Analysis of the relationship between socioeconomic factors and stomach cancer incidence in Slovenia
Abstract:
An unequal population distribution of well-known major risk factors explains much of the variation in the incidence of stomach cancer worldwide. The aim of this study was to determine whether geographical variation of the stomach cancer incidence rate between Slovenia’s municipalities during years 1995–2001 could partially be explained by variations in the socioeconomic status as an indirect stomach cancer risk factor. A composite measure of each region’s socioeconomic status, labelled as deprivation index, was created from basic socioeconomic characteristics of each municipality using factor analysis. Municipalities’ standardized incidence ratios for all stomach cancers and non-cardia stomach cancer were calculated. A fully Bayesian spatial model with a conditionally autoregressive prior was applied using Markov chain Monte Carlo techniques and WinBUGS software. Spatially smoothed maps of stomach cancer incidence rates by 192 Slovenian municipalities show a clear west-to-east gradient. This pattern resembles the geographical variation of socioeconomic indices, but these indices are not significant predictors of stomach cancer incidence. Geographical variation of stomach cancer incidence in Slovenia could be partially explained by the heterogeneous socioeconomic characteristics of its municipalities. It is possible that the socioeconomic status indices used in our study were not enough powerful predictors of stomach cancer risk. Some further methodological research is needed to explain why this association was not statistically evident with the current modeling approach.