PO.PS01.05 · 人群科学
2013-2022年波多黎各胃肠道癌症发病率、死亡率与社会经济地位的地理空间分析
Geospatial analysis of incidence and mortality rates of gastrointestinal cancer and socioeconomic status across Puerto Rico during 2013-2022
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摘要 Abstract
中文摘要
结直肠癌（CRC）、胃癌和胰腺癌被归类为胃肠道（GI）恶性肿瘤。总体而言，它们在波多黎各（PR）男女癌症相关死亡的前十大原因中占据一席，其中CRC是PR诊断第二多、癌症死亡原因第二的癌症。本研究考察了PR各市镇GI癌症发病率和死亡率的空间和时间变异，同时评估了社会人口学因素以及重大扰动（如2017年伊尔玛和玛丽亚飓风、随后的地震以及COVID-19大流行）在两个时期内对这些模式的作用。市镇层面的年龄调整发病率（AAIR）和年龄调整死亡率（AAMR）取自PR中央癌症登记处的2013-2017年和2018-2022年数据。社会人口学数据来自美国社区调查。采用全局Moran指数（I）评估全局空间自相关，并通过分级设色地图（Jenks自然断点法）进行可视化。Getis-Ord Gi*分析识别了高发病率或高死亡率市镇集群（热点）和低发病率或低死亡率市镇集群（冷点），采用Bonferroni校正，置信水平为90%。Wilcoxon秩和检验比较了各时期和热/冷点分类之间的AAIR、AAMR和社会经济指标。统计学显著性设定为p<0.05。分析按时期使用R（版本4.4.1）和R-Studio进行。在整个时期内，AAIR的空间聚集在PR全境显著（Moran's I 0.17，p<0.05）。2013-2017年的聚集为边缘性（Moran's I 0.08，p=0.1），但在2018-2022年变得明显（Moran's I 0.19，p<0.05）。此外，AAMR在2013-2017年期间显示出正向空间自相关（Moran's I 0.22，p<0.001）。2013-2017年，11个市镇为热点，12个为冷点。2018-2022年，出现10个热点——Juana Díaz和Guánica在两个时期均持续存在，而九个新的冷点出现且无重叠。在2013-2017年期间，热点的AAMR较冷点高13%（p<0.001），而在后一时期热点的AAIR显著更高。2013-2017年社会经济地位与热点或冷点无相关；然而，在2018-2022年期间，冷点的社会经济地位显著高于热点：家庭收入较低、贫困率和SNAP参与率较高（p<0.05）。波多黎各的GI癌症呈现出持续的空间聚集：AAIR在2018-2022年加剧，AAMR从2013-2017年热点较高的AAMR转变为2018-2022年与收入相关的梯度，即社会经济水平较高与较低的死亡率相关联。这些发现提示，自然灾害和COVID-19大流行等系统性扰动可能加深了波多黎各脆弱地区现有的不平等。
查看英文原文 English abstract
Colorectal (CRC), gastric, and pancreatic cancers are classified as gastrointestinal (GI) malignancies. Collectively, they rank among the top ten leading causes of cancer-related death in Puerto Rico (PR) for both men and women with CRC being the second most diagnosed and second leading cause of cancer death in PR. This study examines spatial and temporal variations of GI cancer incidence and mortality across municipalities in PR, while evaluating the role of sociodemographic factors and major disruptions -such as Hurricanes Irma and Maria (2017), subsequent earthquakes, and the COVID-19 pandemic- on these patterns across two periods. Age-adjusted incidence rates (AAIRs) and age-adjusted mortality rates (AAMRs) at municipality level were obtained from the PR Central Cancer Registry for 2013-2017 and 2018-2022. Sociodemographic data came from the American Community Survey. Global spatial autocorrelation was assessed using Global Moran's Index (I) and visualized through choropleth maps (Jenks Natural Breaks). Getis-Ord Gi* analysis identified clusters of municipalities with high-incidence or mortality (hot spots) and low-incidence or mortality (cold spots), using Bonferroni correction at a 90% confidence level. Wilcoxon rank-sum tests compared AAIRs, AAMRs, and socioeconomic indicators between periods and spot classifications. Statistical significance was set at p<0.05. Analyses were conducted by period using R (version 4.4.1) and R-Studio. Spatial clustering of AAIRs was significant across PR for the full period (Moran's I 0.17, p<0.05). Clustering in 2013-2017 was marginal (Moran's I 0.08, p=0.1) but became pronounced in 2018-2022 (Moran's I 0.19, p<0.05). Furthermore, AAMRs showed positive spatial autocorrelation for 2013-2017 period (Moran's I 0.22, p<0.001). In 2013-2017, 11 municipalities were hot spots and 12 were cold spots. In 2018-2022, 10 hot spots emerged-Juana Díaz and Guánica persisted across both periods while nine new cold spots appeared with no overlap. In 2013-2017 period, hot spots had 13% higher AAMRs than cold spots (p<0.001), while hot spots had significantly higher AAIRs in the latter period. Socioeconomic status did not correlate with hot or cold spots from 2013-2017; however, cold spots showed significantly higher socioeconomic status than hot spots in the 2018-2022 period: lower household income, and higher rates of poverty and SNAP participation (p<0.05). GI cancer in Puerto Rico exhibits persistent spatial clustering: AAIRs intensified in 2018-2022 and AAMRs shifted from higher AAMRs in hot spots during 2013-2017 to an income-related gradient in 2018-2022, where higher socioeconomic levels were linked to lower mortality. These findings suggest that systemic disruptions such as natural disasters and the COVID-19 pandemic may have deepened existing inequalities in vulnerable regions of Puerto Rico.
利益披露 Disclosure
B. C. Torres-Velasquez, None..
L. M. Castro-Jiménez, None..
Y. Velázquez Oliver, None..
H. Centeno-Girona, None..
C. R. Torres-Cintrón, None..
E. V. Caraballo, None.