Int J Health Geogr - Feasibility and utility of mapping disease risk at the neighbourhood level within a Canadian public health unit: an ecological study.


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CKGROUND: We conducted spatial analyses to determine the geographic variation of cancer at the neighbourhood level (dissemination areas or DAs) within the area of a single Ontario public health unit, Wellington-Dufferin-Guelph, covering a population of 238,326 inhabitants. Cancer incidence data between 1999 and 2003 were obtained from the Ontario Cancer Registry and were geocoded down to the level of DA using the enhanced Postal Code Conversion File. The 2001 Census of Canada provided information on the size and age-sex structure of the population at the DA level, in addition to information about selected census covariates, such as average neighbourhood income.RESULTS: Age standardized incidence ratios for cancer and the prevalence of census covariates were calculated for each of 331 dissemination areas in Wellington-Dufferin-Guelph. The standardized incidence ratios (SIR) for cancer varied dramatically across the dissemination areas. However, application of the Moran's I statistic, a popular index of spatial autocorrelation, suggested significant spatial patterns for only two cancers, lung and prostate, both in males (p < 0.001 and p = 0.002, respectively). Employing Bayesian hierarchical models, areas in the urban core of the City of Guelph had significantly higher SIRs for male lung cancer than the remainder of Wellington-Dufferin-Guelph; and, neighbourhoods in the urban and surrounding rural areas of Orangeville exhibited significantly higher SIRs for prostate cancer. After adjustment for age and spatial dependence, average household income attenuated much of the spatial pattern of lung cancer, but not of prostate cancer.CONCLUSION: This paper demonstrates the feasibility and utility of a systematic approach to identifying neighbourhoods, within the area served by a public health unit, that have significantly higher risks of cancer. This exploratory, ecologic study suggests several hypotheses for these spatial patterns that warrant further investigations. To the best of our knowledge, this is the first Canadian study published in the peer-reviewed literature estimating the risk of relatively rare public health outcomes at a very small areal level, namely dissemination areas.

Resumo Limpo

ckground conduct spatial analys determin geograph variat cancer neighbourhood level dissemin area das within area singl ontario public health unit wellingtondufferinguelph cover popul inhabit cancer incid data obtain ontario cancer registri geocod level da use enhanc postal code convers file census canada provid inform size agesex structur popul da level addit inform select census covari averag neighbourhood incomeresult age standard incid ratio cancer preval census covari calcul dissemin area wellingtondufferinguelph standard incid ratio sir cancer vari dramat across dissemin area howev applic moran statist popular index spatial autocorrel suggest signific spatial pattern two cancer lung prostat male p p respect employ bayesian hierarch model area urban core citi guelph signific higher sir male lung cancer remaind wellingtondufferinguelph neighbourhood urban surround rural area orangevill exhibit signific higher sir prostat cancer adjust age spatial depend averag household incom attenu much spatial pattern lung cancer prostat cancerconclus paper demonstr feasibl util systemat approach identifi neighbourhood within area serv public health unit signific higher risk cancer exploratori ecolog studi suggest sever hypothes spatial pattern warrant investig best knowledg first canadian studi publish peerreview literatur estim risk relat rare public health outcom small areal level name dissemin area

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