there was clinical information that would allow for almost half of these tumours to be included in other categories. The selfsame problem has been described in other countries, such as Brazil<span class="elsevierStyleSup">28</span>.</p><p class="elsevierStylePara">Our results show that all cancer sites classified as well certified in Spain have been reported as such in the USA by Percy et al<span class="elsevierStyleSup">5</span>. However, this author also encountered good agreement rates for oesophagus, bladder, gallbladder, thyroid gland and kidney, locations that did not display a good standard in Spanish studies. In Ontario, Canada, Reynolds<span class="elsevierStyleSup">21</span> similarly observed good DRs and CRs for all those neoplasms classified as well-certified in Spain, with the exception of pancreas, and also found high rates for cervix uterus, bladder, kidney, ovary and endocrine glands. In France, Laplanche et al<span class="elsevierStyleSup">20</span> reported CRs of over 80% for breast, colon-rectum, lung and pancreas, values similar to Spanish figures. In contrast, they found CRs of under 80% for head and neck and cervix, tumours which in Spain register good CRs. Stomach cancer was also well classified in Brazil<span class="elsevierStyleSup">29</span> and Italy<span class="elsevierStyleSup">30</span>. In international comparisons, however, a relevant factor to be considered are differences in international coding practice, since divergences up to 30% have been described by Percy and Muir<span class="elsevierStyleSup">31</span> among western countries using the ICD-9.</p><p class="elsevierStylePara">With respect to accuracy of certification, Percy mentioned the influence of several factors such as age, sex, geographic area, presence of an autopsy or place of death<span class="elsevierStyleSup">5</span>. In Spanish studies, a lower quality has been reported for older ages and for women<span class="elsevierStyleSup">6-8,18</span>. These sex-related differences are reflected in the percentage of ill-defined tumours and ill-defined causes, which are regularly higher in females and could in part be due, both to gynaecological neoplasms<span class="elsevierStyleSup">18</span> and to the older age of women. Insofar as place of death is concerned, a lower quality of death certification has been associated with death at home<span class="elsevierStyleSup">6,7</span>, though other authors have failed to find any difference<span class="elsevierStyleSup">11</span>. Finally, the quality of certification has been shown to be slightly lower in rural areas<span class="elsevierStyleSup">18</span>.</p><p class="elsevierStylePara">As Navarro et al<span class="elsevierStyleSup">17</span> points out, clinical information is needed to validate death certificates, thus implying the exclusion of those cases where this information is not available. Death certificates lacking complementary clinical or anatomo-pathological data could be of worse quality, as they probably include more home deaths. Navarro found that death certificates excluded for this reason belonged to subjects who were, on average, seven years older than those included in her study. All this may well lead to overestimation of the quality reported in many studies.</p><p class="elsevierStylePara">Several strategies have been proposed to motivate and improve physicians' certification<span class="elsevierStyleSup">28</span> such as a periodic assessment of coding practices along with the education and motivation of medical students and physicians. In Spain, several Regional Health Authorities implemented specific workshops that showed their efficacy in enhancing death certificate quality indicators<span class="elsevierStyleSup">32</span>. Yet, these interventions are questioned by Swift's study<span class="elsevierStyleSup">33</span>, which failed to find significant changes in the state of certification after the introduction of formal education into the medical syllabus.</p><p class="elsevierStylePara">A further point of discussion is the effect of the introduction of the ICD-10 on the quality of mortality data. To date, we have been unable to find any validation study in Spain covering the ICD-10 coding period. In 1999, Ruiz et al<span class="elsevierStyleSup">34</span> compared ICD-9 and ICD-10 coding in a huge sample of Spanish death certificates. They reported that, whereas ill-defined condition figures increased almost a 14% with the use of this latest version, neoplasms seemed quite stable. In contrast, our data indicate that the ICD-10 effect might be greater than thought, and that it has also affected tumours coding. This could suggest a worsening in the quality of data, and careful surveillance is thus called for.