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Abstract：
BACKGROUND: The highly variable occurrence of primary liver cancers across the United States emphasize the relevance of location-based factors. Social determinants such as income, educational attainment, housing, and other factors may contribute to regional variations in outcomes. To evaluate their impact, this study identified and analyzed clusters of high mortality from primary liver cancers and the association of location-based determinants with mortality across the contiguous United States.
METHODS: A geospatial analysis of age-adjusted incidence and standardized mortality rates from primary liver cancers from 2000 to 2020 was performed. Local indicators of spatial association identified hot-spots, clusters of counties with significantly higher mortality. Temporal analysis of locations with persistent poverty, defined as high (>20%) poverty for at least 30 years, was performed. Social determinants were analyzed individually or globally using composite measures such as the social vulnerability index or social deprivation index. Disparities in county level social determinants between hot-spots and non-hot-spots were analyzed by univariate and multivariate logistic regression.
RESULTS: There are distinct clusters of liver cancer incidence and mortality, with hotspots in east Texas and Louisiana. The percentage of people living below the poverty line or Hispanics had a significantly higher odds ratio for being in the top quintile for mortality rates in comparison to other quintiles and were highly connected with mortality rates. Current and persistent poverty were both associated with an evolution from non-hotspots to new hotspots of mortality. Hotspots were predominantly associated with locations with significant levels of socioeconomic vulnerability or deprivation.
CONCLUSIONS: Poverty at a county level is associated with mortality from primary liver cancer and clusters of higher mortality. These findings emphasize the importance of addressing poverty and related socio-economic determinants as modifiable factors in public health policies and interventions aimed at reducing mortality from primary liver cancers.
METHODS: A geospatial analysis of age-adjusted incidence and standardized mortality rates from primary liver cancers from 2000 to 2020 was performed. Local indicators of spatial association identified hot-spots, clusters of counties with significantly higher mortality. Temporal analysis of locations with persistent poverty, defined as high (>20%) poverty for at least 30 years, was performed. Social determinants were analyzed individually or globally using composite measures such as the social vulnerability index or social deprivation index. Disparities in county level social determinants between hot-spots and non-hot-spots were analyzed by univariate and multivariate logistic regression.
RESULTS: There are distinct clusters of liver cancer incidence and mortality, with hotspots in east Texas and Louisiana. The percentage of people living below the poverty line or Hispanics had a significantly higher odds ratio for being in the top quintile for mortality rates in comparison to other quintiles and were highly connected with mortality rates. Current and persistent poverty were both associated with an evolution from non-hotspots to new hotspots of mortality. Hotspots were predominantly associated with locations with significant levels of socioeconomic vulnerability or deprivation.
CONCLUSIONS: Poverty at a county level is associated with mortality from primary liver cancer and clusters of higher mortality. These findings emphasize the importance of addressing poverty and related socio-economic determinants as modifiable factors in public health policies and interventions aimed at reducing mortality from primary liver cancers.
摘要：
背景：在美国，原发性肝癌的发生高度可变，强调了基于位置因素的相关性。社会决定因素，如收入，教育程度,住房,和其他因素可能导致结果的区域差异。为了评估他们的影响，这项研究确定并分析了美国邻近地区原发性肝癌的高死亡率集群,以及基于位置的决定因素与死亡率的关联.
方法：对2000年至2020年原发性肝癌的年龄调整发病率和标准化死亡率进行了地理空间分析。空间关联的局部指标确定了热点，死亡率明显较高的县集群。对持续贫困的地区进行时间分析，定义为至少30年的高贫困(>20%)，已执行。使用诸如社会脆弱性指数或社会剥夺指数之类的综合措施对社会决定因素进行了单独或全球分析。通过单变量和多变量逻辑回归分析了热点和非热点之间县级社会决定因素的差异。
结果：肝癌的发病率和死亡率有不同的集群，德克萨斯州东部和路易斯安那州的热点地区。与其他五分之一人口相比，生活在贫困线以下或西班牙裔人口的比例明显高于死亡率最高的五分之一，并且与死亡率高度相关。当前和持续的贫困都与从非热点到新的死亡热点的演变有关。热点主要与社会经济脆弱性或贫困程度很高的地区相关。
结论：县一级的贫困与原发性肝癌的死亡率和更高的死亡率有关。这些发现强调了解决贫困和相关社会经济决定因素的重要性，这些因素是旨在降低原发性肝癌死亡率的公共卫生政策和干预措施中的可改变因素。
方法：对2000年至2020年原发性肝癌的年龄调整发病率和标准化死亡率进行了地理空间分析。空间关联的局部指标确定了热点，死亡率明显较高的县集群。对持续贫困的地区进行时间分析，定义为至少30年的高贫困(>20%)，已执行。使用诸如社会脆弱性指数或社会剥夺指数之类的综合措施对社会决定因素进行了单独或全球分析。通过单变量和多变量逻辑回归分析了热点和非热点之间县级社会决定因素的差异。
结果：肝癌的发病率和死亡率有不同的集群，德克萨斯州东部和路易斯安那州的热点地区。与其他五分之一人口相比，生活在贫困线以下或西班牙裔人口的比例明显高于死亡率最高的五分之一，并且与死亡率高度相关。当前和持续的贫困都与从非热点到新的死亡热点的演变有关。热点主要与社会经济脆弱性或贫困程度很高的地区相关。
结论：县一级的贫困与原发性肝癌的死亡率和更高的死亡率有关。这些发现强调了解决贫困和相关社会经济决定因素的重要性，这些因素是旨在降低原发性肝癌死亡率的公共卫生政策和干预措施中的可改变因素。
