Brain cancer mortality in the United States, 1986 to 1995: A geographic analysis
Brain cancer mortality in the United States, 1986 to 1995: A geographic analysis
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DOI：
10.1215/s1152851703000450
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发表时间：
2004-07-01
期刊：
影响因子：
15.9
通讯作者：
Gregorio, DI
中科院分区：
文献类型：
--
作者：
Fang, ZX;Kulldorff, M;Gregorio, DI
美国癌症死亡率地图集，1950-94（Devesa等人）美国国立卫生研究院1999年发表的一项研究表明，在美国西北部、中北部和东南部地区，脑癌和其他神经系统癌症的发病率较高。该地图集是描述性的，不评估观察到的模式是否仅仅是由于随机变化，或者它们是否反映了疾病风险或治疗做法的真正地理差异。为了正式测试疾病的地理聚集性，我们分析了1986年至1995年美国脑癌死亡率数据，使用Tango的超额事件检验，Cuzick-Edwards k-最近邻检验和空间扫描统计。所有测试都显示，成年男子和妇女的地理聚集具有统计学意义。空间扫描统计数据表明，女性最可能的高死亡率聚集在阿肯色州、密西西比和俄克拉荷马州的部分地区（相对危险度[RR] = 1.22，P < 0.0001），男性最可能的高死亡率聚集在田纳西州和肯塔基州的部分地区（RR = 1.15，P < 0.0001）。检测到几个次级簇，但没有非常局部化和高RR的统计学显著簇。对于儿童脑癌，没有统计学意义的地理集群。令人欣慰的是，没有发现地区性脑癌死亡率非常高的“热点”，虽然发病率不高的大地理集群的原因尚不清楚，脑癌死亡率的地理模式提供了有价值的信息，可以帮助制定病因假设和针对高危人群进行进一步的流行病学和卫生服务研究。
The Atlas of Cancer Mortality in the United States, 1950-94 (Devesa et al.) published in 1999 by the National Institutes of Health suggests that there are elevated rates of brain and other nervous system cancer in the northwestern, north central, and southeastern parts of the country. Being descriptive in nature, the atlas does not evaluate whether observed patterns are simply due to random variation or if they are reflective of true geographical differences in disease risk or treatment practices. To formally test for geographical clustering of disease, we analyzed U.S. brain cancer mortality data from 1986 to 1995 with Tango's Excess Events test, the Cuzick-Edwards k-Nearest-Neighbors test, and the spatial scan statistic. All tests revealed statistically significant geographical clustering for both adult men and women. The spatial scan statistic indicated that the most likely cluster of high mortality was in parts of Arkansas, Mississippi, and Oklahoma (relative risk [RR] = 1.22, P < 0.0001) for women and in parts of Tennessee and Kentucky (RR = 1.15, P < 0.0001) for men. Several secondary clusters were detected, but there were no statistically significant clusters of a very localized nature and a high RR. For childhood brain cancer, there were no statistically significant geographical clusters. It is reassuring that no local brain cancer mortality "hot spots" with very high RRs were found. While the causes of the large geographical clusters with modest RRs are unclear, the geographical pattern of brain cancer mortality provides valuable information that can help in formulating etiological hypotheses and in targeting high-risk populations for further epidemiological and health services research.