Song Insang, Yoo Eun-Hye, Jung Inkyung, Oh Jin-Kyoung, Kim Sun-Young
Department of Geography, University of Oregon, Eugene, OR, 97403, USA.
Department of Geography, The State University of New York at Buffalo, NY, 14261, USA.
Environ Res. 2023 Nov 1;236(Pt 2):116841. doi: 10.1016/j.envres.2023.116841. Epub 2023 Aug 6.
Identification of high-risk areas of cancer, referred to as spatial clusters, can inform targeted policies for cancer control. Although cancer cluster detection could be affected by various geographic characteristics including sociodemographic and environmental factors which impacts could also vary over time, studies accounting for such influence remain limited. This study aims to assess the role of geographic characteristics in the spatial cluster detection for lung and stomach cancer over an extended period.
We obtained sex-specific age-standardized incidence and mortality rates of lung and stomach cancer as well as geographic characteristics across 233 districts in South Korea for three five-year periods between 1999 and 2013. We classified geographic characteristics of each district into four categories: demography, socioeconomic status, behaviors, and physical environments. Specifically, we quantified physical environments using measures of greenness, concentrations of particulate matter and nitrogen dioxide, and air pollution emissions. Finally, we conducted cluster detection analyses using weighted normal spatial scan statistics with the residuals from multiple regression analyses performed with the four progressive sets of geographic attributes.
We found that the size of clusters reduced as we progressively adjusted for geographic covariates. Among the four categories, physical environments had the greatest impact on the reduction or disappearance of clusters particularly for lung cancer consistently over time. Whereas older population affected a decrease of lung cancer clusters in the early period, the contribution of education was large in the recent period. The impact was less clear in stomach cancer than lung cancer.
Our findings highlight the importance of geographic characteristics in explaining the existing cancer clusters and identifying new clusters, which jointly provides practical guidance to cancer control.
识别癌症的高风险区域，即空间聚集区，可为癌症控制的针对性政策提供依据。尽管癌症聚集区检测可能会受到各种地理特征的影响，包括社会人口统计学和环境因素，而且这些因素的影响也可能随时间变化，但考虑到这种影响的研究仍然有限。本研究旨在评估地理特征在长期肺癌和胃癌空间聚集区检测中的作用。
我们获取了1999年至2013年期间韩国233个地区肺癌和胃癌按性别和年龄标准化的发病率和死亡率以及地理特征，涵盖三个五年期。我们将每个地区的地理特征分为四类：人口统计学、社会经济地位、行为和物理环境。具体而言，我们使用绿化程度、颗粒物和二氧化氮浓度以及空气污染排放指标来量化物理环境。最后，我们使用加权正态空间扫描统计方法进行聚集区检测分析，该方法基于对四组递进的地理属性进行多元回归分析得到的残差。
我们发现，随着逐步对地理协变量进行调整，聚集区的规模会减小。在这四类中，物理环境对聚集区的减少或消失影响最大，尤其是对肺癌而言，这种影响在不同时期一直存在。虽然老年人口在早期影响了肺癌聚集区数量的减少，但近期教育的作用很大。胃癌的情况不如肺癌那么明显。
我们的研究结果突出了地理特征在解释现有癌症聚集区和识别新聚集区方面的重要性，这共同为癌症控制提供了实际指导。
