Ray G Thomas, Kulldorff Martin, Asgari Maryam M
Division of Research, Kaiser Permanente Northern California, Oakland.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
JAMA Dermatol. 2016 Nov 1;152(11):1218-1224. doi: 10.1001/jamadermatol.2016.2536.
Rates of skin cancer, including basal cell carcinoma (BCC), the most common cancer, have been increasing over the past 3 decades. A better understanding of geographic clustering of BCCs can help target screening and prevention efforts.
Present a methodology to identify spatial clusters of BCC and identify such clusters in a northern California population.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective study used a BCC registry to determine rates of BCC by census block group, and used spatial scan statistics to identify statistically significant geographic clusters of BCCs, adjusting for age, sex, and socioeconomic status. The study population consisted of white, non-Hispanic members of Kaiser Permanente Northern California during years 2011 and 2012.
Statistically significant geographic clusters of BCC as determined by spatial scan statistics.
Spatial analysis of 28 408 individuals who received a diagnosis of at least 1 BCC in 2011 or 2012 revealed distinct geographic areas with elevated BCC rates. Among the 14 counties studied, BCC incidence ranged from 661 to 1598 per 100 000 person-years. After adjustment for age, sex, and neighborhood socioeconomic status, a pattern of 5 discrete geographic clusters emerged, with a relative risk ranging from 1.12 (95% CI, 1.03-1.21; P = .006) for a cluster in eastern Sonoma and northern Napa Counties to 1.40 (95% CI, 1.15-1.71; P < .001) for a cluster in east Contra Costa and west San Joaquin Counties, compared with persons residing outside that cluster.
In this study of a northern California population, we identified several geographic clusters with modestly elevated incidence of BCC. Knowledge of geographic clusters can help inform future research on the underlying etiology of the clustering including factors related to the environment, health care access, or other characteristics of the resident population, and can help target screening efforts to areas of highest yield.
包括最常见的癌症——基底细胞癌（BCC）在内的皮肤癌发病率在过去30年中一直在上升。更好地了解基底细胞癌的地理聚集情况有助于针对性地开展筛查和预防工作。
提出一种识别基底细胞癌空间聚集的方法，并在北加利福尼亚人群中识别此类聚集。
设计、地点和参与者：这项回顾性研究使用基底细胞癌登记处来确定按普查街区组划分的基底细胞癌发病率，并使用空间扫描统计方法来识别基底细胞癌在统计学上显著的地理聚集，同时对年龄、性别和社会经济地位进行了调整。研究人群包括2011年和2012年期间北加利福尼亚凯撒医疗集团的非西班牙裔白人成员。
通过空间扫描统计确定的基底细胞癌在统计学上显著的地理聚集。
对2011年或2012年被诊断患有至少1例基底细胞癌的28408人进行的空间分析显示，存在基底细胞癌发病率升高的不同地理区域。在所研究的14个县中，基底细胞癌发病率为每10万人年661至1598例。在对年龄、性别和邻里社会经济地位进行调整后，出现了5个离散地理聚集的模式，与聚集区域外的居民相比，索诺马县东部和纳帕县北部的一个聚集区域的相对风险为1.12（95%CI，1.03 - 1.21；P = 0.006），东康特拉科斯塔县和西圣华金县的一个聚集区域的相对风险为1.40（95%CI，1.15 - 1.71；P < 0.001）。
在这项对北加利福尼亚人群的研究中，我们识别出了几个基底细胞癌发病率略有升高的地理聚集区域。了解地理聚集情况有助于为未来关于聚集潜在病因的研究提供信息，包括与环境、医疗保健可及性或居民人口其他特征相关的因素，并有助于将筛查工作针对到产量最高的地区。
