精准防控视角下华中某县肝癌时空特征与环境健康风险分析

Temporal and spatial characteristics and environmental health risk analysis of liver cancer in a county of Central China from perspective of precise prevention and control

  • 摘要:
    背景 精准防控指将整个大区域划分成若干个小区域,明确每一个小区域的发病信息,并据此在小区域上开展防控的手段。它是开展肝癌全面防控的重要抓手,能够让肝癌防控更为精准和高效。目前国内外针对肝癌防控的主流研究大多只精确到省市级,难以符合精准防控的要求。
    目的 以华中地区典型县S县为例,探讨乡镇尺度上肝癌的时空分布与环境健康风险,为精准防控提供科学参考。
    方法 基于S县2009—2018年的肿瘤登记数据中的肝癌数据及相关环境数据,利用地理信息系统制图、全局莫兰指数分析和冷热点探测,开展S县的肝癌时空分析。利用地理探测器,对S县肝癌与各项环境因素细颗粒物(PM2.5)、气溶胶光学厚度(AOD)、气温、降水量、耕地面积占比、归一化植被指数(NDVI)、人口密度、人均国内生产总值(GDP)的相关性进行初步探讨。利用随机森林模型,探讨与S县肝癌关联性较大的环境因素及其累积暴露年限。在此基础上基于四分位数原理构建肝癌总发病率以及分年龄、性别的发病率排名系统并提出精准防控建议。
    结果 ZD、HD、BYJ是肝癌发病率最高的乡镇,逐年发病率的平均值分别为62.84/10万、58.28/10万、40.21/10万;除上述三乡镇外,LW是男性人群和60岁以下人群的肝癌高发区,对应人群逐年发病率平均值分别为50.47/10万和10.59/10万,而LianC是女性人群和60岁及以上人群肝癌高发区,对应人群逐年发病率平均值分别为23.39/10万和131.10/10万。肝癌发病与人口密度、人均GDP、NDVI、AOD关系密切,重要性分别为0.92、0.50、0.43、0.36。持续暴露于危险环境因素到肝癌发病时间间隔多为10年。
    结论 在后续防控工作中,S县的HD、ZD、BYJ需要大力开展肝癌筛查诊治工作,同时HD和LW需要继续贯彻落实环境保护工作。LW需要加强对男性人群和60岁以下人群的肝癌防治工作。LianC需要加强对女性人群和60岁及以上人群的肝癌防治工作。HD周边乡镇需要严防肝癌突然性爆发。此外,还需要加强全县人民特别是60岁及以上人群参与肝癌筛查的意愿。本研究对于精细尺度上开展环境健康效应分析并进行不同人群的肝癌防控和环境保护具有重要参考意义。

     

    Abstract:
    Background Precise prevention and control refers to the means of dividing a large area into several small areas, clarifying the disease information in each small area, and carrying out prevention and control program in the small areas accordingly. It is an important starting point for a comprehensive prevention and control program targeting liver cancer, which can make the prevention and control of liver cancer more accurate and efficient. At present, most of the mainstream research on liver cancer prevention and control at home and abroad is only on the provincial and municipal level, which is difficult to meet the requirements of precise prevention and control.
    Objective Taking S County, a typical county in Central China as an example, to explore the temporal and spatial distribution of liver cancer and environmental health risks at the township scale, so as to provide scientific reference for developing precise prevention and control program.
    Methods Based on the liver cancer data in the tumor registry data and related environmental variables of S County from 2009 to 2018, a spatiotemporal analysis was carried out by using geographic information system mapping, global Moran index analysis, and cold and hot spot detection. The correlations between liver cancer and various environmental factors fine particulate matter (PM2.5), aerosol optical depth (AOD), temperature, precipitation, proportion of cultivated land, normalized difference vegetation index (NDVI), population density, and per capita gross domestic product (GDP) in S County were preliminarily evaluated by using geodetectors. The environmental factors and their cumulative exposure years that were closely related to the liver cancer in S County were investigated by random forest model. On this basis, the towns were categorized based on total, age-specified, and gender-specified incidences of liver cancer through quartile ranking, and precise prevention and control suggestions were proposed.
    Results ZD, HD and BYJ had the highest incidence rates of liver cancer, and the average annual incidence rate was 628/105, 58.28/105, and 40.21/ 105, respectively. In addition to the above three townships, LW was a high incidence area of liver cancer in male population and people under the age of 60 years, whose average annual incidence rate was 50.47/105 and 10.59/105, respectively, while LianC was a high incidence area of liver cancer in female population and people aged 60 years and above, whose average annual incidence was 23.39/105 and 131.10/105 respectively. The incidence of liver cancer was closely related to population density, GDP per capita, NDVI, and AOD, and their importance indicators were 0.92, 0.50, 0.43, and 0.36, respectively. The average time interval between continuous exposure to dangerous environmental factors and the diagnosis of liver cancer was 10 years.
    Conclusion HD, ZD, and BYJ of S County should vigorously carry out liver cancer screening, diagnosis, and treatment in the follow-up prevention and control, while HD and LW should continue to implement environmental protection. LW needs to strengthen the prevention and treatment of liver cancer in male population and population under 60 years old. LianC needs to strengthen the prevention and control of liver cancer in female population and people of and over 60 years of age. The towns around HD need to prevent the sudden outbreak of liver cancer. In addition, it is also necessary to strengthen the willingness of people in the county, especially those of and over 60 years old, to participate in liver cancer screening. This study provides important reference for the analysis of environmental health effects at a fine scale and for the prevention and control of liver cancer and environmental protection in different populations.

     

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