Moore Justin Xavier, Akinyemiju Tomi, Wang Henry E
Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Cancer Epidemiol. 2017 Aug;49:118-127. doi: 10.1016/j.canep.2017.05.013. Epub 2017 Jun 9.
The aims of this study were to identify counties in the United States (US) with high rates of lung cancer mortality, and to characterize the associated community-level factors while focusing on particulate-matter pollution.
We performed a descriptive analysis of lung cancer deaths in the US from 2004 through 2014. We categorized counties as "clustered" or "non-clustered" - based on whether or not they had high lung cancer mortality rates - using novel geospatial autocorrelation methods. We contrasted community characteristics between cluster categories. We performed logistic regression for the association between cluster category and particulate-matter pollution.
Among 362 counties (11.6%) categorized as clustered, the age-adjusted lung cancer mortality rate was 99.70 deaths per 100,000 persons (95%CI: 99.1-100.3). Compared with non-clustered counties, clustered counties were more likely in the south (72.9% versus 42.1%, P<0.01) and in non-urban communities (73.2% versus 57.4, P<0.01). Clustered counties had greater particulate-matter pollution, lower education and income, higher rates of obesity and physical inactivity, less access to healthcare, and greater unemployment rates (P<0.01). Higher levels of particulate-matter pollution (4th quartile versus 1st quartile) were associated with two-fold greater odds of being a clustered county (adjusted OR: 2.10; 95%CI: 1.23-3.59).
We observed a belt of counties with high lung mortality ranging from eastern Oklahoma through central Appalachia; these counties were characterized by higher pollution, a more rural population, lower socioeconomic status and poorer access to healthcare. To mitigate the burden of lung cancer mortality in the US, both urban and rural areas should consider minimizing air pollution.
本研究的目的是确定美国肺癌死亡率高的县，并在关注颗粒物污染的同时，描述相关的社区层面因素。
我们对2004年至2014年美国的肺癌死亡情况进行了描述性分析。我们使用新颖的地理空间自相关方法，根据各县肺癌死亡率是否高，将其分为“聚集型”或“非聚集型”。我们对比了不同聚集类别之间的社区特征。我们对聚集类别与颗粒物污染之间的关联进行了逻辑回归分析。
在被归类为聚集型的362个县（占11.6%）中，年龄调整后的肺癌死亡率为每10万人99.70例死亡（95%置信区间：99.1 - 100.3）。与非聚集型县相比，聚集型县更可能位于南部（72.9%对42.1%，P<0.01）和非城市社区（73.2%对57.4，P<0.01）。聚集型县的颗粒物污染更严重，教育和收入水平更低，肥胖和身体不活动率更高，获得医疗保健的机会更少，失业率更高（P<0.01）。颗粒物污染水平较高（第四四分位数与第一四分位数相比）与成为聚集型县的可能性高出两倍相关（调整后的比值比：2.10；95%置信区间：1.23 - 3.59）。
我们观察到一条从俄克拉荷马州东部到阿巴拉契亚中部肺癌死亡率高的县带；这些县的特点是污染更严重、农村人口更多、社会经济地位更低以及获得医疗保健的机会更差。为减轻美国肺癌死亡负担，城市和农村地区都应考虑尽量减少空气污染。
