[1999 - 2001年塔兰托省部分癌症发病率的统计分析] - Suppr

Graziano Giusi, Bilancia Massimo, Bisceglia Lucia, de Nichilo Gigliola, Pollice Alessio, Assennato Giorgio

Osservatorio epidemiologico regionale, Regione Puglia.

Epidemiol Prev. 2009 Jan-Apr;33(1-2):37-44.

OBJECTIVE

to estimate the spatial distribution of risk, in order to assess its correlation to environmental pollution exposure around the large production facilities located in the Taranto area, and to identify high risk areas not previously reported.

SETTING

Italy, Taranto province (581,508 inhabitants).

DESIGN

incidence data in 29 municipalities of the Taranto province were extracted from the Jonico Salentino Cancer Registry (RTJS) for the following cancer sites: lung (ICDX C33-C34); pleura, pleuric mesothelioma (ICDX C45.0); bladder, malignancies only (ICDX C67); brain (ICDX C70-72); non-Hodgkin lymphoma (ICDX C82-85, C96); leukaemia (ICDX C91-5). Age standardized incidence rates for the whole province were computed. High-level risk areas were classified using a Poisson model, computing area-specific p-values associated to the null hypothesis of no increased risk (i.e. relative risk equal to 1). A hierarchical spatial Bayesian model was estimated to strengthen results: specifically two additional variance components, accounting for relative risk spatial autocorrelation and excess heterogeneity respectively, were considered in the model specification. Bayesian mapping of disease incidence allows for the drawing of regularized (smoothed) maps. To adjust for the effect of socio-economic deprivation, a five-variable index was introduced into the model as an ecological covariate.

RESULTS

an increased risk of lung, pleura and bladder cancer was observed among male residents in the city of Taranto (respectively: SIR 1.24, p-value < 0.01; SIR: 2.21, p-value < 0.01; SIR 1.28, p-value < 0.01). For non-Hodgkin lymphoma, a significant value was observed in the city of Taranto for males (SIR 1.46, p-value < 0.01), as well as in the neighbouring area of Pulsano for females (SIR 3.88, p-value < 0.01). An unexpected increased risk of brain cancer was found in both sexe risk (especially among males) of lung, pleura and bladder cancer is likely related to the chemical pollutants and asbestos, due to the presence of many industries and shipyards in the city of Taranto.

目的

估计风险的空间分布，以评估其与塔兰托地区大型生产设施周边环境污染暴露的相关性，并识别先前未报告的高风险区域。

地点

意大利，塔兰托省（581,508名居民）。

设计

从乔尼科·萨伦蒂诺癌症登记处（RTJS）提取塔兰托省29个市镇以下癌症部位的发病数据：肺癌（ICD-X C33-C34）；胸膜、胸膜间皮瘤（ICD-X C45.0）；膀胱癌，仅恶性肿瘤（ICD-X C67）；脑癌（ICD-X C70-72）；非霍奇金淋巴瘤（ICD-X C82-85，C96）；白血病（ICD-X C91-5）。计算全省的年龄标准化发病率。使用泊松模型对高风险区域进行分类，计算与无风险增加的零假设（即相对风险等于1）相关的特定区域p值。估计了一个分层空间贝叶斯模型以强化结果：具体而言，在模型设定中考虑了另外两个方差成分，分别用于解释相对风险的空间自相关性和过度异质性。疾病发病率的贝叶斯映射允许绘制正则化（平滑）地图。为了调整社会经济剥夺的影响，将一个五变量指数作为生态协变量引入模型。

结果

在塔兰托市男性居民中观察到肺癌、胸膜癌和膀胱癌风险增加（分别为：标准化发病比1.24，p值<0.01；标准化发病比：2.21，p值<0.01；标准化发病比1.28，p值<0.01）。对于非霍奇金淋巴瘤，在塔兰托市男性中观察到显著值（标准化发病比1.46，p值<0.01），在邻近的普尔萨诺地区女性中也观察到显著值（标准化发病比3.88，p值<0.01）。在两性中均发现意外的脑癌风险增加（尤其是男性）。塔兰托市肺癌、胸膜癌和膀胱癌的风险增加可能与化学污染物和石棉有关，因为该市有许多工业和造船厂。