National Cancer Registry Ireland, Kinsale Road, Cork, Ireland Centre for Research in Environmental Epidemiology (CREAL), C. Dr Aiguader, 88, 08003 Barcelona, Spain.
Br J Dermatol. 2011 Apr;164(4):822-9. doi: 10.1111/j.1365-2133.2011.10238.x.
Nonmelanoma skin cancer (NMSC) is the most common cancer in white populations worldwide. International comparisons in incidence are limited because few registries collect comprehensive population-based data.
We describe spatial, urban/rural and socioeconomic variations in NMSC incidence in Ireland, overall and for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) separately. Methods NMSC cases (n=47 347) diagnosed during 1994-2003 were extracted from the National Cancer Registry. Each case was allocated to a small area (electoral district, ED) based on address at diagnosis. Standardized incidence ratios (SIRs) were calculated and smoothed using a Bayesian conditional autoregressive model. Associations between disease and census-derived area-based socioeconomic factors (unemployment, employment type, early school leavers, deprivation category, population density) were investigated using negative binomial regression.
The spatial and socioeconomic distributions differed by subtype, suggesting aetiological differences. For BCC, areas of higher risk were concentrated around the main cities, with small patches on the south and west coast. Higher risks for SCC were seen in the north-east, on the south, mid and north-west coast. BCC risk in males and females, and SCC in males, was significantly higher in those living in the least deprived areas. Risk of BCC and SCC in females was higher in the most densely populated areas.
We observed striking geographical variation in NMSC incidence, which cannot be satisfactorily explained on the basis of known risk factors. Differences by deprivation category and population density may reflect better access to cancer surveillance or care, as well as differences in risk factor exposure.
非黑色素瘤皮肤癌（NMSC）是全世界白人中最常见的癌症。由于很少有登记处收集全面的基于人群的数据，因此发病率的国际比较受到限制。
我们描述了爱尔兰 NMSC 发病率的空间、城乡和社会经济差异，总体上以及分别为基底细胞癌（BCC）和鳞状细胞癌（SCC）。
从国家癌症登记处提取了 1994-2003 年间诊断的 NMSC 病例（n=47347）。根据诊断时的地址，将每个病例分配到一个小区域（选区，ED）。使用贝叶斯条件自回归模型计算并平滑标准化发病率比（SIR）。使用负二项回归调查疾病与普查得出的基于区域的社会经济因素（失业、就业类型、提前离校者、贫困类别、人口密度）之间的关联。
亚型之间的空间和社会经济分布不同，表明病因学差异。对于 BCC，高风险区域集中在主要城市周围，南部和西部沿海地区有小块区域。在东北部、南部、中部和西北部沿海地区，SCC 的风险更高。男性和女性的 BCC 风险以及男性的 SCC 风险在最不贫困地区更高。女性的 BCC 和 SCC 风险在人口最密集的地区更高。
我们观察到 NMSC 发病率存在显著的地理差异，这不能用已知的风险因素来满意地解释。贫困程度和人口密度的差异可能反映了更好的癌症监测或护理机会，以及风险因素暴露的差异。
