Hsieh Jeff Ching-Fu, Cramb Susanna M, McGree James M, Dunn Nathan A M, Baade Peter D, Mengersen Kerrie L
Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia.
PLoS One. 2016 May 5;11(5):e0155086. doi: 10.1371/journal.pone.0155086. eCollection 2016.
An increasing number of studies have identified spatial differences in breast cancer survival. However little is known about whether the structure and dynamics of this spatial inequality are consistent across a region. This study aims to evaluate the spatially varying nature of predictors of spatial inequality in relative survival for women diagnosed with breast cancer across Queensland, Australia. All Queensland women aged less than 90 years diagnosed with invasive breast cancer from 1997 to 2007 and followed up to the end of 2008 were extracted from linked Queensland Cancer Registry and BreastScreen Queensland data. Bayesian relative survival models were fitted using various model structures (a spatial regression model, a varying coefficient model and a finite mixture of regressions model) to evaluate the relative excess risk of breast cancer, with the use of Markov chain Monte Carlo computation. The spatially varying coefficient models revealed that some covariate effects may not be constant across the geographic regions of the study. The overall spatial patterns showed lower survival among women living in more remote areas, and higher survival among the urbanised south-east corner. Notwithstanding this, the spatial survival pattern for younger women contrasted with that for older women as well as single women. This complex spatial interplay may be indicative of different factors impacting on survival patterns for these women.
越来越多的研究已经确定了乳腺癌生存率的空间差异。然而，对于这种空间不平等的结构和动态在一个地区内是否一致，人们却知之甚少。本研究旨在评估澳大利亚昆士兰州被诊断为乳腺癌的女性相对生存率空间不平等预测因素的空间变化性质。从昆士兰癌症登记处和昆士兰乳房筛查数据的关联数据中提取了1997年至2007年期间所有年龄小于90岁、被诊断为浸润性乳腺癌且随访至2008年底的昆士兰女性。使用各种模型结构（空间回归模型、变系数模型和有限混合回归模型）拟合贝叶斯相对生存模型，以评估乳腺癌的相对超额风险，并采用马尔可夫链蒙特卡罗计算方法。空间变系数模型显示，某些协变量效应在研究的地理区域内可能并非恒定不变。总体空间模式显示，居住在更偏远地区的女性生存率较低，而在城市化程度较高的东南角地区生存率较高。尽管如此，年轻女性的空间生存模式与老年女性以及单身女性的模式形成对比。这种复杂的空间相互作用可能表明不同因素对这些女性的生存模式产生了影响。
