Joint Disease Mapping of Two Digestive Cancers in Golestan Province, Iran Using a Shared Component Model

Recent studies have suggested the occurrence patterns and related diet factor of esophagus cancer (EC) and gastric cancer (GC). Incidence of these cancers was mapped either in general and stratified by sex. The aim of this study was to model the geographical variation in incidence of these two related cancers jointly to explore the relative importance of an intended risk factor, diet low in fruit and vegetable intake, in Golestan, Iran.

Data on the incidence of EC and GC between 2004 and 2008 were extracted from Golestan Research Center of Gastroenterology and Hepatology, Hamadan, Iran. These data were registered as new observations in 11 counties of the province yearly. The Bayesian shared component model was used to analyze the spatial variation of incidence rates jointly and in this study we analyzed the data using this model. Joint modeling improved the precision of estimations of underlying diseases pattern, and thus strengthened the relevant results.

From 2004 to 2008, the joint incidence rates of the two cancers studied were relatively high (0.8-1.2) in the Golestan area. The general map showed that the northern part of the province was at higher risk than the other parts. Thus the component representing diet low in fruit and vegetable intake had larger effect of EC and GC incidence rates in this part. This incidence risk pattern was retained for female but for male was a little different.

Using a shared component model for joint modeling of incidence rates leads to more precise estimates, so the common risk factor, a diet low in fruit and vegetables, is important in this area and needs more attention in the allocation and delivery of public health policies.