山东省1970-2013年肝癌死亡率空间聚集性分析及其变化趋势

Spatial clustering analysis and trend of liver cancer death rate in Shandong province, 1970-2013

目的探讨1970-2013年山东省不同县(市、区)肝癌死亡率的空间聚集性及其变化趋势,为制定肝癌防控规划和措施提供依据。方法肝癌死亡率数据取自山东死亡登记系统和全国三次死因回顾性调查数据。利用死亡率和年龄调整死亡率等指标描述不同年代肝癌变化趋势,采用死亡率差别分解法计算死亡率变化中人口因素和非人口因素的贡献值。采用ArcGIS 10.2软件用于空间分析,采用空间扫描统计软件SaTScan 9.4进行肝癌空间聚集分析。结果2011-2013年山东省肝癌粗死亡率(29.89/10万)较1970-1974年(9.72/10万)和1990-1992年(22.08/10万)分别上升208.00%和35.37%,与2004-2005年(30.44/10万)相差不大。肝癌年龄标化死亡率呈现先升高后降低的趋势,2011-2013年标化死亡率(12.62/10万)较1970-1974年上升60.97%,较1990-1992年和2004-2005年分别下降22.38%和21.81%。不同年代肝癌死亡率的差别分析发现,20世纪70年代以来,肝癌粗死亡率总体呈上升趋势,人口因素在其中所占比例越来越大,人口因素对肝癌死亡率上升的贡献值从1990-1992年的3.38%,上升到2004-2005年的29.36%,2011-2013年达到了46.16%。而非人口因素对肝癌死亡率升高的贡献值呈下降趋势。从肝癌死亡率空间分布来看,不同县(市、区)肝癌粗死亡率差异较大,粗死亡率在9.33/10万~65.33/10万之间。采用空间扫描统计软件进行肝癌死亡率空间聚集分析可以发现多个肝癌高死亡率聚集区,2011-2013年主要聚集区分布在胶东半岛地区,覆盖青岛、烟台及威海市的20个县(市、区),该聚集区内的肝癌死亡风险是其他区域的1.54倍。1970-1974年肝癌死亡率空间聚集性分布与2011-2013年结果明显不同,主要聚集区分布在山东省中、西部的大部分地区。结论1970-2013年山东省肝癌死亡率发生了明显的时间和空间变化,应根据这些变化趋势以及其地理空间聚集性,进一步探索肝癌死亡的相关危险因素,为制定切实可行的肝癌区域化防控措施提供依据。

Objective To explore the spatial clustering and trend of liver cancer mortality in different counties of Shandong province from 1970 to 2013,and provide scientific basis for the development of liver cancer prevention and control plan.Methods Cancer mortality data were obtained from Shandong Death Registration System and three national death cause surveys in China.Mortality rate and age adjusted mortality rate were used to describe the trend of liver cancer in different years.Difference decomposing method was applied to estimate the contribution of demographic and non-demographic factors to the change of mortality.Software ArcGIS 10.2 was used for spatial analysis,and software SaTScan 9.4 was used for spatial clustering analysis on liver cancer mortality.Results From 2011 to 2013,the crude mortality rate of liver cancer(29.89/100000)in Shandong increased by 208.00%and 35.37%respectively compared with that during 1970-1974(9.72/100000)and 1990-1992(22.08/100000)and was similar to that during 2004-2005(30.44/100000).While age standardized mortality rate(ASMR)increased first and then decreased.The ASMR during 2011-2013(12.62/100000)increased by 60.97%compared with that during 1970-1974 and decreased by 22.38%and 21.81%compared with that during 1990-1992 and 2004-2005,respectively.According to the difference decomposition analysis on liver cancer mortality in different years,the contribution of population factors to the liver cancer mortality rate increased from 3.38%during 1990-1992 to 29.36%during 2004-2005 and 46.16%during 2011-2013.However,the contribution of non-population factors to the increase of liver cancer mortality decreased.According to the spatial distribution of liver cancer mortality,the crude mortality rate of liver cancer in different counties were quite different,ranging from 9.33/100000 to 65.33/100000.Using the spatial scanning statistical software to analyze the spatial clustering of liver cancer mortality,multi areas with high mortality rate of liver cancer were found,and they were mainly distributed in Jiaodong peninsula from 2011 to 2013,covering 20 counties(cities,districts)in Qingdao,Yantai and Weihai.The risk of liver cancer mortality in this area was 1.54 times higher than that in other areas.The spatial clustering distribution of liver cancer mortality during 1970-1974 was significantly different from that during 2011-2013,the areas with high mortality rate during 1970-1974 were mainly distributed in central and western Shandong.Conclusions There were significant temporal and spatial distribution changes in the mortality rate of liver cancer in Shandong from 1970 to 2013.According to these trends and their geographical and spatial distribution,we should further explore the risk factors of liver cancer,and formulate feasible and area specific prevention and control measures for liver cancer.