Lung cancer mortality risk and its risk factors in Heilongjiang province: a Bayesian spatio-temporal modeling analysis
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摘要:
目的 了解黑龙江省肺癌死亡的时空风险及其影响因素,为肺癌的预防控制提供参考依据。 方法 收集黑龙江省2008 — 2017年肺癌死亡数据,利用基于集成嵌套拉普拉斯逼近(INLA)的贝叶斯时空模型估计黑龙江省肺癌标化死亡比(SMR),并分析肺癌SMR的影响因素。 结果 黑龙江省2008 — 2017年不同区县肺癌SMR时空演变模式不同,但总体肺癌死亡风险显著增长,2008年132个区县中全人口肺癌死亡高风险(RR > 1.0)区县为9个,2017年增长到69个。在全人口、男性和女性中,市级肺癌SMR多因素时空分析结果均未见 ≥ 60岁人口比例、人均年卷烟消费量(滞后20年)、PM2.5(滞后8年)、人均地区生产总值(滞后10年)、城镇采矿业就业人数比例(滞后5年)及农业人口比例(滞后20年)与黑龙江省肺癌SMR显著相关(RR值的95 % CI均包含1),但慢性阻塞性肺疾病(COPD)的年龄标化死亡率(ASMR)均与肺癌SMR呈正相关(全人口:RR = 1.10,95 % CI = 1.04~1.16;男性:RR = 1.09,95 % CI = 1.03~1.16;女性:RR = 1.10,95 % CI = 1.04~1.16)。区县级COPD的ASMR每增加1/10万,全人口肺癌SMR增加0.34 %(95 % CI = 0.22 %~0.46 %),男性SMR增加0.29 %(95 % CI = 0.19 %~0.40 %),女性SMR增加0.33 %(95 % CI = 0.20 %~0.46 %)。 结论 黑龙江省2008 — 2017年肺癌死亡风险整体上逐年增加,COPD可能是该地区肺癌死亡的重要危险因素,建议在COPD患者中开展肺癌筛查,从而有效防控肺癌。 Abstract:Objective To explore temporal-spatial distribution and risk factors of lung cancer mortality risk in Heilongjiang province, and to provide evidences for prevention and control of lung cancer. Methods We collected the data on lung cancer and chronic obstructive pulmonary disease (COPD) mortality in Heilongjiang province from 2008 through 2017 and relevant data on demographics, ambient air pollutants, social economic development were also collected simultaneously. Integrated nested Laplace approximation-based Bayesian spatio-temporal model was used to estimate annual prefecture-specific and district/county-specific standardized mortality ratio (SMR) of lung cancer and to analyze relative risks of lung cancer mortality attributed to various known risk factors. Results During the 10-year period in the province, the lung cancer mortality risk generally increased significantly, although the spatio-temporal pattern of lung cancer SMR was different in different districts/counties. From 2008 to 2017 among 132 districts/counties of the province, the number of district/county with higher lung cancer mortality risk (relative risk [RR] > 1.0 compared to overall risk of the province) increased from 9 to 69. The prefecture-specific age-standarized mortality rate (ASMR) of COPD was positively associated with the SMR of lung cancer (RR for all = 1.10, 95% confidence interval [95% CI]: 1.04 – 1.16; RR for males = 1.09, 95% CI: 1.03 – 1.16; RR for females = 1.10, 95% CI: 1.04 – 1.16). No significant associations were observed between the SMR of lung cancer and other factors including the proportion of the population over 60 years old, annual cigarette consumption per capita (lag 20 years), particulate matter ≤ 2.5 μm in mean aerodynamic diameter (lag 8 years), regional gross domestic production per capita (lag 10 years), the proportion of employed population in urban mining industry (lag 5 years) and the proportion of agricultural population (lag 20 years). A 1/100 000 increment in ASMR of COPD was associated with a 0.34% (95% CI = 0.22% – 0.46%) increase in district/county-specific SMR of lung cancer for all population; while for male and female population, the increase were 0.29% (95% CI: 0.19% – 0.40%) and 0.33% (95% CI: 0.20% – 0.46%), respectively. Conclusion The overall risk of lung cancer mortality was significantly increased from 2008 to 2017 in Heilongjiang province and COPD may be an important risk factor for the mortality. The results suggest that lung cancer screening should be carried out in COPD patients for effective prevention and control of lung cancer mortality. -
Key words:
