A spatial study of oral & pharynx cancer mortality and incidence in the U.S.A.: 2000-2015.

This is a national scale study of spatial oral and pharynx cancer mortality and incidence clusters in the contiguous U.S.A. Spatial and space-time analyses of incidence and mortality rates of oral and pharynx cancers in the contiguous U.S.A. were done at the county resolution, using mortality data for the years 2000-2014 and incidence data for 2001-2015. The disease surveillance software SaTScan™ is used to identify significant cancer clusters that are non-random. In addition to a cluster analysis, regression analysis was used to adjust cancer incidence and mortality for several covariates or risk factors. This is the first study of the contiguous U.S.A. for oral and pharynx cancer in which mortality and incidence rates are studied together. The geographic clustering for mortality is somewhat different from the clustering for incidence. There exist several significant clusters in the contiguous U.S.A., both for oral and pharynx cancer incidence and for mortality. Some of the significant clusters persisted even after adjusting for several key risk factors. These clusters areas suggest a need for further investigation to identify some local concerns or needs to further address such cancer types in those specific sites. We identified statistically significant spatial and space-time clusters of oral and pharynx cancer for mortality and also for incidence in the contiguous US at the county resolution. The most important risk factors for oral cancer incidence are diabetes, alcohol drinking, and obesity, while the top risk factors for mortality are race, cervical cancer, diabetes, and alcohol drinking.

Patterns of ovarian cancer and uterine cancer mortality and incidence in the contiguous USA.

The main objective is to investigate the geographical variation in ovarian cancer and uterine cancer mortality, and to test associations between some risk factors and these cancer types in the contiguous US for mortality and for incidence. The modern disease surveillance software SaTScan™ was used for a spatial cluster analysis to assess any observable geographical variation in ovarian and uterine cancer mortality rates and to identify and test for spatial clusters with elevated relative risk. The analyses were first completed using age adjusted cancer rates for ovarian cancer and for uterine cancer. The cancer data was then adjusted for the risk factors (or covariates) obesity rate, smoking rate, urban, poverty rate, college education rate, race, opioids mortality rate, and for arsenic intake from well water rate. All used data for cancer mortality were for 2000-2014 while incidence data were for 2011-2015. There exist seven significant mortality clusters of ovarian cancer, with large clusters in NW, NE and SE of the US, and there exist two large mortality clusters of uterine cancer in NE and Central US. Most risk factors studied for mortality and for incidence were significant at significance levels much lower than 0.05 for either of the two cancer types, except race for ovarian cancer mortality and arsenic for ovarian incidence. This study has identified several important factors, and these findings could be used for a more effective search for cancer prevention for uterine and ovarian cancer. LIMITATIONS OF THE STUDY: The accuracy of the data could not be controlled as data were downloaded from websites. While the mortality data was complete, the incidence data had counties with missing data. The data were obtained at the county resolution. No data were available on women who had one type of cancer and then had the second type of cancer later in life. Only purely spatial clusters were studied and no temporal analysis was done.

Spatial clusters of life expectancy and association with cardiovascular disease mortality and cancer mortality in the contiguous United States: 1980-2014.

The average life expectancy varies greatly from county to county in USA and there are also spatial variations in the county mortality rates for cardiovascular disease (CVD) and cancer, the top two causes of death. An association between these two groups of diseases has not been identified by cluster analysis previously. The main objective in this study was to investigate and quantify the associations between mortality due to CVD, cancer mortality and life expectancy based on US county data between 1980 and 2014. Regression analysis was used to adjust life expectancy for the mortality due to CVD and that due to cancer. In addition to the spatial life expectancy trends, we also studied existing trends over time with the software JOINPOINT to see how life expectancy is influenced by changes in mortality due to CVD and cancer mortality. The study setting was the 48 contiguous US states, while participants were 3,100 counties and their populations of all ages during the period 1980-2014. The main outcomes are spatial clusters of unusually low or high levels of life expectancy in addition to identifying which county level life expectancy locations were significantly associated with mortality due to CVD and/or cancer. Life expectancy has been improving steadily from 1980 to 2014, but the rate of increase per year (indicated by variation of the trend slope) changed significantly at five joinpoints, the latest of which occurred in 2010 when the slope changed from 0.29 (1980-1982) to 0.03 (2010-2014). Our results reveal that there are significant, purely spatial clusters in some geographical areas where life expectancy rates are significantly higher (or lower) than in the rest of the contiguous US. It is also shown that there is a significant association between the life expectancy level and the corresponding CVD mortality, and there is also a significant association between life expectancy level and the corresponding overall cancer mortality. The general trends (regression slopes) over time for the USA in life expectancy mortality, CVD mortality and cancer mortality have changed significantly after 2009-2010.

