Gastric and Esophageal Cancers Incidence Mapping in Golestan Province, Iran: Using Bayesianegibbs Sampling
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View metadata, citation and similar papers at core.ac.uk brought to you by CORE Osong Public Healthprovided Res Perspectby Golestan 2015University 6(2), of Medical 100e 105Sciences Repository http://dx.doi.org/10.1016/j.phrp.2015.01.004 pISSN 2210-9099 eISSN 2233-6052 - ORIGINAL ARTICLE - Gastric and Esophageal Cancers Incidence Mapping in Golestan Province, Iran: Using BayesianeGibbs Sampling a b, Atefeh-Sadat Hosseintabar Marzoni , Abbas Moghimbeigi *, b Javad Faradmal aGolestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Golestan, Iran. bModeling of Noncommunicable Diseases Research Center, Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. Received: October 26, Abstract 2014 Objectives: Recent studies of esophageal cancer (EC) and gastric cancer (GC) Revised: November 5, have been reported to have high incidence rates of these cancers in Golestan 2014 Province of Iran. The present study describes the geographical patterns of EC and Accepted: January 16, GC incidence based on cancer registry data and display statistically significant 2015 regions within this province. Methods: In order to map the distribution of upper gastrointestinal cancer, KEYWORDS: relative risk (RR) were calculated. Therefore, to estimate a more reliable RR, disease mapping, Poisson regression models were used. The adjusted models (adjusted to urban erural area, sex, and grouped age proportion) were utilized. We considered two- esophageal cancer, component random effects for each observation, an unstructured (non gastric cancer, correlated) and a group of “neighbor” (correlated) heterogeneities. We esti Poisson regression mated the model parameters using Gibbs sampling and empirical Bayes method. We used EC and GC data that were registered with Golestan Research Center of Gastroenterology and Hepatology in the years 2004e2008. Results: The EC and GC maps were drawn for 2004e2008 in the province. Kalaleh and Minoodasht counties have a high RR of EC and GC in the years of study. In almost all years, the areas with a high RR were steady. Conclusion: The EC and GC maps showed significant spatial patterns of risk in Golestan province of Iran. Further study is needed to multivariate clustering and mapping of cancers RRs with considering diet and socioeconomic factors. *Corresponding author. E-mail: [email protected], [email protected] (A. Moghimbeigi). This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright ª 2015 Korea Centers for Disease Control and Prevention. Published by Elsevier Korea LLC. All rights reserved. The Gastric and Esophageal Cancers Incidence Mapping 101 1. Introduction International Agency for Research on Cancer, the In ternational Association of Cancer Registries, and the About 70,000 new cases of cancer were diagnosed in World Health Organization. the Iranian population in 2008 [1]. Esophageal cancer (EC) is the second and the third most common malig nancy in Iranian men and women, respectively [2]. Also, 2.2. Statistical analysis gastric cancer (GC) is a major problem in the world and In many studies, the response variable is the counts of it is the second leading cause of cancer deaths [3]. The rare events, such as the number of new cancer cases in incidence rate of EC/GC is 6.25/8.89 and 5.83/15.21 for the population during a specified time. In such cases it is women and men, respectively (during the period assumed that the response variable has a Poisson dis 2005e2006) [4]. The northeastern part of Iran is known tribution [9]. In this study, SIR, the ratio of observed as the high-risk regions of the EC and GC in both male new cases (yiÞ to the expected number of new cases (eiÞ and female sexes [5]. Golestan is one of the northern was used as the response variable. provinces of Iran. The age-standardized incidence rate bq Z Zyi e i SIRi (ASR) per 100,000 person years of EC in Gonbad (a ei county in Golestan, Iran) is > 100 and this city is one of the high risk areas in the world [2]. The estimations of The SIR is a crude estimate of underlying regional- ASR (per 100,000) of EC are 17.6 and 14.4 in Iran [6] specific relative risks (RR). Hence smoothed estimates and 43.3 and 36.3 in the province for men and women, of RR for disease mapping