Kou Kou, Guo Xiaolei, Baade Peter, Lu Zilong, Fu Zhentao, Chu Jie, Xu Aiqiang, Sun Jiandong
Faculty of Health, Queensland University of Technology, Brisbane, Australia. Email:
Asian Pac J Cancer Prev. 2018 Nov 29;19(11):3161-3166. doi: 10.31557/APJCP.2018.19.11.3161.
Purpose: Almost half of the global esophageal cancer (EC) deaths occurred in China. This study aims to examine the geographic spread of EC mortality in two periods in a large Chinese population. Methods: Age-standardized mortality rates (ASMRs) for 140 county-level units in Shandong Province during the periods 1970-74 and 2011-13 were derived using data from the First National Cause-of-Death Survey and the Shandong Death Registration System, respectively. ASMRs were smoothed using Area-to-Area Poisson kriging technique. Spatial scan statistics were used to detect spatial clusters with higher EC mortality and clusters with greater temporal changes in EC mortality. Results: The provincial average ASMR decreased from 13.0 per 100,000 in 1970-74 to 5.8 in 2010-13. Almost all counties or districts have experienced a decrease in EC mortality, while the reduction was particularly pronounced in the mid-west region. This study has identified a geographical cluster with much higher EC mortality rates and the clustering pattern has largely unchanged over the past 40 years. Residents living in the cluster during 1970-74 were 2.7 (95% CI: 2.2-3.4) times more likely to die from EC than the rest of the province. The corresponding risk ratio for the 2011-13 cluster was 3.7 (95% CI: 2.8-5.0). Conclusions: This study detected a geographically defined subpopulation in Shandong, China with much higher risk of dying from EC. This spatial pattern has been consistent over the past few decades. The results suggest the key drives for geographic variations in esophageal cancer may not have changed.
全球近一半的食管癌死亡病例发生在中国。本研究旨在探讨中国一大群人在两个时期内食管癌死亡率的地理分布情况。方法：分别利用第一次全国死因调查和山东省死亡登记系统的数据，得出山东省140个县级单位在1970 - 1974年和2011 - 2013年期间的年龄标准化死亡率（ASMR）。采用区域到区域的泊松克里金技术对ASMR进行平滑处理。空间扫描统计用于检测食管癌死亡率较高的空间聚集区以及食管癌死亡率有较大时间变化的聚集区。结果：全省平均ASMR从1970 - 1974年的每10万人13.0降至2010 - 2013年的5.8。几乎所有县或区的食管癌死亡率都有所下降，而中西部地区的下降尤为明显。本研究确定了一个食管癌死亡率高得多的地理聚集区，并且在过去40年中聚集模式基本未变。1970 - 1974年居住在该聚集区的居民死于食管癌的可能性是该省其他地区居民的2.7倍（95%可信区间：2.2 - 3.4）。2011 - 2013年聚集区的相应风险比为3.7（95%可信区间：2.8 - 5.0）。结论：本研究在中国山东省发现了一个地理上界定的亚人群，其死于食管癌的风险要高得多。这种空间模式在过去几十年中一直保持一致。结果表明食管癌地理差异的关键驱动因素可能没有改变。
