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