</p><p class="elsevierStylePara">In conclusion, the quality of cancer death certification in Spain for all tumours and all main sites has improved over the last two decades and can be considered comparable to internationally published data. Thus, mortality data constitute a valid indicator to estimate the burden of cancer. However, for some locations, such as the oesophagus or bladder, death certificate information should be approached with caution. Misclassification may generate problems for studying mortality trends and planning future needs. It should be noted that, in general, most available information on the quality of death certification reflects the situation from 1970 to 1990, when the ICD-9 was in use. The relatively recent introduction of the ICD-10 may have affected quality indicators and should thus be carefully monitored. Finally, our results point to the need to improve death certification in the case of Spanish women.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> Acknowledgements</span></p><p class="elsevierStylePara">The work of V. Carvajal was supported by the Carlos III Institute of Health (Grant No. 03/0007). The work of B. Suárez was funded by the Network of Epidemiology and Public Health Research Centres, International Health & Co-operation Foundation (Grant No. C03/09).</p><p class="elsevierStylePara">The authors wish to thank Michael Benedict for his help with the English, and Isabel Izarzugaza for supplying Euskadi's information.</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleItalic"> Correspondencia:</span></p><p class="elsevierStylePara">Beatriz Pérez-Gómez.</p><p class="elsevierStylePara">Área de Epidemiología Ambiental y Cáncer.Centro Nacional de Epidemiología.Instituto de Salud Carlos III.<br></br> Sinesio Delgado, 6. 28029 Madrid. España.</p><p class="elsevierStylePara">Correo electrónico: <a href="mailto:bperez@isciii.es" class="elsevierStyleCrossRefs"> bperez@isciii.es</a></p><p class="elsevierStylePara"><span class="elsevierStyleItalic"> Recibido:</span> 25 de noviembre de 2005. <span class="elsevierStyleItalic">Aceptado:</span> 22 de febrero de 2006.</p>" "pdfFichero" => "138v20nSupl.3a13101089pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec211888" "palabras" => array:5 [ 0 => "Death certificates" 1 => "Mortality" 2 => "Cancer" 3 => "Quality control" 4 => "Spain" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleItalic">Objetivos:</span> Parte de las diferencias en tasas de mortalidad por cáncer entre países europeos podrían deberse a diferencias de calidad en las estadísticas de mortalidad. Nuestro objetivo es sintetizar la información cuantitativa que hay acerca de la calidad de los certificados de defunción de cáncer en España, y se añade una somera descripción de la evolución temporal de la proporción de defunciones por tumores mal definidos, indicador indirecto de calidad. <span class="elsevierStyleItalic">Métodos:</span> Se identificaron los estudios relevantes mediante búsquedas en bases de datos electrónicas (MEDLINE, IME, EMBASE e IBECS), y posteriormente se añadieron referencias presentes en los artículos encontrados. Se extrajo la información acerca de calidad de certificación para cáncer en conjunto y para las principales localizaciones tumorales, y se clasificaron los tumores según sus indicadores de calidad. Se estudió también la tendencia del porcentaje de muertes mal definidas o tumores mal definidos entre 1980-2002. <span class="elsevierStyleItalic">Resultados:</span> En España, el cáncer en conjunto y las principales localizaciones ­pulmón, colon-recto, próstata, estómago, páncreas, mama, útero, cerebro, leucemia, linfomas y mieloma­ están bien certificados. Sin embargo, otras localizaciones como laringe, hígado y esófago están sobrecertificadas, mientras que el cáncer de vejiga, riñón y ovario están infracertificados. Los porcentajes de muertes por tumores o condiciones mal definidas, mayores en mujeres, han disminuido en el período estudiado, aunque la introducción de la CIE-10 ha invertido esta tendencia. <span class="elsevierStyleItalic">Conclusiones:</span> En general, los certificados de cáncer pueden considerarse válidos y útiles para estimar el impacto del cáncer en España, aunque la certificación de algunas localizaciones importantes tendría que mejorar. Debería estudiarse el posible efecto de la introducción de la CIE-10." ] ] "multimedia" => array:14 [ 0 => array:8 [ "identificador" => "tbl1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "138v20nSupl.3-13101089tab01.gif" "imagenAlto" => 932 "imagenAncho" => 1884 "imagenTamanyo" => 62171 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Cross-tabulation of cause of death according to clinical diagnoses and medical death certificates and quality-indicator formulae." ] ] 1 => array:8 [ "identificador" => "tbl2" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "138v20nSupl.3-13101089tab02.gif" "imagenAlto" => 1176 "imagenAncho" => 1925 "imagenTamanyo" => 96639 ] ] ] ] ] "descripcion" => array:1 [ "en" => "A. Quality of cancer death certification in Spain. Characteristics and classification of published studies sorted by publication year" ] ] 2 => array:8 [ "identificador" => "tbl3" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "138v20nSupl.3-13101089tab03.gif" "imagenAlto" => 1745 "imagenAncho" => 1917 "imagenTamanyo" => 135607 ] ] ] ] ] "descripcion" => array:1 [ "en" => "B. Quality of cancer death certification in Spain. Characteristics and classification of published studies sorted by publication year" ] ] 3 => array:8 [ "identificador" => "tbl4" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "138v20nSupl.3-13101089tab04.gif" "imagenAlto" => 958 "imagenAncho" => 1810 "imagenTamanyo" => 85014 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Geographical location of published studies furnishing data on quality of cancer death certification in Spain." ] ] 4 => array:8 [ "identificador" => "tbl5" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "138v20nSupl.3-13101089tab05.gif" "imagenAlto" => 1880 "imagenAncho" => 2596 "imagenTamanyo" => 218050 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Spanish cancer-death-certificate detection and confirmation rates by site" ] ] 5 => array:8 [ "identificador" => "tbl6" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "138v20nSupl.3-13101089tab06.gif" "imagenAlto" => 972 "imagenAncho" => 1932 "imagenTamanyo" => 75889 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Accuracy of death certification for specific cancers in Spain according to Percy's criteria (Percy 1981). Pooled analysis" ] ] 6 => array:8 [ "identificador" => "tbl7" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "138v20nSupl.3-13101089tab07.gif" "imagenAlto" => 1342 "imagenAncho" => 842 "imagenTamanyo" => 36288 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Percentages of deaths due to ill-defined tumours and ill-defined conditions versus all-tumour and all-cause mortality. Trends for the period 1980-2002 by sex and for both sexes." ] ] 7 => array:5 [ "identificador" => "tbl8" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 8 => array:5 [ "identificador" => "tbl9" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 9 => array:5 [ "identificador" => "tbl10" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 10 => array:5 [ "identificador" => "tbl11" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 11 => array:5 [ "identificador" => "tbl12" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 12 => array:5 [ "identificador" => "tbl13" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 13 => array:5 [ "identificador" => "tbl14" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Manual de causas de defunción. Madrid: INE; 1996." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Manual de causas de defunción. Madrid: INE; 1996." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Instituto Nacional de Estadística." ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Análisis de la concordancia de los datos recogidos en el certificado médico de defunción y el boletín estadístico de defunción." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Garrucho G" 1 => "Almazán M" 2 => "Madrazo M" 3 => "Sánchez J" 4 => "Villalobos H" 5 => "Infiesta JA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Sanid Hig Publica" "fecha" => "1990" "volumen" => "64" "paginaInicial" => "63" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2131581" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Análisis de las causas de muerte en la cohorte del síndrome del aceite tóxico. Validación de los certificados oficiales de defunción." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Giménez O" 1 => "Abaitua I" 2 => "Sánchez-Porro P" 3 => "Posada M." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Gac Sanit" "fecha" => "2002" "volumen" => "16" "paginaInicial" => "118" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Validez del boletín estadístico de defunción en la Comunidad Autónoma del País Vasco. Resultados preliminares. Granada: XIX Réunion du groupe pou l'Epidemiologie et l'enregistrement du cancer dans les pays du langue latine; 1994." