Abstract
The increasing pattern of colorectal cancer (CRC) in specific geographic region, compounded by interaction of multifactorial determinants, showed the tendency to cluster. The review aimed to identify and synthesize available evidence on clustering patterns of CRC incidence, specifically related to the associated determinants. Articles were systematically searched from four databases, Scopus, Web of Science, PubMed, and EBSCOHost. The approach for identification of the final articles follows PRISMA guidelines. Selected full-text articles were published between 2016 and 2021 of English language and spatial studies focusing on CRC cluster identification. Articles of systematic reviews, conference proceedings, book chapters, and reports were excluded. Of the final 12 articles, data on the spatial statistics used and associated factors were extracted. Identified factors linked with CRC cluster were further classified into ecology (health care accessibility, urbanicity, dirty streets, tree coverage), biology (age, sex, ethnicity, overweight and obesity, daily consumption of milk and fruit), and social determinants (median income level, smoking status, health cost, employment status, housing violations, and domestic violence). Future spatial studies that incorporate physical environment related to CRC cluster and the potential interaction between the ecology, biology and social determinants are warranted to provide more insights to the complex mechanism of CRC cluster pattern.
Highlights
Cancer is one of the most important causes of mortality and morbidity around the globe
Comparing study locations based on the WHO regions, four studies [11,32,41,42] accounted for the Region of the Americas (AMR), two studies [35,43] from the European Region (EUR)
Attempts to examine the association of area-level determinants and colorectal cancer (CRC) cluster are lacking in ecology as compared to the common biology and social attributes
Summary
Cancer is one of the most important causes of mortality and morbidity around the globe. It is the third cause of death after cardiovascular diseases and road traffic injuries as reported by the Global Burden of Disease Study 2017 [1]. No single hazardous factor is plausibly related to CRC, but individual factors such as sex, age, and family history, lifestyle behaviors including alcohol consumption, high intake of red meat and processed meat, low fruit and vegetable intake, high-fat diet, and physical inactivity were massively studied [6,7,8]. Education on the risk factors for CRC have been. Was the sample frame taken from an appropriate population base so that it closely represented the target/reference population under investigation? Is it clear what outcome variables was used to measured correctly determine using instrustatistical ments/measurements significance that had been and/or trialled, piloted, or precision published estimates? previously?
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