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Colorectal Cancer Risk Factors in North-Eastern Iran

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Colorectal Cancer Risk Factors in North-Eastern Iran See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/336133918 Colorectal cancer risk factors in north-eastern Iran: A retrospective cross- sectional study based on geographical information systems, spatial autocorrelation and regression analys... Preprint · November 2019 CITATIONS READS 0 95 9 authors, including: Ladan Goshayeshi Majid Ghayour-Mobarhan Mashhad University of Medical Sciences Mashhad University of Medical Sciences 41 PUBLICATIONS 156 CITATIONS 384 PUBLICATIONS 4,398 CITATIONS SEE PROFILE SEE PROFILE Soheil Hashtarkhani Sajjad Karimian Mashhad University of Medical Sciences Urmia University of Medical Sciences 11 PUBLICATIONS 9 CITATIONS 3 PUBLICATIONS 0 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Health GIS View project Acute effects of simvastatin to terminate fast reentrant tachycardia through increasing wavelength of AVNRT circuit. View project All content following this page was uploaded by Behzad Kiani on 07 November 2019. The user has requested enhancement of the downloaded file. Geospatial Health 2019; volume 14:793 Colorectal cancer risk factors in north-eastern Iran: A retrospective cross-sectional study based on geographical information systems, spatial autocorrelation and regression analysis Ladan Goshayeshi,1 Ali Pourahmadi,2 Majid Ghayour-Mobarhan,3 Soheil Hashtarkhani,4,5 Sajad Karimian,6 Reza Shahhosein Dastjerdi,1 Babak Eghbali,7 Efat Seyfi,7 Behzad Kiani5 1Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad; 2Department of Computer Engineering, University of Science and Arts of Yazd, Yazd; 3Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad; 4Student Research Committee, Mashhad University of Medical Sciences, Mashhad; 5Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad; 6Student Research Committee, Urmia University of Medical Sciences, Urmia; 7Department of Health, Mashhad University of Medical Sciences, Mashhad, Iran only many interrelated factors that together cause the disease. This ret- Abstract rospective, cross-sectional study aimed to identify potential spa- Colorectal cancer (CRC) is the second most common cancer tial factors contributing to its geographical distribution. Data con- among females and the third most common malignancy in males cerning 1,089 individuals with CRC from the Khorasan-Razavi Province inuse Iran, located in the North-East of the country, were in the world. No single risk factor has been identified, but there are I obtained from the national CRC registry. Local Moran’s statistic was performed to identify clustered areas of CRC occurrence and ordinary least squared regression was calculated to predict fre- Correspondence: Behzad Kiani, Department of Medical Informatics, quency of the disease based on a set of variables, such as diet, Faculty of Medicine, Mashhad University of Medical Sciences, body mass index (BMI) and the proportion of the population ≥50 Mashhad, Iran. years of age. Some dissimilarities related to the geography in the Tel. +989120652983 - Fax: +985138002445. E-mail: [email protected] - [email protected] province and also some neighbourhood-related similarities and dissimilarities of CRC occurrence in the city of Mashhad were found. A significant regression equation was found (F Key words: Colorectal cancer; Geographical information system; 2 Spatial analysis; Cluster analysis; Regression analysis; Ordinary least (4,137)=38.304, P<.000) with an adjusted R of 0.6141. The pre- square; Iran. dicted CRC frequency was -58.3581 with the coefficients for aver- age BMI=+1.594878; fibre intake=-0.610335; consumption of red Contributions: the authors contributed equally. meat +0.078970; and ≥50-year age group =+0.000744. All associ- consumption of red ations were statistically significant, except the meat Conflict of interest: the authors declare no potential conflict of interest. one. The study results illuminate the potential underlying risk factors in areas where the CRC risk is comparatively high and Funding: the work was supportedNon-commercial by Mashhad University of Medical Sciences (funding number: 951211). how the CRC risk factors may play a role in CRC geographic dis- parity. Further research is required to explain the patterns Ethical approval: ethical approval for this study was obtained from observed. We conclude that people should include more fibre in Mashhad University of Medical Sciences (approval number: 951211). their daily diet and decline their BMI to decrease risk of CRC. Received for publication: 14 June 2019 Revision received: 3 October 2019. Accepted for publication: 3 October 