title: Geographical epidemiology of prostate cancer in Great Britain.
abstract: Prostate cancer incidence has increased during recent years, possibly linked to environmental exposures. Exposure to environmental carcinogens is unlikely to be evenly distributed geographically, which may give rise to variations in disease occurrence that is detectable in a spatial analysis. The aim of our study was to examine the spatial variation of prostate cancer in Great Britain at ages 45-64 years. Spatial variation was examined across electoral wards from 1975-1991. Poisson regression was used to examine regional, urbanisation and socioeconomic effects, while Bayesian mapping techniques were used to assess spatial variability. There was an indication of geographical differences in prostate cancer risk at a regional level, ranging from 0.83 (95% CI: 0.78-0.87) to 1.2 (95% CI: 1.1-1.3) across regions. There was significant heterogeneity in the risk across wards, although the range of relative risks was narrow. More detailed spatial analyses within 4 regions did not indicate any clear evidence of localised geographical clustering for prostate cancer. The absence of any marked geographical variability at a small-area scale argues against a geographically varying environmental factor operating strongly in the aetiology of prostate cancer.
authors.affiliation: The Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Imperial College School of Medicine, London, United Kingdom. l.jarup@ic.ac.uk
authors.forename: Lars
authors.initials: L
authors.lastname: Jarup
authors.forename: Nicky
authors.initials: N
authors.lastname: Best
authors.forename: Mireille B
authors.initials: MB
authors.lastname: Toledano
authors.forename: Jon
authors.initials: J
authors.lastname: Wakefield
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
mesh_terms: D001499:Bayes Theorem; D016000:Cluster Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000209:etiology; D012306:Risk; D018570:Risk Assessment; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology; D014507:Urbanization