采用贝叶斯分析方法，确定与早发性结直肠癌患者生存相关的县级生态因素。
Using a Bayesian analytic approach to identify county-level ecological factors associated with survival among individuals with early-onset colorectal cancer.
机构信息
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America.
Division of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America.
出版信息
PLoS One. 2024 Oct 29;19(10):e0311540. doi: 10.1371/journal.pone.0311540. eCollection 2024.
BACKGROUND
In the United States (US), incidence of early age of onset colorectal cancer (EOCRC, diagnosed <50 years of age) has been increasing. Using a Bayesian analytic approach, we evaluated the association between county-level ecological factors and survival among individuals with EOCRC and identified hotspot and coldspot counties with unexplained low and high survival, respectively.
METHODS
Principal component (PC) analysis was used to reduce dimensionality of 36 county-level social, behavioral, and preventive factors from the Centers for Disease Control and Prevention data. Survival information was derived from the Surveillance, Epidemiology, and End Results Program data from January 1, 2000 to December 31, 2019. The association between the identified PCs and survival was evaluated using multivariable spatial generalized linear mixed models. Counties with residual low and high survival (i.e., unexplained by the PCs) were classified as hotspots and coldspots, respectively.
RESULTS
Four PCs were used to explain the spatial variability in 5-year survival among 75,215 individuals with EOCRC: PC1) poverty, chronic disease, health risk behaviors (β = -0.03, 95% credible interval (CrI): -0.04, -0.03); PC2) younger age, chronic disease-free, minority status (β = -0.01, 95% CrI: -0.02, 0.00); PC3) urban environment, preventive services (β = 0.02, 95% CrI: 0.00, 0.03); and PC4) older age (-0.04, 95% CrI: -0.06, -0.02). Among individuals with distant malignancies, the residual spatial variability remained high for two US counties: 1) Salt Lake County, UT residents experiencing 26.5% (95% CrI: 1.5%, 47.8%) lower odds of survival [hotspot], and 2) Riverside County, CA residents experiencing 37% (95% CrI: 7.97%, 78.8%) higher odds survival [coldspot] after adjustment for county-level factors.
CONCLUSIONS
County-level ecological factors are strongly associated with survival among individuals with EOCRC. Yet there is some evidence of survival disparities among individuals with distant malignancies that remain unexplained by the included factors.
背景
在美国，早发性结直肠癌（EOCRC，诊断年龄<50 岁）的发病率一直在上升。本研究采用贝叶斯分析方法，评估了县一级生态因素与 EOCRC 患者生存之间的关系，并确定了生存解释水平低和高的热点和冷点县。
方法
采用主成分（PC）分析方法，对来自疾病控制与预防中心的数据中 36 项县一级社会、行为和预防因素进行降维处理。生存信息来自 2000 年 1 月 1 日至 2019 年 12 月 31 日的监测、流行病学和最终结果计划数据。采用多变量空间广义线性混合模型评估确定的 PCs 与生存之间的关系。将剩余生存解释水平低和高（即无法用 PCs 解释）的县分别归类为热点和冷点。
结果
使用 4 个 PCs 解释了 75215 例 EOCRC 患者 5 年生存率的空间变异性：PC1）贫困、慢性病、健康风险行为（β=-0.03，95%可信区间（CrI）：-0.04，-0.03）；PC2）年轻、无慢性病、少数民族（β=-0.01，95% CrI：-0.02，0.00）；PC3）城市环境、预防服务（β=0.02，95% CrI：0.00，0.03）；和 PC4）年龄较大（β=-0.04，95% CrI：-0.06，-0.02）。在远处恶性肿瘤患者中，美国两个县的剩余空间变异性仍然很高：1）犹他州盐湖县居民的生存率降低了 26.5%（95% CrI：1.5%，47.8%）[热点]，2）加利福尼亚州河滨县居民的生存率升高了 37%（95% CrI：7.97%，78.8%）[冷点]，这是在调整县一级因素后得出的结果。
结论
县一级生态因素与 EOCRC 患者的生存密切相关。然而，远处恶性肿瘤患者的生存存在一定差异，这些差异无法用纳入的因素来解释。
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