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Lee D, Yun HW, Kim N, Park J, Jung KW, Suh M, Shin DW. Exploring age-standardized cancer incidence rates and regional disparities: A retrospective cohort study of 8 major cancers in South Korea. Cancer Epidemiol 2024; 91:102594. [PMID: 38870624 DOI: 10.1016/j.canep.2024.102594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND We analyzed trends in cancer incidence and regional disparities of eight major types of cancer in Korea. METHODS This retrospective cohort study used the data of 17 cities/provinces from the Korea Central Cancer Registry (1999-2020) in South Korea. Age-standardized incidence rates (per 100,000 person-years), between-group variance (per 100,000 person-years)2, and annual percentage changes ( %) were calculated for the eight most common malignancies. Joinpoint regression was utilized to identify the points at which significant changes occur in cancer incidence or regional disparity trends over time to characterize these trends. RESULTS The incidence of stomach cancer decreased as regional disparity decreased and that of colorectal cancer initially increased but recently declined, showing fluctuations in regional disparity. The incidence and regional disparity in liver cancer decreased. The incidence of lung cancer remained stable, with reduced regional disparities. The incidence of breast cancer rose with increasing regional disparity, whereas the incidence of cervical cancer decreased, accompanied by decreased regional disparity. A significant increase in prostate cancer was found, with initially reduced regional disparities but later showed a resurgence. The incidence of thyroid cancer fluctuated alongside variations in regional disparities. CONCLUSION This study revealed cancer incidence and regional variations in each cancer type in Korea. More studies are needed to understand the underlying factors and potential interventions for reducing cancer incidence and addressing regional disparity.
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Affiliation(s)
- Dagyeong Lee
- Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | | | - Nayeon Kim
- National Cancer Control Institute, National Cancer Center, Goyang-si, South Korea
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, Goyang-si, South Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang-si, South Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang-si, South Korea.
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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Park EH, Kang MJ, Jung KW, Park EH, Yun EH, Kim HJ, Kong HJ, Choi CK, Im JS, Seo HG. Regional disparities in major cancer incidence in Korea, 1999-2018. Epidemiol Health 2023; 45:e2023089. [PMID: 37857340 PMCID: PMC10867526 DOI: 10.4178/epih.e2023089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVES This study investigated regional disparities in the incidence of 8 major cancers at the municipal level in Korea during 1999-2018 and evaluated the presence or absence of hot spots of cancer clusters during 2014-2018. METHODS The Korea National Cancer Incidence Database was used. Age-standardized incidence rates were calculated by gender and region at the municipal level for 4 periods of 5 years and 8 cancer types. Regional disparities were calculated as both absolute and relative measures. The possibility of clusters was examined using global Moran's I with a spatial weight matrix based on adjacency or distance. RESULTS Regional disparities varied depending on cancer type and gender during the 20-year study period. For men, the regional disparities of stomach, colon and rectum, lung, and liver cancer declined, and those of thyroid and prostate cancer recently decreased, despite an overall increasing incidence. For women, regional disparities in stomach, colon and rectum, lung, liver, and cervical cancer declined, that of thyroid cancer recently decreased, despite an overall increasing incidence, and that of breast cancer steadily increased. In 2014-2018, breast cancer (I, 0.61; 95% confidence interval [CI], 0.53 to 0.70) showed a high probability of cancer clusters in women, and liver cancer (I, 0.48; 95% CI, 0.40 to 0.56) showed a high probability of cancer clusters in men. CONCLUSIONS Disparities in cancer incidence that were not seen at the national level were discovered at the municipal level. These results could provide important directions for planning and implementing local cancer policies.
