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The spatial distribution of esophageal and gastric cancer in Caspian region of Iran: an ecological analysis of diet and socio-economic influences.

Mohebbi M, Wolfe R, Jolley D, Forbes AB, Mahmoodi M, Burton RC - Int J Health Geogr (2011)

Bottom Line: Regression models were fitted to identify significant covariates, and clusters of elevated rates were identified.We found evidence of systematic clustering for EC and GC in men and women and both sexes combined.EC and GC were associated with aggregated risk factors, including income, urbanisation, and dietary patterns.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. Mohammadreza.Mohebbi@monash.edu

ABSTRACT
Recent studies have suggested a systematic geographic pattern of esophageal cancer (EC) and gastric cancer (GC) incidence in the Caspian region of Iran. The aims of this study were to investigate the association between these cancers and the region's dietary and socioeconomic risk factors and to map EC and GC after adjustment for the risk factors and the removal of random and geographic variations from area specific age standardised incidence ratios (SIRs). We obtained cancer data from the Babol cancer registry from 2001 to 2005, socioeconomic indices from the Statistical Centre of Iran, and dietary patterns from the control group in a case control study conducted in the study region. Regression models were fitted to identify significant covariates, and clusters of elevated rates were identified. We found evidence of systematic clustering for EC and GC in men and women and both sexes combined. EC and GC SIRs were lower in urban areas, and were also lower in areas of high income. EC SIRs were lower in areas with higher proportions of people having unrestricted food choice and higher in areas with higher proportions of people with restricted food choice. EC and GC were associated with aggregated risk factors, including income, urbanisation, and dietary patterns. These variables represent the influence of improved lifestyle which has coincided with a decrease in upper gastrointestinal cancer frequency over recent decades but which has not necessarily been uniform throughout the region.

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Relationship between esophageal (a) and gastric (b) cancer SIRs, and sextiles of the following three socio-economic score factors: income, urbanisation, and literacy. Each boxplot within each panel displays the distribution of the SIRs within that sextile.
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Figure 6: Relationship between esophageal (a) and gastric (b) cancer SIRs, and sextiles of the following three socio-economic score factors: income, urbanisation, and literacy. Each boxplot within each panel displays the distribution of the SIRs within that sextile.

Mentions: Figures 6 and 7 display boxplots of the SIRs by sextile of socio-economic and dietary factor scores. Overall these figures suggest moderate dose-response associations between the socio-economic and dietary factor scores and EC and GC. Confirmation of these associations comes from the results for the multilevel Poisson models for male, female and both sexes in Table 5. For men and women combined, increasing EC SIR in an agglomeration was associated with: decreasing percentage of ward-specific population in the 3rd study-area tertile of the unrestricted food choice factor, increasing percentage in the 3rd tertile of the restricted food choice factor, and decreasing scores of the income and urbanisation factors (p < 0.001). Increasing SIR in an agglomeration for GC was associated with decreasing income score for men and women separately, and urbanisation factors, for men and women combined, (p < 0.001). In addition, for GC the analysis of both sexes combined showed weak associations with the percentage in the 3rd tertile of the unrestricted food choice factor, the percentage in the 3rd tertile of the restricted food choice factor, and the income and literacy factors (p-values in range 0.05 to 0.1). Model smoothed SIR maps after adjustment for covariates from Table 5 with p-value less than 0.1 are illustrated in Figures 3(b) and 4(b).


The spatial distribution of esophageal and gastric cancer in Caspian region of Iran: an ecological analysis of diet and socio-economic influences.

Mohebbi M, Wolfe R, Jolley D, Forbes AB, Mahmoodi M, Burton RC - Int J Health Geogr (2011)

Relationship between esophageal (a) and gastric (b) cancer SIRs, and sextiles of the following three socio-economic score factors: income, urbanisation, and literacy. Each boxplot within each panel displays the distribution of the SIRs within that sextile.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3050677&req=5

Figure 6: Relationship between esophageal (a) and gastric (b) cancer SIRs, and sextiles of the following three socio-economic score factors: income, urbanisation, and literacy. Each boxplot within each panel displays the distribution of the SIRs within that sextile.
Mentions: Figures 6 and 7 display boxplots of the SIRs by sextile of socio-economic and dietary factor scores. Overall these figures suggest moderate dose-response associations between the socio-economic and dietary factor scores and EC and GC. Confirmation of these associations comes from the results for the multilevel Poisson models for male, female and both sexes in Table 5. For men and women combined, increasing EC SIR in an agglomeration was associated with: decreasing percentage of ward-specific population in the 3rd study-area tertile of the unrestricted food choice factor, increasing percentage in the 3rd tertile of the restricted food choice factor, and decreasing scores of the income and urbanisation factors (p < 0.001). Increasing SIR in an agglomeration for GC was associated with decreasing income score for men and women separately, and urbanisation factors, for men and women combined, (p < 0.001). In addition, for GC the analysis of both sexes combined showed weak associations with the percentage in the 3rd tertile of the unrestricted food choice factor, the percentage in the 3rd tertile of the restricted food choice factor, and the income and literacy factors (p-values in range 0.05 to 0.1). Model smoothed SIR maps after adjustment for covariates from Table 5 with p-value less than 0.1 are illustrated in Figures 3(b) and 4(b).

Bottom Line: Regression models were fitted to identify significant covariates, and clusters of elevated rates were identified.We found evidence of systematic clustering for EC and GC in men and women and both sexes combined.EC and GC were associated with aggregated risk factors, including income, urbanisation, and dietary patterns.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. Mohammadreza.Mohebbi@monash.edu

ABSTRACT
Recent studies have suggested a systematic geographic pattern of esophageal cancer (EC) and gastric cancer (GC) incidence in the Caspian region of Iran. The aims of this study were to investigate the association between these cancers and the region's dietary and socioeconomic risk factors and to map EC and GC after adjustment for the risk factors and the removal of random and geographic variations from area specific age standardised incidence ratios (SIRs). We obtained cancer data from the Babol cancer registry from 2001 to 2005, socioeconomic indices from the Statistical Centre of Iran, and dietary patterns from the control group in a case control study conducted in the study region. Regression models were fitted to identify significant covariates, and clusters of elevated rates were identified. We found evidence of systematic clustering for EC and GC in men and women and both sexes combined. EC and GC SIRs were lower in urban areas, and were also lower in areas of high income. EC SIRs were lower in areas with higher proportions of people having unrestricted food choice and higher in areas with higher proportions of people with restricted food choice. EC and GC were associated with aggregated risk factors, including income, urbanisation, and dietary patterns. These variables represent the influence of improved lifestyle which has coincided with a decrease in upper gastrointestinal cancer frequency over recent decades but which has not necessarily been uniform throughout the region.

Show MeSH
Related in: MedlinePlus