Dataset Information

A spatiotemporal analysis of invasive cervical cancer incidence in the state of Maryland between 2003 and 2012.

ABSTRACT: PURPOSE:Invasive cervical cancer (ICC) rates have tremendously declined in the United States, yet new cases consistently occur in Maryland and throughout the United States. We hypothesized that although rates have generally declined, this decline is uneven across counties and over time. METHODS:Space-time cluster detection analysis was conducted to evaluate clusters of ICC incidence at the county level within Maryland between 2003 and 2012. RESULTS:The most likely cluster was a cluster of low incidence, which included 6 counties in eastern Maryland for the period 2009-2012. A secondary cluster of low rates, comprising 2 metropolitan counties in northern Maryland, was observed for the period 2009-2012. Two of the three clusters of high ICC rates occurred in 2009-2012 in the large metropolitan area of Baltimore City and another cluster in Frederick County, in rural western Maryland. The third cluster of high rates was observed 2005-2008, in western Maryland. CONCLUSION:In recent periods, some Maryland counties have experienced anomalously high or low ICC incidence. Clusters of high incidence are not explained by differences in screening rates and may be due to failures in follow-up care for cervical abnormalities that need to be investigated. Clusters of low incidence may represent areas of successful ICC control.

SUBMITTER: Peprah S

PROVIDER: S-EPMC5899020 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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A spatiotemporal analysis of invasive cervical cancer incidence in the state of Maryland between 2003 and 2012.

Peprah Sally S Curreiro Frank C FC Hayes Jennifer H JH Stern Kimberly K Parekh Shalini S D'Souza Gypsyamber G

Cancer causes & control : CCC 20180312 4-5

<h4>Purpose</h4>Invasive cervical cancer (ICC) rates have tremendously declined in the United States, yet new cases consistently occur in Maryland and throughout the United States. We hypothesized that although rates have generally declined, this decline is uneven across counties and over time.<h4>Methods</h4>Space-time cluster detection analysis was conducted to evaluate clusters of ICC incidence at the county level within Maryland between 2003 and 2012.<h4>Results</h4>The most likely cluster w ...[more]

PMID: 29532367

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Project description:BackgroundLittle is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women's higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women.MethodsData for cervical cancers diagnosed in 2003-2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women.ResultsOf 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ?1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9-3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality.ConclusionsSurvival was lowest for women with comorbidity. However, there wasn't a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted.ImpactThe results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).

Project description:BackgroundDisparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa.MethodsWe included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004-2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors.ResultsWe included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health.ConclusionsThe results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.

Project description:BackgroundHIV-infected persons are at increased risk of opportunistic infections, including invasive nontyphoidal Salmonella (iNTS) infections; antiretroviral therapy (ART) reduces this risk. We explored changing iNTS incidence associated with increasing ART availability in South Africa.MethodsLaboratory-based surveillance for iNTS was conducted in Gauteng Province, South Africa, with verification using the National Health Laboratory Service's Central Data Warehouse (CDW), between 2003 and 2013. Isolates were serotyped at the Centre for Enteric Diseases. CDW data on patient numbers obtaining HIV viral load measurements provided estimates of numbers of HIV-infected patients receiving ART. A Poisson regression model was used to measure the changing incidence of iNTS infection from 2003 to 2013. The correlation between the incidence of iNTS and ART use from 2004 to 2013 was determined using Pearson's correlation coefficient.ResultsFrom 2003-2013, the incidence of iNTS per 100,000 population per year decreased from 5.0 to 2.2 (p < .001). From 2004 to 2013, the incidence per 100,000 population of HIV viral load testing increased from 75.2 to 3,620.3 (p < .001). The most common serotypes causing invasive disease were Salmonella enterica serovar Typhimurium (Salmonella Typhimurium), and Salmonella Enteritidis: 2,469 (55.4%) and 1,156 (25.9%) of 4,459 isolates serotyped, respectively. A strong negative correlation was observed between decreasing iNTS incidence and increasing ART use from 2004 to 2013 (r = -0.94, p < .001). Similarly, decreasing incidence of invasive Salmonella Typhimurium infection correlated with increasing ART use (r = -0.93, p < .001). Incidence of invasive Salmonella Enteritidis infection increased, however (r = 0.95, p < .001). Between 2003 and 2004, fewer adult men than women presented with iNTS (male-to-female rate ratio 0.73 and 0.89, respectively). This was reversed from 2005 through 2013 (ranging from 1.07 in 2005 to 1.44 in 2013). Adult men accessed ART less (male-to-female rate ratio ranging from 0.61 [2004] to 0.67 [2013]).ConclusionsThe incidence of iNTS infections including Salmonella Typhimurium decreased significantly in Gauteng Province in association with increased ART utilization. Adult men accessed ART programs less than women, translating into increasing iNTS incidence in this group. Monitoring iNTS incidence may assist in monitoring the ART program. Increasing incidence of invasive Salmonella Enteritidis infections needs further elucidation.

Dataset Information

A spatiotemporal analysis of invasive cervical cancer incidence in the state of Maryland between 2003 and 2012.

Publications

A spatiotemporal analysis of invasive cervical cancer incidence in the state of Maryland between 2003 and 2012.

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