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Affiliation(s)
- Eun Hye Park
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Mee Joo Kang
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyu-Won Jung
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Hye Park
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - E Hwa Yun
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hye-Jin Kim
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyun-Joo Kong
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Chang Kyun Choi
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jeong-Soo Im
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hong Gwan Seo
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - The Community of Population-Based Regional Cancer Registries*
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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Rodrigues V, Martins R, de Sousa B. Spatio-temporal trends of the age-at-menarche percentiles among Portuguese women since 1920. BMC Womens Health 2023; 23:476. [PMID: 37679702 PMCID: PMC10486027 DOI: 10.1186/s12905-023-02608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND This work aims to study the spatio-temporal evolution of a woman's age at menarche in the central region of Portugal. One of the concerns of the study is early or late menarches; thus, we consider percentile regression to build the respective curves as opposed to the more traditional mean regression approach. METHODS We analysed the data from [Formula: see text] women born in the period 1920-1973 who attended a free breast cancer screening program between 1990 and 2019. Distributional regression models inside the package GAMLSS in R were considered. These methods allowed us not only to model the location (mean) of the specific probability distribution of the age at menarche, but also allowed for the scale (variance) parameter of this distribution to depend on covariates. Additionally, a spatial random-effect was considered in order to capture the correlation at the regional level. The obtained clustered spatial effects were analysed to assess geographical differences among the percentiles of the age at menarche by year of birth. RESULTS A decreasing trend in the age at menarche (about 1.5 years in 5 decades) and regional differences for all the considered percentiles were found. Women living in the north-central areas of the central region of Portugal tend to have menarche at older ages. CONCLUSION We obtained percentile estimates for the age at menarche by year of birth and region of residence and demonstrated that these two explanatory variables have an impact on the explanation about the decreasing trend in age at a woman's first menstruation.
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Affiliation(s)
- Vitor Rodrigues
- Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Liga Portuguesa Contra o Cancro, Núcleo Regional do Centro, Rua Dr. António José de Almeida, 329 - piso 2 - Sala 56, 3000-045, Coimbra, Portugal
| | - Rui Martins
- Departamento de Estatística e Investigação Operacional, Faculdade de Ciências, Universidade de Lisboa, Portugal; Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Lisboa, Portugal.
| | - Bruno de Sousa
- Faculty of Psychology and Education Sciences (FPCE); Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
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Nguyen CT, Song I, Jung I, Choi Y, Kim S. Changes in spatial clusters of cancer incidence and mortality over 15 years in South Korea: Implication to cancer control. Cancer Med 2023; 12:17418-17427. [PMID: 37489117 PMCID: PMC10501259 DOI: 10.1002/cam4.6365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The temporal investigation of high-risk areas of cancer incidence and mortality can provide practical implications in cancer control. We aimed to investigate the changes in spatial clusters of incidence and mortality from 1999 through 2013 by major cancer types in South Korea. METHODS We applied flexible scan statistics to identify spatial clusters of cancer incidence and mortality by three 5-year periods and seven major cancer types using the counts of new cases and deaths and population in 244 districts during 1999-2013. Then, we compared the changes across three periods in the locations of primary clusters of incidence and mortality by cancer types. To explore the determinants that possibly affect cancer cluster areas, we compared geographic characteristics between clustered and non-clustered areas. RESULTS While incidence clusters for lung, stomach, and liver cancer remained in the same areas over 15 years, mortality clusters were relocated to the areas similar to those of incidence clusters. In contrast, colorectal, breast, cervical, and prostate cancer displayed consistently different locations of clusters over time, indicating the disappearance of existing clusters and the appearance of new clusters. Cluster areas tended to show higher portions of older population, unemployment, smoking, and cancer screening compared to non-cluster areas particularly for mortality. CONCLUSIONS Our findings of diverse patterns of changes in cancer incidence and mortality clusters over 15 years can indicate the degree of effectiveness in cancer prevention and treatment depending on the area and suggest the need for area-specific applications of different cancer control programs.
