Qi Li

Spatial clustering of gynecological cancers in China: A countrywide migration-adjusted analysis at the district level

In China, the incidence rates of major gynecological cancers have increased consistently over the past decade. Spatial epidemiological analyses are crucial for informing precision prevention strategies through visual risk mapping. However, previous studies, primarily based on residential registry data, often overlook migrant populations, potentially introducing selection bias. We conducted a countrywide, district/county-level spatial analysis of cervical, uterine corpus, and ovarian cancer incidence in China, utilizing Bayesian model-derived estimates that adjusted for internal migration. Global and local Moran's I statistics were employed to detect and visualize significant spatial clustering patterns, specifically high-high (HH) clusters (areas with high incidence surrounded by other high-incidence areas) and low-low (LL) clusters (areas with low incidence surrounded by other low-incidence areas). Significant positive spatial autocorrelation was detected for the three cancers(P < 0.000001). For cervical cancer, 836 districts/counties showed HH clustering (predominantly in central and southeastern coastal regions), while 1013 displayed LL clustering (concentrated in northeastern, northern, and western China). For uterine corpus cancer, 899 districts and counties formed HH clusters, notably in northeastern, northern, and southeastern coastal areas, while 982 districts and counties showed LL clusters, primarily in central and southwestern regions. For ovarian cancer, 794 districts and counties demonstrated HH clustering, with concentrations in northeastern, northern, and southeastern coastal zones, while 857 districts and counties exhibited LL clustering, primarily distributed across eastern, central-southern, and southwestern China. As the first countrywide spatial study to incorporate migration-adjusted data, our findings reveal marked geographic disparities in gynecological cancer incidence in China. These results underscore the necessity for region-specific prevention strategies and highlight that resource allocation must account for population mobility. This study provides a replicable framework for other regions facing similar migration-related health challenges.

Cervical cancer incidence rates considering migration status in mainland China using Bayesian model—Estimation based on 2016 cancer registry data

AbstractIn mainland China, cancer registration relies on household‐registered populations, overlooking migrant populations. Estimating cervical cancer incidence among permanent residents, including migrants, offers a more accurate representation of the true burden. The data from 487 cancer registries across China in 2016 were analyzed using a Bayesian spatial regression model with the integrated nested Laplace approximation‐stochastic partial differential equation method. The study estimated cervical cancer incidence among household‐registered populations and adjusted for migrant populations using a weighting method based on interprovincial distribution and age stratification to derive the incidence of cervical cancer in the permanent residents. Data from the China Population Census, the China Migrants Dynamic Survey, and the Urban Statistical Yearbook were incorporated. The estimated crude incidence rate of cervical cancer among permanent residents was 17.4/100,000 in mainland China, with an age‐standardized incidence rate (ASIR) of 17.2/100,000. The largest disparities in cervical cancer crude incidence rate between permanent residents and household‐registered populations were observed in Guizhou (2.4/100,000, 95% CI 1.9–2.9/100,000), Zhejiang (−1.2/100,000, 95% CI −1.8 to −0.6/100,000) and Tianjin (−1.1/100,000, 95% CI −1.5 to −0.7/100,000). The number of the estimated cervical cancer incident cases was 8948. Guangdong saw an increase of 887 cases, while Henan had a decrease of 1430 cases. Guizhou had the highest ASIR (28.1/100,000), and Beijing had the lowest ASIR (11.0/100,000). The significance of this study is that it improves the accuracy of cervical cancer data in China. These findings provide evidence for developing cervical cancer prevention and control strategies, and offer insights for other countries and regions facing migration challenges.

Impact of the COVID‐19 pandemic on the hospital attendance of patients with primary cervical cancer in Heilongjiang, China

AbstractInformation regarding the impact of the coronavirus disease 2019 (COVID‐19) pandemic on cervical cancer in mainland China is lacking. We explored its impact on the hospital attendance of patients with primary cervical cancer. We included 1918 patients with primary cervical cancer who initially attended Harbin Medical University Cancer Hospital between January 23, 2019, and January 23, 2021. Attendance decreased by 31%, from 1135 in 2019 to 783 in 2020, mainly from January to June (𝜒2 = 73.362, P &lt; .001). The percentage of patients detected by screening decreased from 12.1% in January‐June 2019 to 5.8% in January‐June 2020 (𝜒2 = 7.187, P = .007). Patients with stage I accounted for 28.4% in 2020 significantly lower than 36.6% in 2019 (𝜒2 = 14.085, P &lt; .001), and patients with stage III accounted for 27.1% in 2020 significantly higher than 20.5% in 2019 (𝜒2 = 11.145, P &lt; .001). Waiting time for treatment was extended from 8 days (median) in January‐June and July‐December 2019 to 16 days in January‐June (𝜒2 = 74.674, P &lt; .001) and 12 days in July‐December 2020 (𝜒2 = 37.916, P &lt; .001). Of the 179 patients who delayed treatment, 164 (91.6%) were for the reasons of the healthcare providers. Compared to 2019, the number of patients in Harbin or non‐Harbin in Heilongjiang Province and outside the province decreased, and cross‐regional medical treatment has been hindered. The COVID‐19 pandemic has negatively impacted cervical cancer patient attendance at the initial phase. These results are solid evidence that a strategy and mechanism for the effective attendance of cervical cancer patients in response to public health emergencies is urgently needed.