were calculated using respectively [2]. Preliminary research carried out by the empirical Bayes method. We suppose that yi, the num Iran cancer institute has shown that EC accounts for ber of disease observed in study i-th county, has a about 9% of all cancers and 27% of digestive cancers, Poisson distribution [yiw Poisson ðqieiÞ,iZ 1,.,N]. and its prevalence in men is about 1.7 times higher than where qi is the RR and the expected number of cases in in women [4]. Recent research has reported that ASR the i-th county calculates as: P (per 100,000) of GC in Iran is about 26.1 in and 11.1 in N y Z PiZ1 i women [6]. ei ni N Z n In recent years, several studies have been conducted i 1 i to map the geographical spread of EC and GC incidence where ni is the population at risk in the i-th county. using adjusted age-specific standardized incidence ratio In the model for RR to account heterogeneity, we (SIR) in the southwest of the Caspian Sea from 2001 to considered two-component random effects for each 2005 [7,8]. The previous studies have considered observation, an unstructured (noncorrelated heteroge counties of northern provinces of Iran as clustered. Most neity) and a group of “neighbor” (correlated heteroge counties of Golestan are in the high-risk incidence rate neity) random effects [10e12]. This model has been cluster [7,8]. However, the incidences of these cancers presented and extended for disease mapping and clus are not the same in all regions of the province, despite tering [13,14]. It is formulated as follows: being in a high-risk cluster. The purpose of this study is log qiZa þ ui þ vi to evaluate and adjust EC and GC for contextual risk factors from 2004 to 2008, then identify counties in where a is the overall effect, ui is correlated heteroge Golestan province that have the highest observed count/ neity, and vi is the uncorrelated heterogeneity. Whereas expected count of these cancers compared with other estimating RR in each region depends on the neigh regions within this province. Comparison with the re borhood, we applied the clustering structure for the w ð ; t2Þ sults of other studies over the years can also be valuable. spatial correlations. Where vi N 0 n and accordingly for ui, Besag and Newell [14] have proposed a condi tional autoregressive structure as: 2. Materials and methods j ; s ; t2 w ; t2 ui uj i j u N ui i 2.1. Study population X The population this study was residents of Golestan P1 uiZ ujwij province. The estimated midyear population between jwij j 2004 and 2008 that are stratified by sex, age (� 69 years > and 69 years), and place of residence (urban or rural) t2 t2 ZP u was obtained from the statistical center of Iran. The i occurrences of new cases of EC and GC during a period jwij of 4 years (2004e2008) were established from Golestan Research Center of Gastroenterology and Hepatology. 1 if i; j counties are adjacent w Z The cancers were registered with procedures that are ij 0 otherwise widely established throughout the world by the 102 A.-S. Hosseintabar Marzoni, et al Table 1. The median (M), and 2.5 and 97.5 percentiles of covariates effects on log (relative risk) in the adjusted model. 2004 2005 2006 2007 2008 Variables 2.5% M 97.5% 2.5% M 97.5% 2.5% M 97.5% 2.5% M 97.5% 2.5% M 97.5% Area EC -0.960 -0.007 1.196 -0.614 0.284 2.327 -0.881 0.050 1.523 -0.995 -0.043 0.931 -0.709 0.139 1.085 GC -0.893 0.006 0.914 -0.697 0.058 0.934 -0.907 -0.034 0.817 -0.795 0.030 1.066 -1.037 -0.079 0.747 Sex EC -2.328 -0.038 2.183 -2.888 0.042 3.368 -2.302 -0.019 2.535 -2.323 -0.040 2.139 -2.391 0.004 2.201 GC -2.203 -0.017 2.050 -2.092 0.001 2.124 -2.093 -0.014 2.091 -2.074 -0.011 2.197 -2.238 -0.033 2.032 Age EC -1.980 -0.067 1.825 -2.702 -0.108 2.588 -2.117 -0.068 1.979 -1.704 -0.022 1.974 -2.228 -0.062 2.172 GC -1.749 -0.010 1.718 -1.736 -0.020 1.706 -1.626 -0.003 1.747 -1.973 -0.052 1.635 -1.735 -0.015 1.732 EC Z esophageal cancer; GC Z gastric cancer. where, the tu and tv control variability of u and v.We We used OpenBUGS version 3.1.2 (produced by have used the empirical Bayes model for estimating the Medical Research Council (MRC) and Imperial College, model parameters. Uninformative prior distributions for UK), the Bayesian analysis of complex statistical soft the parameters of the model were considered as: ware to estimate parameters of the model with the GibbseBayesian method.