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Affiliation(s)
- Cham Thi Nguyen
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and PolicyNational Cancer CenterGoyang‐siRepublic of Korea
| | - Insang Song
- Department of GeographyUniversity of OregonEugeneOregonUSA
| | - Inkyung Jung
- Department of Biomedical Systems InformaticsYonsei UniversitySeoulRepublic of Korea
| | - Yoon‐Jung Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and PolicyNational Cancer CenterGoyang‐siRepublic of Korea
| | - Sun‐Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and PolicyNational Cancer CenterGoyang‐siRepublic of Korea
- Department of Cancer AI and Digital Health, Graduate School of Cancer Science and PolicyNational Cancer CenterGoyang‐siRepublic of Korea
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Kim SH, Ock M, Jo MW, Park S. Estimation of utility weights for prostate-related health states in Korea. J Prev Med Public Health 2022; 55:243-252. [PMID: 35677998 PMCID: PMC9201095 DOI: 10.3961/jpmph.21.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Seon-Ha Kim
- Department of Nursing, Dankook University, Cheonan,
Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul,
Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
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Spatial distribution and determinants of thyroid cancer incidence from 1999 to 2013 in Korea. Sci Rep 2021; 11:22474. [PMID: 34795315 PMCID: PMC8602462 DOI: 10.1038/s41598-021-00429-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022] Open
Abstract
We evaluated the spatial variation in thyroid cancer incidence and its determinants in Korea considering its importance in cancer prevention and control. This study was based on the ecological design with cancer incidence data by administrative district from the National Cancer Center and regional characteristics generated from the Korea Community Health Survey Data. We identified spatial clusters of thyroid cancer incidences based on spatial scan statistics. Determinants of regional variation in thyroid cancer incidence were assessed using the Besag-York-Mollie model with integrated nested Laplace approximations. Spatial clusters for low and high thyroid cancer incidences were detected in the northeastern and southwestern regions, respectively. Regional variations in thyroid cancer incidence can be attributed to the prevalence of recipients of basic livelihood security (coefficient, - 1.59; 95% credible interval [CI], - 2.51 to - 0.67), high household income (coefficient, 0.53; 95% CI, 0.31 to 0.76), heavy smoking (coefficient, - 0.91; 95% CI, - 1.59 to - 0.23), thyroid dysfunction (coefficient, 3.24; 95% CI, 1.47 to 5.00), and thyroid cancer screening (coefficient, 0.38; 95% CI, 0.09 to 0.67). This study presented the spatial variations in thyroid cancer incidence, which can be explained by the prevalence of socioeconomic factors, thyroid cancer screening, thyroid dysfunction, and smoking.
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Jang J, Yoo DS, Chun BC. Spatial epidemiologic analysis of the liver cancer and gallbladder cancer incidence and its determinants in South Korea. BMC Public Health 2021; 21:2090. [PMID: 34774036 PMCID: PMC8590754 DOI: 10.1186/s12889-021-12184-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/01/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There have been reports on regional variation in prevalence of hepatitis B and C, and Clonorchis sinensis (C. sinensis) infection, which indicates potential of spatial variation in liver cancer and gallbladder cancer incidence in Korea. Therefore, we aimed to assess the regional variation of liver and gallbladder cancer incidence and its determinants based on the regional distribution of risk factors, including hepatitis B infection in Korea. METHODS This study used an ecological study design and district-level cancer incidence statistics generated by the National Cancer Center. Spatial clusters of liver and gallbladder cancer incidence were detected based on spatial scan statistics using SaTScan™ software. We set the size of maximum spatial scanning window of 25 and 35% of the population at risk for analyses of liver and gallbladder cancer, respectively. Significance level of 0.05 was used to reject the null hypothesis of no cluster. We fitted the Besag-York-Mollie model using integrated nested Laplace approximations to assess factors that influence the regional variation in cancer incidence. RESULTS Spatial clusters with high liver cancer incidence rates were detected in the southwestern and southeastern regions of Korea. High gallbladder cancer incidence rates are clustered in the southeastern region. Regional liver cancer incidence can be accounted for the prevalence of high household income (coefficient, - 0.10; 95% credible interval [CI], - 0.18 to - 0.02), marital status (coefficient, - 0.14; 95% CI, - 0.25 to - 0.03), the incidence of hepatitis B (coefficient, 0.87; 95% CI, 0.29 to 1.44), and liver cancer screening (coefficient, 0.06; 95% CI, 0.00 to 0.12), while gallbladder cancer incidence was related to the prevalence of high household income (coefficient, - 0.03; 95% CI, - 0.05 to 0.00) and living close to a river with a high prevalence of liver fluke infection (coefficient, 0.55; 95% CI, 0.14 to 0.96). CONCLUSIONS This study demonstrated geographic variation in liver and gallbladder cancer incidence, which can be explained by determinants such as hepatitis B, income, marital status, and living near a river.
