Elsevier

Cancer Epidemiology

Volume 52, February 2018, Pages 63-69
Cancer Epidemiology

Nationwide analysis on the impact of socioeconomic land use factors and incidence of urothelial carcinoma

https://doi.org/10.1016/j.canep.2017.12.001Get rights and content

Highlights

  • Nationwide data of cancer registries in Germany was analyzed and showed regional “hot-spots” of high incidence rates of urothelial carcinoma

  • Results on incidence rates revealed clusters with high incidence rates of up to 151% and 126% for men and women in Germany, respectively.

  • Socioeconomic land use factors (agricultural, industrial and residential) have an unequal association with tumor incidence.

  • These land use factors may be associated with a relative risk increase for urothelial carcinoma.

Abstract

Background

Incidence rates for urothelial carcinoma (UC) have been reported to differ between countries within the European Union (EU). Besides occupational exposure to chemicals, other substances such as tobacco and nitrite in groundwater have been identified as risk factors for UC. We investigated if regional differences in UC incidence rates are associated with agricultural, industrial and residential land use.

Methods

Newly diagnosed cases of UC between 2003 and 2010 were included. Information within 364 administrative districts of Germany from 2004 for land use factors were obtained and calculated as a proportion of the total area of the respective administrative district and as a smoothed proportion. Furthermore, information on smoking habits was included in our analysis. Kulldorff spatial clustering was used to detect different clusters. A negative binomial model was used to test the spatial association between UC incidence as a ratio of observed versus expected incidence rates, land use and smoking habits.

Results

We identified 437,847,834 person years with 171,086 cases of UC. Cluster analysis revealed areas with higher incidence of UC than others (p = 0.0002). Multivariate analysis including significant pairwise interactions showed that the environmental factors were independently associated with UC (p < 0.001). The RR was 1.066 (95% CI 1.052–1.080), 1.066 (95% CI 1.042–1.089) and 1.067 (95% CI 1.045–1.093) for agricultural, industrial and residential areas, respectively, and 0.996 (95% CI 0.869–0.999) for the proportion of never smokers.

Conclusion

This study displays regional differences in incidence of UC in Germany. Additionally, results suggest that socioeconomic factors based on agricultural, industrial and residential land use may be associated with UC incidence rates.

Introduction

Urothelial carcinoma (UC) represents the 8th most common death attributed to cancer in men in the United States of America and shows rising incidence rates in both men and women with increasing age [1]. There are approximately 28,500 newly diagnosed patients with UC per year in Germany which represents the fourth highest incidence rate in the European Union (EU) [2].

Urothelial carcinoma may develop in the entire urinary tract, while approximately 90% of tumors are located in the urinary bladder and only 5–10% of carcinomas are found in the upper urinary tract [2], [3]. In Germany, bladder cancer occurs nearly three times more often in men than in women [4]. These differences might be explained by higher tobacco consumption in men and a higher work-related exposure to chemicals [5], [6]. While incidence rates for UC are increasing [7], [8], mortality rates are declining due to optimized diagnostics and accessibility to modern treatment modalities [9].

Tumor incidence rates differ between countries within the EU [10]. Highest incidence rates for UC are found in Spain, whereas Finland has the lowest tumor incidence [7]. Reasons for these differences are still matter of debate [11]. Occupational exposure to chemicals such as aromatic amines, tobacco and nitrite are only some known risk factors that might play a potential role for incidence differences [12], [13], [14].

There are only few epidemiological studies that have investigated regional differences in tumor incidence. In this study we investigated UC incidence rates in administrative districts in Germany and furthermore analyzed if these incidence rates are related to different socioeconomic factors. These factors are agricultural, industrial as well as residential land use in each administrative district in Germany. We furthermore included information on smoking habits in Germany, to account for the fact that tobacco is considered a major risk factor for UC.

Section snippets

Data sources and cancer registries

Information on tumor cases and information on corresponding population density was obtained from the German Centre for Cancer Registry Data (ZfKD), Robert-Koch-Institute (RKI). All cases between 2003 and 2010 were included. At time of analysis tumor documentation was available with over 95% completeness in ten federal states (Hamburg, Lower Saxony, Bremen, North Rhine Westphalia 2007–2010 and in the administrative districts of Munster also for 2003–2006, Rhineland Palatinate, Bavaria, Saarland,

Patient characteristics and incidence

Between 2003 and 2010 a total of 437,847,834 patient years under observation with 171,086 newly diagnosed cases were evaluated (observed cases). Cases where ICD-10-GM classification did not yield a specific tumor location and were not associated to UC were excluded (n = 4840). Median age was 75 years for women and 72 years for men (Table 1). Cumulative incidence was 39.07 cases per 100,000 persons-years, gender specific incidence was 58.60 for men and 20.50 for women per 100,000 person-years.

Discussion

In this study we were able to show regional differences in incidence rates for UC in Germany and outlined the potential influence of agricultural, industrial and residential land use in administrative districts in Germany.

Incidence rates for UC have been reported to differ within the countries of the EU. Reasons are multifactorial and potentially reflect behavioral and environmental patterns as demonstrated in other countries such as the USA [1].

In our study, UC incidence was increasing with

Conclusion

To our knowledge this is the first analysis on regional differences in tumor incidence for UC in Germany. We furthermore demonstrated to what extend different socioeconomic factors within each administrative district have a potential impact on tumor incidence. Further studies for example cluster analysis at a smaller geographic scale are necessary to support our results and reveal local hazards which might be relevant for incidence differences in Germany.

Conflict of interest statement

No conflicts of interest are declared.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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    Maximilian P Brandt and Kilian M Gust as well as Eva Herrmann and Georg Bartsch have equally contributed to this manuscript.

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