Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35131 Padova, Italy.
Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Int J Environ Res Public Health. 2022 Mar 15;19(6):3467. doi: 10.3390/ijerph19063467.
Asbestos exposure is a recognized risk factor for ovarian cancer and malignant mesothelioma. There are reports in the literature of geographical ecological associations between the occurrence of these two diseases. Our aim was to further explore this association by applying advanced Bayesian techniques to a large population (10 million people).
We specified a series of Bayesian hierarchical shared models to the bivariate spatial distribution of ovarian and pleural cancer mortality by municipality in the Lombardy Region (Italy) in 2000-2018.
Pleural cancer showed a strongly clustered spatial distribution, while ovarian cancer showed a less structured spatial pattern. The most supported Bayesian models by predictive accuracy (widely applicable or Watanabe-Akaike information criterion, ) provided evidence of a shared component between the two diseases. Among five municipalities with significant high standardized mortality ratios of ovarian cancer, three also had high pleural cancer rates. Wide uncertainty was present when addressing the risk of ovarian cancer associated with pleural cancer in areas at low background risk of ovarian cancer.
We found evidence of a shared risk factor between ovarian and pleural cancer at the small geographical level. The impact of the shared risk factor can be relevant and can go unnoticed when the prevalence of other risk factors for ovarian cancer is low. Bayesian modelling provides useful information to tailor epidemiological surveillance.
石棉暴露是卵巢癌和恶性间皮瘤的公认危险因素。文献中有关于这两种疾病在地理生态方面存在关联的报道。我们的目的是通过应用先进的贝叶斯技术对 1000 万人的大人群进行研究，进一步探讨这种关联。
我们针对 2000-2018 年意大利伦巴第地区（意大利）各市政当局卵巢癌和胸膜癌死亡率的双变量空间分布，指定了一系列贝叶斯分层共享模型。
胸膜癌的空间分布呈现出强烈的聚类特征，而卵巢癌的空间分布模式则不太规则。预测准确性最高的（广泛适用或 Watanabe-Akaike 信息准则）贝叶斯模型提供了两种疾病之间存在共享成分的证据。在五个卵巢癌标准化死亡率比值显著较高的市政当局中，有三个也有较高的胸膜癌发病率。在卵巢癌低背景风险地区，胸膜癌相关的卵巢癌风险存在广泛的不确定性。
我们在小地理水平上发现了卵巢癌和胸膜癌之间存在共同风险因素的证据。当卵巢癌的其他风险因素的流行率较低时，这种共同风险因素的影响可能是相关的，而且可能会被忽视。贝叶斯模型为量身定制流行病学监测提供了有用的信息。
