1970-2013年山东省结直肠癌死亡空间聚集性分析及其变化趋势 (Spatial clustering analysis and trend of colorectal cancer death in Shandong Province of China, 1970-2013)

Objective: To explore the spatial aggregation and trend of colorectal cancer mortality in different counties of Shandong Province from 1970 to 2013, and to provide the scientific basis for making the plan of colorectal cancer prevention and control. Methods: Cancer mortality data was obtained from Shandong Death Registration System and three nationwide retrospective cause-of-death surveys. Used average reported mortality rate(ARMR) and age standardized mortality rate(ASMR) to describe the trend of colorectal cancer in different years.Difference decomposing method was applied to estimate the contribution of demographic and non-demographic factors for the change of mortality.ArcGIS 10.2 was used for spatial analysis, and SaTScan v9.4 was used for spatial clustering analysis of colorectal cancer mortality. Results: From 2011 to 2013, the ARMR of colorectal cancer (8.50/100 000) in Shandong Province increased by 150.00%, 67.98% and 27.25% respectively compared with that of 1970-1974(3.40/100 000), 1990-1992 (5.06/100 000) and 2004-2005(6.68/100 000). While ASMR increased first and then decreased. The ASMR in 2011-2013 (3.06/100 000) increased by 19.07% compared with that of 1970-1974, and decreased by 7.83% and 2.24% compared with that of 1990-1992 and 2004-2005, respectively.According to the difference decomposition analysis of colorectal cancer mortality in different years, the increasing contribution value of population factors to the colorectal cancer mortality rate increased from 6.86% of 1990-1992 to 47.61% of 2004-2005, and 58.04% of 2011-2013.However, the contribution of non population factors to the increase of colorectal cancer mortality was decreasing. According to the spatial distribution of colorectal cancer mortality, the ARMR of colorectal cancer in different counties were quite different, ranging from 2.02 to 26.53/100 000.Used the spatial scanning statistical software to analyze the spatial clustering of colorectal cancer mortality, many high mortality clustering areas were found.From 2011 to 2013, the clustering areas were distributed in the east of Shandong Province(Qingdao, Yantai and Weihai), as well as in the north and central part of Shandong Province(Jinan, Zibo and Dongying). The risk of colorectal cancer death in these clusters was 1.23-1.90 times higher than that in other regions. The spatial clustering distribution of colorectal cancer mortality of 1970-1974 was different from that of 2011-2013. The distribution of aggregation areas was relatively scattered of 2011-2013, and there were multiple aggregation areas in the southwest of Shandong Province. Conclusion: There are significant temporal and spatial changes in colorectal cancer mortality in Shandong Province from 1970 to 2013.Based on these changing trends and their geographic spatial clustering, the related risk factors for colorectal cancer mortality should be further explored, in order to provide the basis for formulating feasible regionalized prevention and control measures of colorectal cancer.