Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
Veterinary Epidemiology Division, Animal and Plant Quarantine Agency, 177, Hyeoksin 8-ro, Gimcheon-si, 39660, Gyeongsangbuk-do, Republic of Korea.
BMC Public Health. 2021 Nov 14;21(1):2090. doi: 10.1186/s12889-021-12184-8.
There have been reports on regional variation in prevalence of hepatitis B and C, and Clonorchis sinensis (C. sinensis) infection, which indicates potential of spatial variation in liver cancer and gallbladder cancer incidence in Korea. Therefore, we aimed to assess the regional variation of liver and gallbladder cancer incidence and its determinants based on the regional distribution of risk factors, including hepatitis B infection in Korea.
This study used an ecological study design and district-level cancer incidence statistics generated by the National Cancer Center. Spatial clusters of liver and gallbladder cancer incidence were detected based on spatial scan statistics using SaTScan™ software. We set the size of maximum spatial scanning window of 25 and 35% of the population at risk for analyses of liver and gallbladder cancer, respectively. Significance level of 0.05 was used to reject the null hypothesis of no cluster. We fitted the Besag-York-Mollie model using integrated nested Laplace approximations to assess factors that influence the regional variation in cancer incidence.
Spatial clusters with high liver cancer incidence rates were detected in the southwestern and southeastern regions of Korea. High gallbladder cancer incidence rates are clustered in the southeastern region. Regional liver cancer incidence can be accounted for the prevalence of high household income (coefficient, - 0.10; 95% credible interval [CI], - 0.18 to - 0.02), marital status (coefficient, - 0.14; 95% CI, - 0.25 to - 0.03), the incidence of hepatitis B (coefficient, 0.87; 95% CI, 0.29 to 1.44), and liver cancer screening (coefficient, 0.06; 95% CI, 0.00 to 0.12), while gallbladder cancer incidence was related to the prevalence of high household income (coefficient, - 0.03; 95% CI, - 0.05 to 0.00) and living close to a river with a high prevalence of liver fluke infection (coefficient, 0.55; 95% CI, 0.14 to 0.96).
This study demonstrated geographic variation in liver and gallbladder cancer incidence, which can be explained by determinants such as hepatitis B, income, marital status, and living near a river.
已有报告显示，乙型肝炎和丙型肝炎以及华支睾吸虫（C. sinensis）感染的流行存在地域差异，这表明韩国肝癌和胆囊癌的发病率存在潜在的地域差异。因此，我们旨在评估基于韩国乙型肝炎感染等危险因素的地域分布，评估肝癌和胆囊癌发病率的地域变化及其决定因素。
本研究采用生态研究设计和国家癌症中心生成的区县级癌症发病率统计数据。基于 SaTScan™软件的空间扫描统计，检测肝癌和胆囊癌发病率的空间聚类。我们分别将肝脏和胆囊癌分析的最大空间扫描窗大小设置为 25%和 35%的人口。采用贝叶斯-约克-莫利模型，采用集成嵌套拉普拉斯近似法评估影响癌症发病率地域变化的因素。
在韩国的西南部和东南部地区检测到肝癌发病率较高的空间聚类。胆囊癌发病率较高的地区呈聚集性分布在东南部地区。区域肝癌发病率可归因于高家庭收入（系数，-0.10；95%可信区间[CI]，-0.18 至-0.02）、婚姻状况（系数，-0.14；95% CI，-0.25 至-0.03）、乙型肝炎发病率（系数，0.87；95% CI，0.29 至 1.44）和肝癌筛查（系数，0.06；95% CI，0.00 至 0.12），而胆囊癌发病率与高家庭收入（系数，-0.03；95% CI，-0.05 至 0.00）和居住在河流附近且肝吸虫感染率高（系数，0.55；95% CI，0.14 至 0.96）有关。
本研究表明，肝癌和胆囊癌的发病率存在地域差异，这可以通过乙型肝炎、收入、婚姻状况和居住在河流附近等决定因素来解释。
