Abstract
BackgroundThere have been reports on regional variation in prevalence of hepatitis B and C, and Clonorchis sinensis (C. sinensis) infection, which indicates potential of spatial variation in liver cancer and gallbladder cancer incidence in Korea. Therefore, we aimed to assess the regional variation of liver and gallbladder cancer incidence and its determinants based on the regional distribution of risk factors, including hepatitis B infection in Korea.MethodsThis study used an ecological study design and district-level cancer incidence statistics generated by the National Cancer Center. Spatial clusters of liver and gallbladder cancer incidence were detected based on spatial scan statistics using SaTScan™ software. We set the size of maximum spatial scanning window of 25 and 35% of the population at risk for analyses of liver and gallbladder cancer, respectively. Significance level of 0.05 was used to reject the null hypothesis of no cluster. We fitted the Besag-York-Mollie model using integrated nested Laplace approximations to assess factors that influence the regional variation in cancer incidence.ResultsSpatial clusters with high liver cancer incidence rates were detected in the southwestern and southeastern regions of Korea. High gallbladder cancer incidence rates are clustered in the southeastern region. Regional liver cancer incidence can be accounted for the prevalence of high household income (coefficient, − 0.10; 95% credible interval [CI], − 0.18 to − 0.02), marital status (coefficient, − 0.14; 95% CI, − 0.25 to − 0.03), the incidence of hepatitis B (coefficient, 0.87; 95% CI, 0.29 to 1.44), and liver cancer screening (coefficient, 0.06; 95% CI, 0.00 to 0.12), while gallbladder cancer incidence was related to the prevalence of high household income (coefficient, − 0.03; 95% CI, − 0.05 to 0.00) and living close to a river with a high prevalence of liver fluke infection (coefficient, 0.55; 95% CI, 0.14 to 0.96).ConclusionsThis study demonstrated geographic variation in liver and gallbladder cancer incidence, which can be explained by determinants such as hepatitis B, income, marital status, and living near a river.
Highlights
There have been reports on regional variation in prevalence of hepatitis B and C, and Clonorchis sinensis (C. sinensis) infection, which indicates potential of spatial variation in liver cancer and gallbladder cancer incidence in Korea
The prevalences of hepatitis B infection, heavy alcohol consumption, receiving liver cancer screenings, who were married people and living with their spouses, visiting a public health center at least once within the last year, and people who were diagnosed with gastroduodenal ulcers in the spatial cluster region with high liver cancer incidence was significantly higher
We found that the high gallbladder cancer incidence rate was linked to living in the Sigungu districts near rivers located in areas with a high prevalence of C. sinensis infection
Summary
There have been reports on regional variation in prevalence of hepatitis B and C, and Clonorchis sinensis (C. sinensis) infection, which indicates potential of spatial variation in liver cancer and gallbladder cancer incidence in Korea. A higher prevalence of liver fluke infection was observed among gastrointestinal disease patients whose residence or place of birth was near rivers located in the Gyeongsang and South Jeolla provinces than among patients who lived or were born in regions near rivers located in other divisions [9]. These results imply that regional variation has the potential to cause a difference in liver and gallbladder cancer incidence rates in Korea due to regional differences in the prevalence of hepatitis B and C. sinensis
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