2019. Introduction ©Copyright: the Author(s), 2019 Cancer is a major public health problem and the second most et al Licensee PAGEPress, Italy common reason for global mortality (Siegel ., 2019). Geospatial Health 2019; 14:793 Colorectal cancer (CRC) is the second most common cancer doi:10.4081/gh.2019.793 among females and the third most common malignancy in males et al This article is distributed under the terms of the Creative Commons worldwide (Fitzmaurice ., 2017). CRC develops when the Attribution Noncommercial License (CC BY-NC 4.0) which permits any DNA mutations occur in cells of the colon or rectum making cells noncommercial use, distribution, and reproduction in any medium, pro- unable to control their growth and division. In many cases, these vided the original author(s) and source are credited. mutated cells die without known cause or following attack by the immune system. However, sometimes the mutated cells escape [Geospatial Health 2019; 14:793] [page 219] Article immune surveillance and start to grow out of control, they form physical activity and smoking), capability of medical services e.g tumour(s) in the colorectal part of the intestines, often resulting in ( ., financial aspects and access to medical services) and envi- et al metastatic growth also in other organs (Janssen ., 2017). The ronmental factors all include CRC determinants (DeChello and et al disease represented the loss of 15,800,000 disability-adjusted life Sheehan, 2007; Haggar and Boushey, 2009; Brenner ., 2014; et al et al years in 2013, 56% of which in middle- and low-income countries Shah ., 2014; Adeola ., 2018). Many factors are interrelat- et al and 44% in industrialized countries (Fitzmaurice ., 2015). ed and environmental elements may strongly exacerbate the There is a high probability that these figures are skewed in the impact of other hazardous factors. Indeed, patients regularly i.e direction of a higher percentage in low-income countries. exposed to environmental variables ( . air contamination, pesti- In Iran, CRC is the fourth most malignant growth in men and cides, water pollution and heavy metals) might be at higher risk for et al et al et al et al the third most common cancer disease in women (Mansori ., CRC (Chang ., 2015; Yuan ., 2016; Nawi ., 2019). 2018). No single hazardous factor has been identified, but individ- Therefore, spatial examination of the CRC incidence is of great e.g e.g ual factors ( ., sex, age and family history), way of life ( ., diet, significance in the study of the epidemiology of the disease. only use Non-commercial Figure 1. The study area in North-East Iran: Khorasan-Razavi Province. [page 220] [Geospatial Health 2019; 14:793] Article et al Results, when substantiated, would be useful as guide to policy Bagheri . (2017) found hotspots and coldspots of this disease makers for more efficient interventions aimed at disease preven- of various intensity in outer, regional and remote areas of New tion. Geographical Information System (GIS) empowers investiga- South Wales, Australia. et al tions on the spatial distribution of diseases (Kiani ., 2017b). Performing spatial cluster analysis based on various statistical et al et al Previous studies have utilized several methods based on GIS for approaches, Al-Ahmadi . (2013) and Li . (2017) working et al spatial examination of CRC occurrence. Shah . (2014) carried in southern China and Saudi Arabia, respectively, found out a spatial analysis of CRC cases in Kuala Lumpur, Malaysia widespread clusters indicating a link between geography and can- et al covering the years 1995-2011 utilizing spatial autocorrelation cer occurrence, while Torres . (2018) used ordinary least methods. Their investigation demonstrated Chinese as having the squares (OLS) regression to explore associated environmental and highest number of registered cases and that they were concentrated socio-economic risk factors of CRC in the city of Baltimore, USA in northern Petaling and Kuala Lumpur districts, an important dis- from 2000 to 2010. OLS regression analysis lends itself to mod- tinction in the spatial dissemination of CRC occurrence. Spatial elling linear relationships leading to a better understanding of the autocorrelation methods have been used to investigate whether the factors behind observed global spatial patterns and outcome pre- et al observed value of a variable in one territory is independent of val- diction (Lawson ., 2016). To our best knowledge, spatial vari- ues of the variable in neighbouring areas (Griffith and Paelinck, ation of CRC incidence has not been investigated in Khorasan- et al 2018). A study by Halimi . (2019) highlighted clustered Razavi Province, Iran. Furthermore, we did not find a study apply-
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