Abstract
Reported age standardized incidence rates for esophageal cancer in Iran are 0.88 and 6.15 for females and males, at fifth and the eighth ranks, respectively, of cancers overall. The present study aimed to map relative risk using more realistic and less problematic methods than common estimators. In this ecological investigation, the studied population consisted of all esophageal cancer patients in Iran from 2005 to 2007. The Bayesian multilevel space-time model with three levels of county, province, and time was used to measure the relative risk of esophageal cancer. Analyses were conducted using R package INLA. The total number of registered patients was 7,160. According to the results, the three-level model with adjustment for risk factors of physical activity and smoking had the best fit among all models .The overall temporal trend was significantly increasing. At county level, Ahar, Marand, Salmas, Bojnoord, Saghez, Sarakhs, Shahroud and Torbatejam had the highest relative risks. Physical activity was found to have significant direct association with risk of developing esophageal cancer. Given to great variation across geographical areas, many different factors affect the incidence of esophageal cancer. Conducting further studies at the individual level in areas with high incidence could provide more detailed information on risk factors of esophageal cancer.
Highlights
The causes of human death have been shifted from infectious diseases to non-communicable ones; In developed countries, the incidence of cancers is outpacing cardiovascular diseases (Mohammadpour Tahamtan et al, 2013).Cancer is one of the main causes of death and disabling factors all around the world
North Khorasan, Golestan, Ardabil, West Azerbaijan, East Azerbaijan, Kurdistan and some regions of Semnan provinces) have higher levels of esophageal cancer incidence in comparison with desert and southern regions(especially Sistan and Baluchestan, Bushehrand and Hormozgan provinces).It is necessary to investigate the causes of cancer in high-risk areas and the relationship between these factors and the results of this study
The present investigation is the first mapping of esophageal cancer incidence rate in Iran at county level
Summary
The causes of human death have been shifted from infectious diseases to non-communicable ones; In developed countries, the incidence of cancers is outpacing cardiovascular diseases (Mohammadpour Tahamtan et al, 2013).Cancer is one of the main causes of death and disabling factors all around the world. Cancer is the second cause of death in the world (Scholefield, 2000) and Over 70 percent of deaths occur due to cancer in developing and developed countries (Mathers and Boschi-Pinto, 2000). It is the third cause of death in Iran after cardiovascular diseases and accidents. The three-level model with adjustment for risk factors of physical activity and smoking had the best fit among all models .The overall temporal trend was significantly increasing. Conducting further studies at the individual level in areas with high incidence could provide more detailed information on risk factors of esophageal cancer
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