Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.
Int J Cancer. 2023 Nov 15;153(10):1746-1757. doi: 10.1002/ijc.34657. Epub 2023 Jul 24.
Space-time analysis of mortality risk is useful to evaluate the epidemiologic transitions at the subnational level. In our study, we analysed the death certificate records for lung cancer in Italy in 1995-2016, obtained from the Italian National Institute of Statistics. Our objective was to investigate the spatial-temporal evolution of lung cancer mortality by sex and province of residence (n = 107) using the birth cohort as relevant time axis. We built Bayesian space-time models with space-time interactions. Among males (n = 554 829), mortality peaked in the 1920-1929 cohort, followed by a generalised decline. Among females (n = 158 619), we found novel original evidence for a peak in the 1955-1964 cohort, equivalent to a 35-year delay, with a downward trend being observed thereafter. Over time, the documented north-south decreasing mortality gradient has been replaced by a west-east decreasing gradient. Naples has become the province at highest risk in Italy, both among males and females. This pattern is consistent with an epidemiologic transition of risk factors for lung cancer to the south-west of the country and raises concern, because 5-year age-standardised net survival from the disease in this geographic area is lower than in northern and central Italy. The variability of mortality rates among provinces has changed over time, with an increasing homogeneity for males and an opposite trend for females in the more recent birth cohorts. These unprecedented observations provide evidence for a profound spatio-temporal transition of lung cancer mortality in Italy.
时空分析对于评估国家以下层面的流行病学转变非常有用。在本研究中，我们分析了意大利国家统计局 1995-2016 年的肺癌死亡证明记录。我们的目的是通过出生队列作为相关时间轴，调查意大利男性（n=554829）和女性（n=158619）肺癌死亡率的时空演变。我们构建了具有时空相互作用的贝叶斯时空模型。在男性中（n=554829），死亡率在 1920-1929 队列中达到峰值，随后普遍下降。在女性中（n=158619），我们发现了一个新的原始证据，表明 1955-1964 队列的死亡率达到峰值，相当于 35 年的延迟，此后呈下降趋势。随着时间的推移，记录的南北死亡率逐渐降低的梯度已被东西逐渐降低的梯度所取代。那不勒斯已成为意大利男性和女性中风险最高的省份。这种模式与肺癌危险因素向该国西南部的流行病学转变一致，并令人担忧，因为在该地理区域，这种疾病的 5 年年龄标准化净生存率低于意大利北部和中部。各省份死亡率的可变性随时间发生了变化，男性的同质性增加，而在最近的出生队列中女性的趋势则相反。这些前所未有的观察结果为意大利肺癌死亡率的深刻时空转变提供了证据。