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Validez del boletín estadístico de defunción en la Comunidad Autónoma del País Vasco. Resultados preliminares. Granada: XIX Réunion du groupe pou l'Epidemiologie et l'enregistrement du cancer dans les pays du langue latine; 1994." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Izarzurgaza I" 1 => "Sastre B" 2 => "Ibarrola T." ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Accuracy of cancer death certificates and its effect on cancer mortality statistics." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Percy C" 1 => "Stanek E II.I" 2 => "Gloeckler L." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Public Health" "fecha" => "1981" "volumen" => "71" "paginaInicial" => "242" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7468855" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Validez de los certificados de defunción por cáncer en Mallorca." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Cáffaro M" 1 => "Garau I" 2 => "Cabeza E" 3 => "Franch P" 4 => "Obrador A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "1995" "volumen" => "9" "paginaInicial" => "166" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7558629" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Validez de la certificación de la muerte por cáncer en la Comunidad de Murcia." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Cirera L" 1 => "Navarro C." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Oncología" "fecha" => "2002" "volumen" => "25" "paginaInicial" => "264" "paginaFinal" => "72" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Exactitud del diagnóstico de cáncer en los certificados de defunción de la provincia de Granada." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Martínez C" 1 => "Sánchez MJ" 2 => "Rodríguez M" 3 => "Alaminos FJ" 4 => "Medina MJ." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Revista de Oncología" "fecha" => "2000" "volumen" => "2" "paginaInicial" => "245" "paginaFinal" => "52" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Aproximación a calidade das estadísticas de mortalidade. Galicia 1987." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Carballeira Roca C" 1 => "Vázquez Fernández E" 2 => "Brana Rey N" 3 => "López Rois F" 4 => "Loureiro Santamaria C" 5 => "Hervada Vidal J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "1989" "volumen" => "3" "paginaInicial" => "566" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2517787" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Fiabilidad de las estadísticas de mortalidad. Valencia: Conselleria de Sanitat i Consum. Generalitat Valenciana. Monografies Sanitàries. Serie A. N.o 2; 1986." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Fiabilidad de las estadísticas de mortalidad. Valencia: Conselleria de Sanitat i Consum. Generalitat Valenciana. Monografies Sanitàries. Serie A. N.o 2; 1986." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "García-Benavides F." ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Quality of death certificates in Valencia, Spain." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "García-Benavides F" 1 => "Bolumar F" 2 => "Peris R." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Public Health" "fecha" => "1989" "volumen" => "79" "paginaInicial" => "1352" "paginaFinal" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2782500" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Validación de la causa básica de defunción en Barcelona, 1985." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Pañella H" 1 => "Borrell C" 2 => "Rodríguez C" 3 => "Roca J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "1989" "volumen" => "92" "paginaInicial" => "129" "paginaFinal" => "34" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Valoración histopatológica de los boletines de defunción en Soria en 1985." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Ruiz Liso JM" 1 => "Sanz Anquela JM" 2 => "Alfaro Torres J" 3 => "Dodero de Solano S" 4 => "García Pérez MA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Sanid Hig Publica" "fecha" => "1989" "volumen" => "63" "paginaInicial" => "41" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2519488" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Tendencias temporales de la mortalidad por cáncer de cérvix en Cataluña 1975-1992: Análisis del Boletín Estadístico de Defunción y del Registro de Cáncer de Girona." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Sánchez Garrido MV" 1 => "Izquierdo Font A" 2 => "Beltrán Fabregat M" 3 => "Bosch José FX" 4 => "Viladiu Quemada P." