Spatial clustering of endemic Burkitt's lymphoma in high-risk regions of Kenya
Spatial clustering of endemic Burkitt's lymphoma in high-risk regions of Kenya
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DOI：
10.1002/ijc.22179
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发表时间：
2007-01-01
影响因子：
6.4
通讯作者：
Wilson, Mark L.
中科院分区：
文献类型：
--
作者：
Rainey, Jeanette J.;Omenah, Dorine;Wilson, Mark L.
地方性伯基特淋巴瘤（eBL）是撒哈拉以南非洲最常见的儿童癌症，在肯尼亚西部发病率很高，该地区也经历了全地方性疟疾。全地流行疟疾已被确定为这种癌症的病因学的辅助因素。我们推测，eBL可能在空间上集群在这个区域内。我们回顾了1999年至2004年在尼扬扎省总医院诊断的所有eBL病例的病历，以了解病例的居住信息，从而检验这一假设。两个集群检测方法，Anselin的本地Moran空间自相关性和空间扫描检验统计量的测试，适用于此住宅数据，以确定是否有统计学意义的高风险和低风险地区存在于该省。在为期6年的研究期间，有272名儿童被诊断患有eBL，平均年发病率为每10万儿童2.15例。使用经验贝叶斯平滑率，局部Moran检验确定了1个低eBL风险的大多中心区域（p值<0.01）和2个高eBL风险的显著多中心集群（p值<0.001）。空间扫描检测到3个小的独立低风险区域（p值<0.02）和2个高风险集群（p值= 0.001），两者在位置上与从局部Moran分析中识别的那些相似。在疟疾高传播地区，EBL风险升高的显著空间聚集性和疟疾不常见地区发病率降低的显著空间聚集性表明，疟疾在复杂的EBL病因学中起作用，但也可能涉及其他因素。(c)2006 Wiley-Liss，Inc.
Endemic Burkitt's lymphoma (eBL), the most common childhood cancer in sub-Saharan Africa, occurs at a high incidence in western Kenya, a region that also experiences holoendemic malaria. Holoendemic malaria has been identified as a co-factor in the etiology of this cancer. We hypothesized that eBL may cluster spatially within this region. Medical records for all eBL cases diagnosed from 1999 through 2004 at Nyanza Provincial General Hospital were reviewed for case residential information to examine this hypothesis. Two cluster detection methods, Anselin's Local Moran test for spatial autocorrelation and a spatial scan test statistic, were applied to this residential data to determine whether statistically significant high- and low-risk areas were present in the Province. During the 6-year study period, 272 children were diagnosed with eBL, with an average annual incidence of 2.15 cases per 100,000 children. Using Empirical Bayes smoothed rates, the Local Moran test identified I large multi-centered area of low eBL risk (p-values < 0.01) and 2 significant multi-centered clusters of high eBL risk (p-values < 0.001). The spatial scan detected 3 small independent low-risk areas (p-values < 0.02) and 2 high-risk clusters (p-values = 0.001), both similar in location to those identified from the Local Moran analysis. Significant spatial clustering of elevated eBL risk in high-malaria transmission regions and of reduced incidence where malaria is infrequent suggests that malaria plays a role in the complex eBL etiology, but that additional factors are also likely involved. (c) 2006 Wiley-Liss, Inc.