Geographical, temporal and racial disparities in late-stage prostate cancer incidence across Florida: a multiscale joinpoint regression analysis.
Geographical, temporal and racial disparities in late-stage prostate cancer incidence across Florida: a multiscale joinpoint regression analysis.
复制标题
DOI：
10.1186/1476-072x-10-63
复制
发表时间：
2011-12-05
影响因子：
4.9
通讯作者：
Xiao H
中科院分区：
文献类型：
--
作者：
Goovaerts P;Xiao H
尽管与前列腺癌相关的发病率和死亡率最近有所下降，但在美国仍然存在显著的种族/民族差异。可视化和模型化前列腺癌晚期发病率的时间趋势，以及它们如何随地理位置和种族而变化，应该有助于解释这种差异。连接点回归越来越多地被用来确定健康结果时间序列的变化时间和程度。然而，大多数对时间趋势的分析是空间的，并在国家层面上进行，或者针对单一的癌症登记进行。对佛罗里达州每个县的非西班牙裔白人和非西班牙裔黑人前列腺癌晚期病例的年度比例时间序列(1981-2007)进行了分析。数据中的噪声首先用二项克立格法过滤，结果用连接点回归进行建模。在州一级以及大城市和非大城市县的群体中也进行了类似的分析。通过时间趋势的平行度和重合度检验，发现了显著的种族差异。引入了一种新的差异统计方法来衡量种族差异频率的空间和时间变化。自1981年以来，国家级晚期诊断百分比下降了50%；90年代S引入前列腺特异性抗原(PSA)筛查后，这一下降速度加快。在大都市和非大都市层面的分析显示，最近城市地区晚期诊断的频率增加，这一趋势对白人男性来说意义重大。晚期诊断的年下降速度和显着下降的发病年份在不同的县和种族群体之间差异很大。大多数年平均百分比变化(AAPC)不显著的县位于佛罗里达州白人男性的狭长地带，而他们聚集在佛罗里达州东南部黑人男性的狭长地带。新的差异统计表明，种族差异的空间范围在1990年达到顶峰，因为黑人男性被观察到的晚期诊断的频率早期下降。在空间框架之外分析癌症发病率和死亡率的时间趋势并不令人满意，因为这会导致人们忽视重大的地理差异，这可能会对各种干预措施的影响产生新的见解。在佛罗里达州观察到的嵌套地理区域之间的差异表明，可修改的面积单位问题(MAUP)也影响了时间变化的分析。
Although prostate cancer-related incidence and mortality have declined recently, striking racial/ethnic differences persist in the United States. Visualizing and modelling temporal trends of prostate cancer late-stage incidence, and how they vary according to geographic locations and race, should help explaining such disparities. Joinpoint regression is increasingly used to identify the timing and extent of changes in time series of health outcomes. Yet, most analyses of temporal trends are aspatial and conducted at the national level or for a single cancer registry. Time series (1981-2007) of annual proportions of prostate cancer late-stage cases were analyzed for non-Hispanic Whites and non-Hispanic Blacks in each county of Florida. Noise in the data was first filtered by binomial kriging and results were modelled using joinpoint regression. A similar analysis was also conducted at the state level and for groups of metropolitan and non-metropolitan counties. Significant racial differences were detected using tests of parallelism and coincidence of time trends. A new disparity statistic was introduced to measure spatial and temporal changes in the frequency of racial disparities. State-level percentage of late-stage diagnosis decreased 50% since 1981; a decline that accelerated in the 90's when Prostate Specific Antigen (PSA) screening was introduced. Analysis at the metropolitan and non-metropolitan levels revealed that the frequency of late-stage diagnosis increased recently in urban areas, and this trend was significant for white males. The annual rate of decrease in late-stage diagnosis and the onset years for significant declines varied greatly among counties and racial groups. Most counties with non-significant average annual percent change (AAPC) were located in the Florida Panhandle for white males, whereas they clustered in South-eastern Florida for black males. The new disparity statistic indicated that the spatial extent of racial disparities reached a peak in 1990 because of an early decline in frequency of late-stage diagnosis observed for black males. Analyzing temporal trends in cancer incidence and mortality rates outside a spatial framework is unsatisfactory, since it leads one to overlook significant geographical variation which can potentially generate new insights about the impact of various interventions. Differences observed among nested geographies in Florida show how the modifiable areal unit problem (MAUP) also impacts the analysis of temporal changes.