Fairley L, Forman D, West R, Manda S
Northern and Yorkshire Cancer Registry and Information Service, St James's Institute of Oncology, St James's University Hospital, Level 6, Bexley Wing, Beckett Street, Leeds LS9 7TF, UK.
Br J Cancer. 2008 Dec 2;99(11):1786-93. doi: 10.1038/sj.bjc.6604757. Epub 2008 Nov 4.
Primary Care Trust (PCT) estimates of survival lack robustness as there are small numbers of deaths per year in each area, even when incidence is high. We assess PCT-level spatial variation in prostate cancer survival using Bayesian spatial models of excess mortality. We extracted data on men diagnosed with prostate cancer between 1990 and 1999 from the Northern and Yorkshire Cancer Registry and Information Service database. Models were adjusted for age at diagnosis, period of diagnosis and deprivation. All covariates had a significant association with excess mortality; men from more deprived areas, older age at diagnosis and diagnosed in 1990-1994 had higher excess mortality. The unadjusted relative excess risks (RER) of death by PCT ranged from 0.75 to 1.66. After adjustment, areas of high and low excess mortality were smoothed towards the mean, and the RERs ranged from 0.74 to 1.49. Using Bayesian smoothing techniques to model cancer survival by geographic area offers many advantages over traditional methods; estimates in areas with small populations or low incidence rates are stabilised and shrunk towards local and global risk estimates improving reliability and precision, complex models are easily handled and adjustment for covariates can be made.
初级保健信托基金（PCT）对生存率的估计缺乏稳健性，因为即使发病率很高，每个地区每年的死亡人数也很少。我们使用超额死亡率的贝叶斯空间模型评估前列腺癌生存率在PCT层面的空间差异。我们从北部和约克郡癌症登记与信息服务数据库中提取了1990年至1999年期间被诊断为前列腺癌的男性的数据。模型针对诊断时的年龄、诊断时期和贫困程度进行了调整。所有协变量都与超额死亡率有显著关联；来自贫困地区的男性、诊断时年龄较大以及在1990 - 1994年被诊断出的男性超额死亡率更高。按PCT划分的未调整死亡相对超额风险（RER）范围为0.75至1.66。调整后，高和低超额死亡率地区向均值平滑，RER范围为0.74至1.49。使用贝叶斯平滑技术按地理区域对癌症生存率进行建模比传统方法具有许多优势；人口少或发病率低的地区的估计值得到稳定，并向局部和全局风险估计值收缩，提高了可靠性和精度，复杂模型易于处理，并且可以对协变量进行调整。
