Spatial Variations and Gender Differences in the Associations Between Lung Cancer Mortality Rate and Contextual...

To develop effective health policies and prevention strategies for reducing lung cancer mortality, it is essential to understand its associations with contextual factors, yet prior studies have produced inconsistent results suggesting the associations might vary over space. Very few studies have explicitly examined gender-specific spatial variations in the associations and investigated how the spatial patterns are shaped by community socioeconomic characteristics. This study aimed to examine spatial variations and gender differences in associations of lung cancer mortality rate with contextual environmental, socioeconomic, and health factors in response to the varying socioeconomic characteristics across 159 counties in Georgia, USA for 2019-2023. Following a cross-sectional ecological study design based on county-level aggregated data, this study linked three environmental, fifteen socioeconomic, and fourteen health factors to lung cancer mortality rates for males and females, and conducted various statistical and spatial analyses including Geographically Weighted Regression (GWR) to explore the spatially varying associations of lung cancer mortality rate with those contextual factors. As an explanatory local spatial statistical technique, GWR revealed that the associations varied across space and gender, with significant links observed in fewer counties than nonsignificant ones. No significant spatial autocorrelation was detected in the residuals from the GWR models of lung cancer mortality rate for either males or females (I=-0.121, p = 0.064 for males; I=-0.110, p = 0.098 for females). Key findings include: (1) radon was a more consistent factor associated with elevated lung cancer mortality rates than PM_2.5 and ozone, particularly for males in urban and suburban areas, while air pollutants were significant only in some rural counties; (2) higher socioeconomic and household vulnerabilities increased risks for both genders in rural counties, whereas higher minority populations and greater housing density were linked to lower risks, especially for males in northern urban/suburban counties; (3) prevalences of chronic diseases and smoking were significant factors associated with elevated lung cancer mortality rate for both genders, with chronic diseases showing more spatially consistent effects among females, while annual checkup was a stronger factor associated with reduced lung cancer mortality rate for females, especially in less socioeconomically vulnerable urban/suburban counties; and (4) health factors had the strongest and most spatially consistent effects on mortality rate, followed by socioeconomic and then environmental factors. These findings suggest that effective lung cancer control requires public health policies and preventive measures to be locally tailored, gender-sensitive, emphasizing chronic disease management, smoking cessation, regular preventive care, and socioeconomic development.