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摘要
A spatial scan statistic was used to monitor geographic variation among 35,167 incident prostate cancer cases diagnosed in Massachusetts, Connecticut and Rhode Island from 1994 to 1998, in relation to the 1990 populations of men 20+ years of age living in that region. Results from the combined-states analysis were compared to those from single-states. Impact of scanning procedures set to examine up to 50% or no more than10% of at-risk populations also was evaluated.With scanning set to 50%, 5 locations in the combined-states analysis were identified with markedly distinct incidence rates. Fewer than expected cases were estimated for nearly all Connecticut, Rhode Island and West Central Massachusetts, whereas census tracts on and around Cape Cod, and areas of Southwestern Connecticut and adjacent to greater Boston were estimated to have yielded more than expected incidence. Results of single-state analyses exhibited several discrepancies from the combined-states analysis. More conservative scanning found many more locations with varying incidence, but discrepancies between the combined- and single-state analysis were fewer.It is important to acknowledge the conditional nature of spatial analyses and carefully consider whether a true cluster of events is identified or artifact stemming from selection of study area size and/or scanning properties.Spatial analyses of health events can provide helpful information that informs our understanding of the determinants and control of diseases within populations. Geographic studies have discerned the non-random nature of health hazards [1], at-risk populations [2], disease occurrence [3,4], progression [5], screening [6], treatment [7,8], and end results [9,10].By their nature, spatial analyses of health events are zero sum problems wherein overall rates (cases per 100,000 persons), proportions (deaths among diagnosed cases) or case counts (birds carrying West Nile virus) applicable to a defined study area (nation, region, stat
