Liver Cancer Incidence and Area-Level Geographic Disparities in Pennsylvania-A Geo-Additive Approach.

Angel G Ortiz,Shannon M Lynch,Evelyn T González,Kristen A Sorice,Kevin A Henry,Minhhuyen Nguyen,Daniel Wiese

doi:10.3390/ijerph17207526

Abstract

Many neighborhood socioeconomic index measures (nSES) that capture neighborhood deprivation exist but the impact of measure selection on liver cancer (LC) geographic disparities remains unclear. We introduce a Bayesian geoadditive modeling approach to identify clusters in Pennsylvania (PA) with higher than expected LC incidence rates, adjusted for individual-level factors (age, sex, race, diagnosis year) and compared them to models with 7 different nSES index measures to elucidate the impact of nSES and measure selection on LC geospatial variation. LC cases diagnosed from 2007–2014 were obtained from the PA Cancer Registry and linked to nSES measures from U.S. census at the Census Tract (CT) level. Relative Risks (RR) were estimated for each CT, adjusted for individual-level factors (baseline model). Each nSES measure was added to the baseline model and changes in model fit, geographic disparity and state-wide RR ranges were compared. All 7 nSES measures were strongly associated with high risk clusters. Tract-level RR ranges and geographic disparity from the baseline model were attenuated after adjustment for nSES measures. Depending on the nSES measure selected, up to 60% of the LC burden could be explained, suggesting methodologic evaluations of multiple nSES measures may be warranted in future studies to inform LC prevention efforts.

Highlights

According to the American Cancer Society, liver cancer (LC) has more than tripled since 1980 with mortality rates increasing by nearly 3% every year since 2000 [1]
This study found that the incorporation of neighborhood socioeconomic index measures (nSES) indices and single nSES variables related to neighborhood stability and race/ethnicity, coupled with individual-level race/ethnicity, could lead to the identification of fewer neighborhoods to target for intervention than previous recommendations to target Black, Hispanics and those born 1950–1959 [9]
We found that neighborhood Socio-economic status (SES) index measures help to explain liver cancer geographic disparities more than individual factors alone

Summary

Introduction

According to the American Cancer Society, liver cancer (LC) has more than tripled since 1980 with mortality rates increasing by nearly 3% every year since 2000 [1]. More than 40,000 new cases and over 30,000 deaths attributed to LC are estimated for 2020 nationwide [1]. Like the U.S, liver cancer incidence rates are on the rise in Pennsylvania, with an estimated 1870 new cases and 1270 deaths from liver cancer likely to occur in 2020, accounting for about 4% of all cancer-related mortalities in the coming year [2]. In the last two decades, Hispanics and Asians continue to have the highest incidence of liver cancer and in the Black population, liver cancer incidence rates are increasing rapidly, widening the gap between Whites and Blacks [3].

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Conclusion