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Spatial Analysis of Lung Cancer Mortality in the American West to Improve Allocation of Medical Resources
Applied Spatial Analysis and Policy ( IF 2.043 ) Pub Date : 2019-12-27 , DOI: 10.1007/s12061-019-09331-5
Ruth Kerry , Pierre Goovaerts , Ben Ingram , Casey Tereault

Over 80% of lung cancer incidence in the USA has been linked with smoking, yet causes of lung cancer mortality (LCM) are more complex and have been linked with a range of cultural, environmental, economic and health, lifestyle variables. These all vary spatially yet spatial studies of lung cancer are rare. This paper investigates spatial patterns in county-level LCM and the factors related to it in the western US which has markedly lower rates of LCM than the eastern US. Two variables, not previously investigated, that could be partially responsible for lower rates in the west are included in the analysis. These are elevation and membership of the Church of Jesus Christ of Latter-day Saints (LDS). Analysis involved aspatial and spatial regression, geographically weighted regression (GWR) and univariate and bi-variate local Moran’s I (LMI) cluster analysis. Regression showed that the explanatory power of covariates varies with the area or region studied although the LDS population and elevation, were important both nationally and within the west. GWR analysis showed how correlations between the dependent and independent variables, and regression coefficients, vary spatially within the western region. This showed broad and smooth trends in the non-stationarity of correlations and coefficients with generally different behavior in the coastal compared to mountain west states. Bivariate LMI analysis was helpful in identifying small clusters of problem counties. These included counties in WY and CO that produce oil and gas with large transient male populations that smoke, counties in CA associated with severe air pollution problems and poor rural counties in several states that have high rates of unemployment and lack of medical facilities. This improved understanding of spatial patterns could be used so that screening/educational efforts and location of the medical facilities can be improved to target the locations and population groups most at risk.

中文翻译:

美国西部肺癌死亡率的空间分析,以改善医疗资源的分配

在美国,超过80%的肺癌发病率与吸烟有关,但肺癌死亡率(LCM)的原因更为复杂,并与一系列文化,环境,经济和健康,生活方式变量有关。这些都在空间上变化,但是对肺癌的空间研究很少。本文研究了县级LCM的空间格局及其相关因素,而在美国西部,LCM的发生率明显低于美国东部。分析中包括两个以前没有调查过的变量,它们可能是造成西部地区房价下降的部分原因。这些是耶稣基督后期圣徒教会(LDS)的职位和成员资格。分析涉及空间和空间回归,地理加权回归(GWR)以及单变量和二变量局部Moran I(LMI)聚类分析。回归表明,尽管LDS的人口和海拔在全国和西部都很重要,但协变量的解释力随所研究的区域或地区而异。GWR分析表明,在西部地区,因变量和自变量之间的相关性以及回归系数在空间上如何变化。与沿海山区国家相比,沿海地区的相关系数和系数的非平稳性表现出广泛而平稳的趋势,且行为普遍不同。二元LMI分析有助于确定问题县的小集群。其中包括怀俄明州和科罗拉多州生产石油和天然气的县,这些县有大量短暂的男性吸烟人群,加利福尼亚州的县与严重的空气污染问题相关,而一些州的贫困县失业率高且缺乏医疗设施。可以使用对空间模式的这种更好的理解,以便可以改进筛查/教育工作以及医疗设施的位置,以针对最容易受到威胁的位置和人群。
更新日期:2019-12-27
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