Medical University of Villa Clara, Santa Clara, Cuba.
MEDICC Rev. 2013 Jul;15(3):16-21. doi: 10.37757/MR2013V15.N3.5.
Cancer has historically been a main cause of death in Cuba, with lung cancer the number one cause of cancer death in both sexes. Cancer morbidity and mortality rates are the basic measures of cancer impact in the community. Cancer mortality has been one of the major applications of geographic analysis and has made important progress in recent decades thanks to access to mortality statistics and to development and availability of geographic information systems. Cuba does not have a strong tradition of etiologic research using spatial analysis. High levels of lung cancer morbidity and mortality in Villa Clara and growing interest in spatial analysis as an epidemiologic tool motivated this study.
To identify spatial and/or spatiotemporal clusters of lung cancer morbidity and case fatality in the province of Villa Clara, and to demonstrate the value of cluster analysis as an epidemiologic tool.
Descriptive observational study based on administrative data, using the technique of space-time scan statistics. The study focused on new cases diagnosed in 2004 and case-fatality for those cases through 2009. Variables used were: cases diagnosed, deaths, date of diagnosis, date of death, municipality and Cartesian geocoding for each municipality.
The study identified significant spatial and spatiotemporal clusters of greater than expected lung cancer incidence (municipalities of Encrucijada, Camajuaní, Cifuentes, Sagua la Grande, Caibarién and Santa Clara) and case fatality (Encrucijada, Camajuaní, Cifuentes, Sagua la Grande, Caibarién, Santa Clara, Placetas and Manicaragua).
Although the results are not explanatory, the spatial and spatiotemporal patterns of excess lung cancer risk and case-fatality can support hypothesis generation for research and eventual interventions for targeted prevention and management.
癌症一直是古巴主要的死亡原因，肺癌是男女癌症死亡的首要原因。癌症发病率和死亡率是癌症对社区影响的基本衡量标准。癌症死亡率是地理分析的主要应用之一，由于获得了死亡率统计数据以及地理信息系统的开发和可用性，近几十年来取得了重要进展。古巴在使用空间分析进行病因研究方面没有很强的传统。由于古巴维亚克拉拉省肺癌发病率和死亡率居高不下，以及对空间分析作为一种流行病学工具的兴趣日益浓厚，促使开展了这项研究。
确定维亚克拉拉省肺癌发病率和病死率的空间和/或时空聚集，并展示聚类分析作为一种流行病学工具的价值。
本研究是基于行政数据的描述性观察研究，使用时空扫描统计技术。研究重点是 2004 年诊断的新病例以及 2009 年这些病例的病死率。所用变量包括：诊断病例数、死亡人数、诊断日期、死亡日期、市以及每个市的笛卡尔地理编码。
研究发现肺癌发病率（恩克鲁西达、卡马亚乌伊、西富恩特斯、萨瓜拉格兰德、卡瓦伊雷恩和圣克拉拉等市）和病死率（恩克鲁西达、卡马亚乌伊、西富恩特斯、萨瓜拉格兰德、卡瓦伊雷恩、圣克拉拉、普拉塞塔斯和马尼卡瓜等市）存在显著的空间和时空聚集。
尽管结果不具有解释性，但肺癌风险和病死率过高的空间和时空模式可以为研究和最终针对特定人群的预防和管理干预措施提供假说生成的依据。
