Spatial and space-time clusters of brain tumor and CNS incidence and mortality in the contiguous USA: 2000–2014

Abstract

Abstract Objective Investigate geographical variations in brain/central nervous system (CNS) cancer incidence and mortality, and test associations between covariates and brain/CNS cancer for the years 2000–2014 in the contiguous USA. Methods The disease surveillance software (SaTScanTM) was used to measure observable geographical variation in brain/CNS cancer incidence and mortality rates and identify and test spatial and space-time clusters with elevated relative risk. The analysis was done with age-adjusted brain/CNS cancer mortality and incidence counts data, including ICD codes C710–C719, C379, C740–C749, and C750–C759. The cancer data were then adjusted for covariates or risk factors, such as obesity, smoking, poverty, race, arsenic, air pollution, land pollution, water pollution, gender, health insurance, diabetes, glyphosate, superfund site density, and proximity to nuclear power plants. Results Several significant spatial clusters of brain/CNS cancer exist for incidence in the Northeast and the Northwest, while spatial mortality clusters cover additional parts of the US. There also exist several significant space-time clusters for incidence and mortality. Conclusions There exist significant and non-random brain/CNS cancer incidence and mortality clusters after adjusting for multiple covariates or risk factors. The thirteen covariates studied can assist in a better understanding of possible associations in geographical areas where the incidence or mortality rates are higher than expected. There is a significant association between several of the studied risk factors and the incidence rates of brain/CNS cancers, and the mortality rates. These results have the potential to provide a scientific framework that is based on surveillance, allowing health agencies to intervene to try to reduce the elevated rates of brain/CNS cancer in some parts of the contiguous US.