Caulley Lisa, Sawada Michael, Hinther Kelsey, Ko Ya-Tung Iris, Crowther John A, Kontorinis Georgios
Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.
The Ottawa Hospital, Ottawa, Ontario, Canada.
PLoS One. 2017 May 11;12(5):e0175489. doi: 10.1371/journal.pone.0175489. eCollection 2017.
Although the natural history of vestibular schwannomas (VS) has been previously studied, few studies have investigated associated epidemiological factors, primarily because of the lack of large available cohorts.
The objective of this study was to perform a multi-scale geographical analysis of the period prevalence of VS in West Scotland from 2000 to 2015.
Adults diagnosed with sporadic VS were identified through the National Health Services of West Scotland database and geocoded to the unit postcode. To assess whether the cohort of VS cases could be pooled into a period prevalence measure, the locations of VS cases were analyzed by sex using Cross-L and Difference-K functions. VS period prevalence was examined at two aggregate spatial scales: the postcode district and a coarser scale of NHS Health Boards. The spatial structure of period prevalence within each level of spatial aggregation was measured using univariate global and local Moran's I. Bivariate local Moran's I was used to examine the between-scale variability in period prevalence from the postcode district level to the NHS Health Boards levels. Prior to spatial autocorrelation analyses, the period prevalence at the postcode district was tested for stratified spatial heterogeneity within the NHS Health Boards using Wang's q-Statistic.
A total of 512 sporadic VS were identified in a population of over 3.1 million. Between 2000 and 2015, VS period prevalence was highest within the NHS Health Boards of Greater Glasgow and Clyde, Ayrshire and Arran and the Western Isles. However, at the NHS scale, period prevalence exhibited no spatial autocorrelation globally or locally. At the district scale, Highland exhibited the most unusual local spatial autocorrelation. Bivariate local Moran's I results indicated general stability of period prevalence across the postcode district to Health Boards scales. However, locally, some postcode districts in Greater Glasgow and Clyde, Ayrshire and Arran exhibited unusually low district to zone spatial autocorrelation in period prevalence, as did the southern parts of the Western Isles. Some unusually high period prevalence values between the postcode district to Health Board scale were found in Tayside, Forth Valley and Dumfries and Galloway.
Geographic variability in VS in West Scotland was identified in this patient population, showing that there are areas, even remote, with unusually high or low period prevalence. This can be partially attributed to links between primary and tertiary care. Potential genetic or environmental risk factors that may contribute to geographic variation in this disease within Scotland are also a possibility but require further investigation.
尽管此前已对前庭神经鞘瘤（VS）的自然病史进行过研究，但很少有研究调查相关的流行病学因素，主要原因是缺乏大量可用的队列研究。
本研究的目的是对2000年至2015年西苏格兰VS的期间患病率进行多尺度地理分析。
通过西苏格兰国民医疗服务体系数据库识别出被诊断为散发性VS的成年人，并将其地理编码到单位邮政编码。为了评估VS病例队列是否可以汇总为期间患病率指标，使用交叉L函数和差异K函数按性别分析VS病例的位置。在两个总体空间尺度上检查VS期间患病率：邮政编码区和更粗略的国民医疗服务体系健康委员会尺度。使用单变量全局和局部莫兰指数测量每个空间聚合水平内期间患病率的空间结构。使用双变量局部莫兰指数检查从邮政编码区水平到国民医疗服务体系健康委员会水平期间患病率的尺度间变异性。在进行空间自相关分析之前，使用王的q统计量测试邮政编码区的期间患病率在国民医疗服务体系健康委员会内的分层空间异质性。
在超过310万人口中总共识别出512例散发性VS。在2000年至2015年期间，VS期间患病率在大格拉斯哥和克莱德、艾尔郡和阿兰以及西部群岛的国民医疗服务体系健康委员会中最高。然而，在国民医疗服务体系尺度上，期间患病率在全局或局部均未表现出空间自相关性。在地区尺度上，高地表现出最不寻常的局部空间自相关性。双变量局部莫兰指数结果表明，从邮政编码区到健康委员会尺度，期间患病率总体稳定。然而，在局部地区，大格拉斯哥和克莱德、艾尔郡和阿兰的一些邮政编码区在期间患病率上表现出异常低的地区到区域空间自相关性，西部群岛南部也是如此。在泰赛德、福斯谷以及邓弗里斯和加洛韦发现了一些从邮政编码区到健康委员会尺度期间患病率异常高的值。
在该患者群体中发现了西苏格兰VS的地理变异性，表明存在一些地区，甚至偏远地区具有异常高或低的期间患病率。这部分可归因于初级和三级医疗之间的联系。在苏格兰，可能导致这种疾病地理变异的潜在遗传或环境风险因素也是一种可能性，但需要进一步调查。