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Affiliation(s)
- Jieun Jang
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Dae-Sung Yoo
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.,Veterinary Epidemiology Division, Animal and Plant Quarantine Agency, 177, Hyeoksin 8-ro, Gimcheon-si, 39660, Gyeongsangbuk-do, Republic of Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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Min JS, Jeong SH, Park JH, Kim T, Jung EJ, Ju YT, Jeong CY, Kim JY, Park M, Lee YJ. A comparison of quality of life between patients with small and large gastric remnant volumes after gastrectomy for gastric cancer. Medicine (Baltimore) 2021; 100:e26954. [PMID: 34414961 PMCID: PMC8376383 DOI: 10.1097/md.0000000000026954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/24/2021] [Indexed: 01/04/2023] Open
Abstract
The impact of gastric remnant volumes (GRVs) after gastrectomy on patients' quality of life (QOL) has not yet been clarified. The aim of the present study was to compare QOL after gastrectomy between small and large gastric remnant volume patients.We prospectively collected clinical data from 78 consecutive patients who underwent distal gastrectomy with Billroth II gastrojejunostomy for gastric cancer. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Stomach questionnaire and gastric computed tomography scans were performed. The patients were subdivided into 2 groups by remnant stomach volume (the S group ≤110 mL vs L group >110 mL).The worst scores for most items were observed at postoperative month 1 and usually improved thereafter. There was no difference in the STO22 score except for dysphagia between the S and L groups after gastrectomy (P > .05). The QOL score of dysphagia was different at postoperative 6 months (S vs L, 12.4 vs 22.8, P < .03), but there was no difference at postoperative months 1, 3, 12, 24, or 36 (P > .05).The remnant gastric volume after partial gastrectomy affects neither functional differences nor QOL after 6 months following appropriate radical surgery.
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Affiliation(s)
- Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, South Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Taehan Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Miyeong Park
- Department of Anesthesiology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
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Application of Epidemiological Geographic Information System: An Open-Source Spatial Analysis Tool Based on the OMOP Common Data Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217824. [PMID: 33114631 PMCID: PMC7663469 DOI: 10.3390/ijerph17217824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/20/2022]
Abstract
Background: Spatial epidemiology is used to evaluate geographical variations and disparities in health outcomes; however, constructing geographic statistical models requires a labor-intensive process that limits the overall utility. We developed an open-source software for spatial epidemiological analysis and demonstrated its applicability and quality. Methods: Based on standardized geocode and observational health data, the Application of Epidemiological Geographic Information System (AEGIS) provides two spatial analysis methods: disease mapping and detecting clustered medical conditions and outcomes. The AEGIS assesses the geographical distribution of incidences and health outcomes in Korea and the United States, specifically incidence of cancers and their mortality rates, endemic malarial areas, and heart diseases (only the United States). Results: The AEGIS-generated spatial distribution of incident cancer in Korea was consistent with previous reports. The incidence of liver cancer in women with the highest Moran’s I (0.44; p < 0.001) was 17.4 (10.3–26.9). The malarial endemic cluster was identified in Paju-si, Korea (p < 0.001). When the AEGIS was applied to the database of the United States, a heart disease cluster was appropriately identified (p < 0.001). Conclusions: As an open-source, cross-country, spatial analytics solution, AEGIS may globally assess the differences in geographical distribution of health outcomes through the use of standardized geocode and observational health databases.
