DeChello Laurie M, Sheehan T Joseph
Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT 06030-6325, USA.
Int J Health Geogr. 2007 Jun 4;6:20. doi: 10.1186/1476-072X-6-20.
The aims of this study were to determine if observed geographic variations in colorectal cancer incidence are simply random or are statistically significant deviations from randomness, whether statistically significant excesses are temporary or persistent, and whether they can be explained by risk factors such as socioeconomic status (SES) or the percent of the population residing in an urban area rather than a rural area. Between 1995 and 1998, 6360 male and 6628 female invasive colorectal cancer cases were diagnosed in Massachusetts residents. Cases were aggregated to Census tracts and analyzed for deviations from random occurrence with respect to both location and time.
Six geographic areas that deviated significantly from randomness were uncovered in the age-adjusted analyses of males: three with higher incidence rates than expected and eight lower than expected. In the age-adjusted analyses of females, one area with a higher incidence rate, and one area with a lower incidence rate than expected, were found. After adjustment for SES and percent urban, some of these areas were no longer significantly different.
Public health practitioners can use the results of this study to focus their attention onto areas in Massachusetts that need to increase colorectal screening or have elevated risk of colorectal cancer incidence.
本研究的目的是确定观察到的结直肠癌发病率的地理差异是单纯随机的，还是在统计学上显著偏离随机性；具有统计学意义的发病率过高情况是暂时的还是持续的；以及这些差异是否可以用社会经济地位（SES）或城市地区而非农村地区的人口百分比等风险因素来解释。1995年至1998年期间，马萨诸塞州居民中诊断出6360例男性和6628例女性浸润性结直肠癌病例。病例按普查区汇总，并分析其在位置和时间方面与随机发生情况的偏差。
在对男性进行年龄调整后的分析中，发现了六个明显偏离随机性的地理区域：三个发病率高于预期，八个低于预期。在对女性进行年龄调整后的分析中，发现一个发病率高于预期的区域和一个发病率低于预期的区域。在对社会经济地位和城市人口百分比进行调整后，其中一些区域不再有显著差异。
公共卫生从业者可以利用本研究结果，将注意力集中在马萨诸塞州需要加强结直肠癌筛查或结直肠癌发病率风险较高的地区。
