Núñez-González Solange, Bedoya Estefania, Simancas-Racines Daniel, Gault Christopher
Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador.
SAGE Open Med. 2020 May 4;8:2050312120918285. doi: 10.1177/2050312120918285. eCollection 2020.
The aim of this study is two fold. First, it describes the temporal trends of malignant melanoma mortality from 2000 to 2016 in Ecuador. Second, it analyzes the spatial clusters of high mortality rates due to malignant melanoma in the country, from 2011 to 2016.
This is an ecological study; we included all death certificates of malignant melanoma from the National Institute of Statistics and Census database in Ecuador from 2000 to 2016. We calculated crude mortality rates and age-standardized mortality rates, all rates are expressed as deaths per 100,000 population. In order to assess the trend of malignant melanoma rates, we obtained average annual percent changes through Joinpoint regression analysis. Spatial scan statistics were used to identify high-risk clusters and the spatial autocorrelation was evaluated through a global Moran index.
In Ecuador, between 2000 and 2016, malignant melanoma caused a total of 958 deaths. Crude mortality rates increased significantly (annual percent change = 4.8%; 95% confidence interval: 2.6-7.0), the age-standardized mortality rate also increased (annual percent change: 2.9%; 95% confidence interval: 0.5-5.4). The most likely cluster included 19 cantons and the second most likely cluster included 10 cantons, located in the Highlands region. The Global Moran I index for the study period shows a positive spatial autocorrelation (0.32; p = 0.001).
Mortality due to malignant melanoma in Ecuador significantly increased over the 17-year study period; the spatial analysis and spatial autocorrelation indicates the presence of high-risk occurrence clusters in the Highlands region of the country.
本研究有两个目的。其一，描述2000年至2016年厄瓜多尔恶性黑色素瘤死亡率的时间趋势。其二，分析2011年至2016年该国恶性黑色素瘤高死亡率的空间聚集情况。
这是一项生态学研究；我们纳入了厄瓜多尔国家统计和普查数据库中2000年至2016年所有恶性黑色素瘤死亡证明。我们计算了粗死亡率和年龄标准化死亡率，所有率均以每10万人口中的死亡数表示。为了评估恶性黑色素瘤率的趋势，我们通过Joinpoint回归分析获得了平均年度百分比变化。空间扫描统计用于识别高风险聚集区，并通过全局莫兰指数评估空间自相关性。
在厄瓜多尔，2000年至2016年期间，恶性黑色素瘤共导致958人死亡。粗死亡率显著上升（年度百分比变化=4.8%；95%置信区间：2.6 - 7.0），年龄标准化死亡率也有所上升（年度百分比变化：2.9%；95%置信区间：0.5 - 5.4）。最可能的聚集区包括19个县，第二可能的聚集区包括10个县，均位于高地地区。研究期间的全局莫兰I指数显示存在正空间自相关性（0.32；p = 0.001）。
在为期17年的研究期间，厄瓜多尔恶性黑色素瘤死亡率显著上升；空间分析和空间自相关性表明该国高地地区存在高风险发病聚集区。