A spatial study of bladder cancer mortality and incidence in the contiguous US: 2000-2014.

Bladder cancer is a significant health issue across the United States of America (USA). Evidence of unequal distribution of a disease or condition's incidence and mortality would suggest that important geographically-defined variables may play a role. In this study, a spatial cluster analysis of bladder cancer mortality identified significant hot spots in some parts of the USA. Regression analysis modelling estimated the effects of selected covariates or risk factors for bladder cancer mortality and also incidence. Spatial heat maps and cluster identification were done for mortality and incidence. The main result was the significant association between bladder cancer mortality and arsenic intake from well water. A similar result was also obtained for cancer incidence and arsenic. Additionally, there are certain geographic areas that appear to have bladder cancer mortality rates beyond the simple association with the studied covariates. These geographic areas warrant further investigation to better understand why cancer mortality is unusually high in such geographic areas and to potentially identify additional local concerns or needs to further address bladder cancer mortality in those specific sites.

Spatial Clusters of Breast Cancer Mortality and Incidence in the Contiguous USA: 2000-2014.

BACKGROUND: Clusters of breast cancer with varied incidence or mortality are known to exist. No national scale of analysis of geographical variation in breast cancer incidence has been published before for the contiguous USA. METHODS: This was a spatial cluster analysis of incidence and mortality data on breast cancer in the contiguous USA at the county resolution. Data for the years 2000-2014 were downloaded and analyzed with the software SaTScan with the goal to identify significant spatial clusters of breast cancer. Regression analysis was used to then adjust breast cancer incidence and mortality for several key risk factors such as age, smoking, particulate matter air pollution, physical inactivity, urban living, education level, and race. RESULTS: Spatial clusters of counties for higher than expected breast cancer incidence and also for breast cancer mortality were identified. All identified clusters have p < 0.05. The mortality clusters show the mean breast cancer rates inside the cluster, while the incidence clusters show the relative risk inside each cluster. This is the first study of the contiguous USA for breast cancer mortality and incidence together. The clustering for mortality is quite different from the clustering for incidence. Using the software JOINPOINT, it is shown that the annual US downward trend for breast cancer mortality slowed down in recent years. CONCLUSIONS: There exist several significant clusters in the contiguous USA, both for breast cancer incidence and for breast cancer mortality. Some of the clusters persisted even after adjusting for several key risk factors. These geographic areas warrant further investigation to potentially identify additional local concerns or needs to further address female breast cancer in those specific sites.

Prediction of Vancomycin Dose for Recommended Trough Concentrations in Pediatric Patients With Cystic Fibrosis.

Vancomycin is a key antibiotic used in the treatment of multiple conditions including infections associated with cystic fibrosis and methicillin-resistant Staphylococcus aureus. The present study sought to develop a model based on empirical evidence of optimal vancomycin dose as judged by clinical observations that could accelerate the achievement of desired trough level in children with cystic fibrosis. Transformations of dose and trough were used to arrive at regression models with excellent fit for dose based on weight or age for a target trough. Results of this study indicate that the 2 proposed regression models are robust to changes in age or weight, suggesting that the daily dose on a per-kilogram basis is determined primarily by the desired trough level. The results show that to obtain a vancomycin trough level of 20 µg/mL, a dose of 80 mg/kg/day is needed. This analysis should improve the efficiency of vancomycin usage by reducing the number of titration steps, resulting in improved patient outcome and experience.

Bacterial growth response to photoactive quinones.

Quinones are known producers of reactive oxygen species (ROS) that may be toxic in natural aquatic environments. In this study, the effects of parent quinones and their photodegradation products on bacterial growth were determined, and photochemical ROS formation rates were measured. Using (3)H-leucine incorporation to measure growth of the bacterium Pseudomonas aeruginosa and natural seawater bacterioplankton, growth inhibition was observed when samples were exposed to dichlone, chloranil and sodium anthraquinone-2-sulfonate (AQ2S). For seawater, compared with other quinones tested, dichlone showed the greatest toxicity in the dark, and AQ2S toxicity was greatest during simultaneous exposure to sunlight. Photodegraded chloranil and dichlone showed decreased toxicity compared with nonirradiated samples. For P. aeruginosa, AQ2S and its photodegradation products showed the greatest toxicity during simultaneous exposure to sunlight. Chloranil photodegradation products showed reduced toxicity compared with the parent compound during simultaneous exposure to sunlight. Dichlone was the only compound to show any toxicity to P. aeruginosa in the dark, and its photodegradation products were more toxic than the parent compound. Based on the results of dark and light controlled experiments measuring bacterial growth and estimated ROS production rates, ROS alone does not account for relative differences in toxicity between these quinones.