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "1996" "volumen" => "10" "paginaInicial" => "67" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8755158" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Mortalidad por tumores malignos en la ciudad de Barcelona." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Bosch Jose FJ" 1 => "García González A" 2 => "Orta Buj J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Sanid Hig Publica" "fecha" => "1981" "volumen" => "55" "paginaInicial" => "31" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7348386" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The accuracy of medical certifications of cancer deaths and of cancer diagnosis in the municipal area of Barcelona in 1979." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Bosch FX" 1 => "García A" 2 => "Orta J" 3 => "Juvanet J" 4 => "Camprodon A" 5 => "Pumarola A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Oncol" "fecha" => "1983" "volumen" => "30" "paginaInicial" => "17" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6679909" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Validez del Boletín Estadístico de Defunción como fuente de datos en las estadísticas sobre el cáncer. Un estudio preliminar. Bol Salud Región Murciana; 1984;4:177-80." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Validez del Boletín Estadístico de Defunción como fuente de datos en las estadísticas sobre el cáncer. Un estudio preliminar. Bol Salud Región Murciana; 1984;4:177-80." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Navarro Sánchez C" 1 => "Sánchez Sánchez JA" 2 => "Molina Illán JA." ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Exactitud de los certificados de defunción por cáncer en Zaragoza. Bol Epidemiol Aragón; 1988;5:199-206." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Exactitud de los certificados de defunción por cáncer en Zaragoza. Bol Epidemiol Aragón; 1988;5:199-206." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Diputación General de Aragón." ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Certificado médico de defunción: su fiabilidad." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Nava Caballero JM" 1 => "Huguet Recasens M" 2 => "Carrasco MA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Sanid Hig Publica" "fecha" => "1986" "volumen" => "60" "paginaInicial" => "85" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3749769" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Quality of death certificates in cases of cancer death in France." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Laplanche A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Bull Cancer" "fecha" => "1998" "volumen" => "85" "paginaInicial" => "967" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9951424" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Reliability of cancer mortality statistics in Ontario: a comparison of incident and death diagnoses, 1979-1983." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Reynolds DL" 1 => "Nguyen VC" 2 => "Clarke EA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Public Health" "fecha" => "1991" "volumen" => "82" "paginaInicial" => "120" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2049703" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "La calidad de la causa básica de muerte del Boletín Estadístico de Defunción. España, 1985." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Regidor E" 1 => "Rodríguez C" 2 => "Ronda E" 3 => "Gutiérrez JL" 4 => "Redondo JL." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "1993" "volumen" => "7" "paginaInicial" => "12" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8468142" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Cancer surveillance with particular reference to the uses of mortality data." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Griffith GW." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Epidemiol" "fecha" => "1976" "volumen" => "5" "paginaInicial" => "69" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/770353" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Patterns of urban mortality. Report of the Inter-American investigation of mortality. Pan American Health Organization. Scientific Publication. 1967;151." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Patterns of urban mortality. Report of the Inter-American investigation of mortality. Pan American Health Organization. Scientific Publication. 1967;151." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Puffer RR" 1 => "Griffith GW." ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Mortalidad por cáncer y otras causas en España en 2002. Área de Epidemiología Ambiental y Cáncer. Centro Nacional de Epidemiología. ISCIII. [Actualizado 2005; citado 9-8-2005]. Disponible en: http://cne.isciii.es/htdocs/cancer/mort2002.txt" "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Mortalidad por cáncer y otras causas en España en 2002. Área de Epidemiología Ambiental y Cáncer. Centro Nacional de Epidemiología. ISCIII. [Actualizado 2005; citado 9-8-2005]. Disponible en: http://cne.isciii.es/htdocs/cancer/mort2002.txt" "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "López-Abente G" 1 => "Pollán M" 2 => "Aragonés N" 3 => "Pérez-Gómez B." ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Plan Integral del Cáncer. Situación del cáncer en España. Madrid: Ministerio de Sanidad y Consumo; 2003." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Plan Integral del Cáncer. Situación del cáncer en España. Madrid: Ministerio de Sanidad y Consumo; 2003." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "López-Abente G" 1 => "Pollán M" 2 => "Aragonés N" 3 => "Pérez-Gómez B" 4 => "Hernández V" 5 => "Lope V" 6 => "et al." ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The accuracy of liver cancer as the underlying cause of death on death certificates." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Percy C" 1 => "Ries LG" 2 => "Van Holten VD." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Public Health Rep" "fecha" => "1990" "volumen" => "105" "paginaInicial" => "361" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2116637" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Reliability and accuracy of reported causes of death from cancer. I. Reliability of all cancer reported in the State of Rio de Janeiro, Brazil. Cad Saude Publica. 1997;13 Suppl 1:39-52." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Reliability and accuracy of reported causes of death from cancer. I. Reliability of all cancer reported in the State of Rio de Janeiro, Brazil. Cad Saude Publica. 1997;13 Suppl 1:39-52." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Monteiro GT" 1 => "Koifman RJ" 2 => "Koifman S." ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Reliability and accuracy of reported causes of death from cancer. II. Accuracy of stomach cancer reported in the municipality of Rio de Janeiro County, Brazil. Cad Saude Publica. 1997;13 Suppl 1:53-65." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Reliability and accuracy of reported causes of death from cancer. II. Accuracy of stomach cancer reported in the municipality of Rio de Janeiro County, Brazil. Cad Saude Publica. 1997;13 Suppl 1:53-65." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Monteiro GT" 1 => "Koifman RJ" 2 => "Koifman S." ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Use of mortality statistics for the study of the distribution of digestive system tumors: characteristics and quality of the data." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Barchielli A" 1 => "De Angelis R" 2 => "Frova L." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Ist Super Sanita" "fecha" => "1996" "volumen" => "32" "paginaInicial" => "433" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9382415" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The international comparability of cancer mortality data. Results of an international death certificate study." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Percy C" 1 => "Muir C." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Epidemiol" "fecha" => "1989" "volumen" => "129" "paginaInicial" => "934" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2705435" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Aprendizaje y satisfacción de los talleres de pre y posgrado de medicina para la mejora en la certificación de las causas de defunción, 1992-1996." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Cirera L" 1 => "Martínez C" 2 => "Contreras J" 3 => "Navarro C." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Salud Pública" "fecha" => "1998" "volumen" => "72" "paginaInicial" => "185" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9810826" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Death certification: an audit of practice entering the 21st century." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Swift B" 1 => "West K." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Pathol" "fecha" => "2002" "volumen" => "55" "paginaInicial" => "275" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11919211" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Comparabilidad entre la novena y la décima revisión de la Clasificación Internacional de Enfermedades aplicada a la codificación de la causa de muerte en España." