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Shreves AH, Buller ID, Chase E, Creutzfeldt H, Fisher JA, Graubard BI, Hoover RN, Silverman DT, Devesa SS, Jones RR. Geographic Patterns in U.S. Lung Cancer Mortality and Cigarette Smoking. Cancer Epidemiol Biomarkers Prev 2023; 32:193-201. [PMID: 36413442 PMCID: PMC9905286 DOI: 10.1158/1055-9965.epi-22-0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/08/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite the success of smoking cessation campaigns, lung cancer remains the leading cause of cancer death in the U.S. Variations in smoking behavior and lung cancer mortality are evident by sex and region. METHODS Applying geospatial methods to lung cancer mortality data from the National Vital Statistics System and county-level estimates of smoking prevalences from the NCI's Small Area Estimates of Cancer-Related Measures, we evaluated patterns in lung cancer mortality rates (2005-2018) in relation to patterns in ever cigarette smoking prevalences (1997-2003). RESULTS Overall, ever smoking spatial patterns were generally associated with lung cancer mortality rates, which were elevated in the Appalachian region and lower in the West for both sexes. However, we also observed geographic variation in mortality rates that is not explained by smoking. Using Lee's L statistic for assessing bivariate spatial association, we identified counties where the ever smoking prevalence was low and lung cancer rates were high. We observed a significant cluster of counties (n = 25; P values ranging from 0.001 to 0.04) with low ever smoking prevalence and high mortality rates among females around the Mississippi River region south of St. Louis, Missouri and a similar and smaller cluster among males in Western Mississippi (n = 12; P values ranging from 0.002 to 0.03) that has not been previously described. CONCLUSIONS Our analyses identified U.S. counties where factors other than smoking may be driving lung cancer mortality. IMPACT These novel findings highlight areas where investigation of environmental and other risk factors for lung cancer is needed.
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Affiliation(s)
- Alaina H Shreves
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Ian D Buller
- Occupational and Environmental Epidemiology Branch, DCEG, NCI, NIH Bethesda, Maryland.,Cancer Prevention Fellowship Program, Division of Cancer Prevention, NCI, NIH, Bethesda, Maryland
| | - Elizabeth Chase
- Biostatistics Branch, DCEG, NCI, NIH, Bethesda, Maryland.,Department of Biostatistics, University of Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Hannah Creutzfeldt
- Occupational and Environmental Epidemiology Branch, DCEG, NCI, NIH Bethesda, Maryland.,Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Jared A Fisher
- Occupational and Environmental Epidemiology Branch, DCEG, NCI, NIH Bethesda, Maryland
| | | | | | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, DCEG, NCI, NIH Bethesda, Maryland
| | - Susan S Devesa
- Infections and Immunology Branch, DCEG, NCI, NIH, Bethesda, Maryland
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