- lung cancer /
- mortality risk /
- risk factor /
- Bayesian spatio-temporal model
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表 1 贝叶斯时空模型
模型 公式 时空交互作用项 A $\log{\theta }_{it}=\alpha + {\mu }_{i} + {\nu }_{i} + \left(\beta + {\delta }_{i}\right)×t$ ${\delta }_{i}×t$ B $ \log{\theta }_{it}=\alpha + {\mu }_{i} + {\nu }_{i} + {\gamma }_{t} + {\phi }_{t} $ C $ \log{\theta }_{it}=\alpha + {\mu }_{i} + {\nu }_{i} + {\gamma }_{t} + {\phi }_{t} + {\delta }_{it} $ $ {{\delta }_{it}: \nu }_{i} \otimes {\phi }_{t} $ D $ \log{\theta }_{it}=\alpha + {\mu }_{i} + {\nu }_{i} + {\gamma }_{t} + {\phi }_{t} + {\delta }_{it} $ $ {\delta }_{it}:{\nu }_{i} \otimes {\gamma }_{t} $ E $ \log{\theta }_{it}=\alpha + {\mu }_{i} + {\nu }_{i} + {\gamma }_{t} + {\phi }_{t} + {\delta }_{it} $ $ {{\delta }_{it}: \mu }_{i} \otimes {\phi }_{t} $ F $ \log{\theta }_{it}=\alpha + {\mu }_{i} + {\nu }_{i} + {\gamma }_{t} + {\phi }_{t} + {\delta }_{it} $ $ {{\delta }_{it}: \mu }_{i} \otimes {\gamma }_{t} $ 表 2 黑龙江省2008 — 2017年区县级肺癌SMR全局Moran′s I指数
年份 全人口 男性 女性 Moran′s I 值 P 值 Moran′s I 值 P 值 Moran′s I 值 P 值 2008 0.156 0.002 0.137 0.005 0.168 0.001 2009 0.161 0.003 0.154 0.002 0.112 0.016 2010 0.119 0.011 0.110 0.016 0.129 0.007 2011 0.174 0.001 0.166 0.001 0.133 0.006 2012 0.137 0.004 0.117 0.010 0.142 0.003 2013 0.037 0.193 0.016 0.329 0.034 0.214 2014 0.234 < 0.001 0.231 < 0.001 0.189 < 0.001 2015 0.054 0.133 – 0.068 0.863 0.227 < 0.001 2016 0.042 0.187 0.014 0.352 0.037 0.213 2017 0.174 < 0.001 0.145 0.003 0.150 0.002 表 3 黑龙江省区县级全人口肺癌SMR时空分析模型评价指标
模型 $ \bar{D} $ pD DIC DICc WAIC LS A 16608 250 16858 16937 18303 9232 B 19457 138 19595 19611 20569 10236 C 9909 1120 11029 25119 10847 6254 D 9863 968 10831 15903 10700 5897 E 9992 1111 11103 25427 10995 6367 F 9943 968 10911 16335 10841 6007 注:$ \bar{D} $表示偏差后验均值之和,用于度量模型拟合度;pD表示有效参数个数,用于度量模型复杂度。 表 4 黑龙江省市级肺癌SMR影响因素单因素分析
因素 全人口 男性 女性 RR 值 95 % CI RR 值 95 % CI RR 值 95 % CI COPD的ASMR(1/10万) 1.0078 1.0035~1.0120 1.0074 1.0028~1.0120 1.0076 1.0033~1.0119 ≥ 60岁人口比例(%) 1.0113 0.9842~1.0389 1.0119 0.9825~1.0419 1.0100 0.9813~1.0394 农业人口比例(滞后20年,%) 1.0003 0.9985~1.0021 0.9998 0.9979~1.0017 1.0008 0.9988~1.0028 人均年卷烟消费量(滞后20年,支) 1.0000 0.9998~1.0002 1.0000 0.9998~1.0002 1.0000 0.9998~1.0003 人均地区生产总值(滞后10年,元) 1.0000 1.0000~1.0000 1.0000 1.0000~1.0000 1.0000 1.0000~1.0000 城镇采矿业就业人数比例(滞后5年,%) 0.9991 0.9967~1.0014 0.9992 0.9967~1.0018 0.9988 0.9962~1.0014 PM2.5(滞后8年,μg/m3) 1.0039 0.9949~1.0130 1.0033 0.9938~1.0126 1.0053 0.9953~1.0155 PM10(μg/m3) 1.0007 0.9976~1.0039 1.0005 0.9971~1.0040 1.0007 0.9973~1.0041 人均公共绿地面积(滞后7年,m2) 0.9995 0.9917~1.0072 1.0025 0.9938~1.0114 0.9966 0.9873~1.0059 城市燃气普及率(滞后7年,%) 0.9999 0.9984~1.0015 1.0004 0.9987~1.0022 0.9994 0.9976~1.0012 表 5 黑龙江省市级肺癌SMR影响因素多因素分析(模型D)a
因素 全人口 男性 女性 RR 值 95 % CI RR 值 95 % CI RR 值 95 % CI COPD的ASMR(1/10万) 1.0992 1.0408~1.1601 1.0934 1.0296~1.1599 1.0983 1.0394~1.1590 ≥ 60岁人口比例(%) 1.0168 0.9362~1.1050 1.0263 0.9367~1.1249 1.0005 0.9152~1.0951 农业人口比例(滞后20年,%) 1.0033 0.9667~1.0418 0.9952 0.9566~1.0361 1.0074 0.9670~1.0502 人均年卷烟消费量(滞后20年,支) 1.0004 0.9366~1.0689 0.9996 0.9303~1.0743 1.0018 0.9345~1.0747 人均地区生产总值(滞后10年,元) 0.9959 0.9327~1.0638 0.9874 0.9204~1.0599 1.0055 0.9411~1.0749 城镇采矿业就业人数比例(滞后5年,%) 0.9887 0.9471~1.0320 0.9897 0.9444~1.0371 0.9850 0.9401~1.0316 PM2.5(滞后8年,μg/m3) 1.0224 0.9769~1.0716 1.0147 0.9681~1.0642 1.0328 0.9807~1.0910 注:a 采用模型D进行多因素分析时,对COPD标化死亡率、≥ 60岁人口比例、农业人口比例(滞后20年)、人均年卷烟消费量(滞后20年)、人均地区生产总值(滞后10年)、城镇采矿业就业人数比例(滞后5年)、PM2.5(滞后8年)等7个变量进行了标准化处理,以比较不同变量的RR值大小。 -
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