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Ruiz M" 1 => "Cirera Suárez L" 2 => "Pérez G" 3 => "Borrell C" 4 => "Audica C" 5 => "Moreno C" 6 => "et al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2002" "volumen" => "16" "paginaInicial" => "526" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12459136" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02139111/00000020000000S3/v0_201307171022/13101089/v0_201307171023/en/main.assets" "Apartado" => array:4 [ "identificador" => "779" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Revisiones" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02139111/00000020000000S3/v0_201307171022/13101089/v0_201307171023/en/138v20nSupl.3a13101089pdf001.pdf?idApp=WGSE&text.app=https://gacetasanitaria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13101089?idApp=WGSE" ]
Idioma original: Inglés
año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 5 | 3 | 8 |
2024 Octubre | 63 | 42 | 105 |
2024 Septiembre | 104 | 32 | 136 |
2024 Agosto | 86 | 49 | 135 |
2024 Julio | 57 | 41 | 98 |
2024 Junio | 61 | 22 | 83 |
2024 Mayo | 66 | 55 | 121 |
2024 Abril | 57 | 30 | 87 |
2024 Marzo | 46 | 25 | 71 |
2024 Febrero | 48 | 35 | 83 |
2024 Enero | 50 | 34 | 84 |
2023 Diciembre | 44 | 15 | 59 |
2023 Noviembre | 87 | 44 | 131 |
2023 Octubre | 60 | 34 | 94 |
2023 Septiembre | 64 | 24 | 88 |
2023 Agosto | 47 | 16 | 63 |
2023 Julio | 74 | 34 | 108 |
2023 Junio | 69 | 30 | 99 |
2023 Mayo | 71 | 24 | 95 |
2023 Abril | 57 | 27 | 84 |
2023 Marzo | 72 | 29 | 101 |
2023 Febrero | 62 | 35 | 97 |
2023 Enero | 47 | 23 | 70 |
2022 Diciembre | 61 | 30 | 91 |
2022 Noviembre | 96 | 63 | 159 |
2022 Octubre | 54 | 50 | 104 |
2022 Septiembre | 50 | 39 | 89 |
2022 Agosto | 81 | 84 | 165 |
2022 Julio | 65 | 64 | 129 |
2022 Junio | 84 | 51 | 135 |
2022 Mayo | 75 | 66 | 141 |
2022 Abril | 82 | 57 | 139 |
2022 Marzo | 104 | 71 | 175 |
2022 Febrero | 90 | 59 | 149 |
2022 Enero | 63 | 40 | 103 |
2021 Diciembre | 56 | 47 | 103 |
2021 Noviembre | 90 | 66 | 156 |
2021 Octubre | 65 | 67 | 132 |
2021 Septiembre | 60 | 56 | 116 |
2021 Agosto | 55 | 45 | 100 |
2021 Julio | 76 | 32 | 108 |
2021 Junio | 74 | 33 | 107 |
2021 Mayo | 85 | 73 | 158 |
2021 Abril | 143 | 87 | 230 |
2021 Marzo | 77 | 51 | 128 |
2021 Febrero | 41 | 24 | 65 |
2021 Enero | 36 | 20 | 56 |
2020 Diciembre | 43 | 29 | 72 |
2020 Noviembre | 32 | 15 | 47 |
2020 Octubre | 32 | 26 | 58 |
2020 Septiembre | 37 | 41 | 78 |
2020 Agosto | 30 | 30 | 60 |
2020 Julio | 20 | 29 | 49 |
2020 Junio | 68 | 33 | 101 |
2020 Mayo | 25 | 11 | 36 |
2020 Abril | 39 | 20 | 59 |
2020 Marzo | 77 | 14 | 91 |
2020 Febrero | 65 | 23 | 88 |
2020 Enero | 34 | 11 | 45 |
2019 Diciembre | 43 | 29 | 72 |
2019 Noviembre | 20 | 10 | 30 |
2019 Octubre | 38 | 19 | 57 |
2019 Septiembre | 17 | 17 | 34 |
2019 Agosto | 20 | 8 | 28 |
2019 Julio | 23 | 9 | 32 |
2019 Junio | 28 | 25 | 53 |
2019 Mayo | 28 | 20 | 48 |
2019 Abril | 33 | 16 | 49 |
2019 Marzo | 22 | 13 | 35 |
2019 Febrero | 26 | 17 | 43 |
2019 Enero | 19 | 19 | 38 |
2018 Diciembre | 15 | 13 | 28 |
2018 Noviembre | 40 | 13 | 53 |
2018 Octubre | 38 | 37 | 75 |
2018 Septiembre | 34 | 7 | 41 |
2018 Agosto | 30 | 10 | 40 |
2018 Julio | 28 | 12 | 40 |
2018 Junio | 38 | 14 | 52 |
2018 Mayo | 38 | 10 | 48 |
2018 Abril | 12 | 5 | 17 |
2018 Marzo | 21 | 7 | 28 |
2018 Febrero | 15 | 2 | 17 |
2018 Enero | 29 | 5 | 34 |
2017 Diciembre | 25 | 6 | 31 |
2017 Noviembre | 24 | 10 | 34 |
2017 Octubre | 26 | 6 | 32 |
2017 Septiembre | 20 | 8 | 28 |
2017 Agosto | 14 | 12 | 26 |
2017 Julio | 14 | 2 | 16 |
2017 Junio | 80 | 11 | 91 |
2017 Mayo | 60 | 9 | 69 |
2017 Abril | 23 | 5 | 28 |
2017 Marzo | 24 | 7 | 31 |
2017 Febrero | 11 | 1 | 12 |
2017 Enero | 8 | 5 | 13 |
2016 Diciembre | 44 | 9 | 53 |
2016 Noviembre | 27 | 5 | 32 |
2016 Octubre | 39 | 8 | 47 |
2016 Septiembre | 17 | 6 | 23 |
2016 Agosto | 0 | 3 | 3 |
2016 Julio | 0 | 8 | 8 |
2015 Noviembre | 1 | 0 | 1 |
2015 Octubre | 1 | 0 | 1 |
2015 Septiembre | 1 | 0 | 1 |
2015 Agosto | 3 | 0 | 3 |
2015 Julio | 1 | 0 | 1 |
2015 Junio | 2 | 0 | 2 |
2015 Abril | 1 | 0 | 1 |
2015 Marzo | 2 | 0 | 2 |
2015 Febrero | 2 | 0 | 2 |
2015 Enero | 2 | 0 | 2 |
2014 Diciembre | 6 | 0 | 6 |
2014 Noviembre | 8 | 0 | 8 |
2014 Octubre | 5 | 0 | 5 |
2014 Septiembre | 8 | 0 | 8 |
2014 Agosto | 10 | 0 | 10 |
2014 Julio | 10 | 0 | 10 |
2014 Junio | 4 | 0 | 4 |
2014 Mayo | 8 | 0 | 8 |
2014 Abril | 6 | 0 | 6 |
2014 Marzo | 3 | 1 | 4 |
2014 Febrero | 7 | 0 | 7 |
2014 Enero | 9 | 1 | 10 |
2013 Diciembre | 9 | 1 | 10 |
2013 Noviembre | 22 | 2 | 24 |
2013 Octubre | 31 | 1 | 32 |
2013 Septiembre | 17 | 1 | 18 |
2013 Agosto | 24 | 1 | 25 |
2013 Julio | 17 | 2 | 19 |
2006 Diciembre | 1489 | 0 | 1489 |