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Choi IJ, Kim CG, Lee JY, Kim YI, Kook MC, Park B, Joo J. Family History of Gastric Cancer and Helicobacter pylori Treatment. N Engl J Med 2020; 382:427-436. [PMID: 31995688 DOI: 10.1056/nejmoa1909666] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Helicobacter pylori infection and a family history of gastric cancer are the main risk factors for gastric cancer. Whether treatment to eradicate H. pylori can reduce the risk of gastric cancer in persons with a family history of gastric cancer in first-degree relatives is unknown. METHODS In this single-center, double-blind, placebo-controlled trial, we screened 3100 first-degree relatives of patients with gastric cancer. We randomly assigned 1838 participants with H. pylori infection to receive either eradication therapy (lansoprazole [30 mg], amoxicillin [1000 mg], and clarithromycin [500 mg], each taken twice daily for 7 days) or placebo. The primary outcome was development of gastric cancer. A prespecified secondary outcome was development of gastric cancer according to H. pylori eradication status, assessed during the follow-up period. RESULTS A total of 1676 participants were included in the modified intention-to-treat population for the analysis of the primary outcome (832 in the treatment group and 844 in the placebo group). During a median follow-up of 9.2 years, gastric cancer developed in 10 participants (1.2%) in the treatment group and in 23 (2.7%) in the placebo group (hazard ratio, 0.45; 95% confidence interval [CI], 0.21 to 0.94; P = 0.03 by log-rank test). Among the 10 participants in the treatment group in whom gastric cancer developed, 5 (50.0%) had persistent H. pylori infection. Gastric cancer developed in 0.8% of participants (5 of 608) in whom H. pylori infection was eradicated and in 2.9% of participants (28 of 979) who had persistent infection (hazard ratio, 0.27; 95% CI, 0.10 to 0.70). Adverse events were mild and were more common in the treatment group than in the placebo group (53.0% vs. 19.1%; P<0.001). CONCLUSIONS Among persons with H. pylori infection who had a family history of gastric cancer in first-degree relatives, H. pylori eradication treatment reduced the risk of gastric cancer. (Funded by the National Cancer Center, South Korea; ClinicalTrials.gov number, NCT01678027.).
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Affiliation(s)
- Il Ju Choi
- From the Center for Gastric Cancer (I.J.C., C.G.K., J.Y.L., Y.-I.K., M.-C.K.), the Division of Cancer Epidemiology and Management, Research Institute (I.J.C., Y.-I.K., B.P., J.J.), and the Biostatistics Collaboration Team, Research Core Center, Research Institute (B.P.) - all at the National Cancer Center, Goyang, South Korea
| | - Chan Gyoo Kim
- From the Center for Gastric Cancer (I.J.C., C.G.K., J.Y.L., Y.-I.K., M.-C.K.), the Division of Cancer Epidemiology and Management, Research Institute (I.J.C., Y.-I.K., B.P., J.J.), and the Biostatistics Collaboration Team, Research Core Center, Research Institute (B.P.) - all at the National Cancer Center, Goyang, South Korea
| | - Jong Yeul Lee
- From the Center for Gastric Cancer (I.J.C., C.G.K., J.Y.L., Y.-I.K., M.-C.K.), the Division of Cancer Epidemiology and Management, Research Institute (I.J.C., Y.-I.K., B.P., J.J.), and the Biostatistics Collaboration Team, Research Core Center, Research Institute (B.P.) - all at the National Cancer Center, Goyang, South Korea
| | - Young-Il Kim
- From the Center for Gastric Cancer (I.J.C., C.G.K., J.Y.L., Y.-I.K., M.-C.K.), the Division of Cancer Epidemiology and Management, Research Institute (I.J.C., Y.-I.K., B.P., J.J.), and the Biostatistics Collaboration Team, Research Core Center, Research Institute (B.P.) - all at the National Cancer Center, Goyang, South Korea
| | - Myeong-Cherl Kook
- From the Center for Gastric Cancer (I.J.C., C.G.K., J.Y.L., Y.-I.K., M.-C.K.), the Division of Cancer Epidemiology and Management, Research Institute (I.J.C., Y.-I.K., B.P., J.J.), and the Biostatistics Collaboration Team, Research Core Center, Research Institute (B.P.) - all at the National Cancer Center, Goyang, South Korea
| | - Boram Park
- From the Center for Gastric Cancer (I.J.C., C.G.K., J.Y.L., Y.-I.K., M.-C.K.), the Division of Cancer Epidemiology and Management, Research Institute (I.J.C., Y.-I.K., B.P., J.J.), and the Biostatistics Collaboration Team, Research Core Center, Research Institute (B.P.) - all at the National Cancer Center, Goyang, South Korea
| | - Jungnam Joo
- From the Center for Gastric Cancer (I.J.C., C.G.K., J.Y.L., Y.-I.K., M.-C.K.), the Division of Cancer Epidemiology and Management, Research Institute (I.J.C., Y.-I.K., B.P., J.J.), and the Biostatistics Collaboration Team, Research Core Center, Research Institute (B.P.) - all at the National Cancer Center, Goyang, South Korea
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