title: Variations in societal characteristics of spatial disease clusters: examples of colon, lung and breast cancer in Japan.
abstract: BACKGROUND
  Spatial analyses and ecological studies are essential for epidemiology and public health. The present study combining these two methods was performed to identify spatial clusters of selected types of cancer in Japan and to determine their societal characteristics focusing on homogeneity among clusters.
  
  
  RESULTS
  Spatial clusters of high mortality rates of male colon and lung cancer and of female breast cancer were identified by the spatial scan statistic using Japanese municipal data (N = 3360) from 1993 to 1998 and also municipalities were divided into four societal clusters based on socioeconomic indicators and population density (urban-rich, suburban, rural-poor, and clutter). Five, seven, and four mortality clusters were identified for lung, colon and breast cancer, respectively. For colon and breast cancer, most municipalities of all except one cluster were included in a single societal cluster (urban-rich). The municipalities associated with mortality clusters for lung cancer belonged to various societal clusters.
  
  
  CONCLUSIONS
  Increased mortality rates of colon and breast cancer can be explained by homogenous societal characteristics related to urbanisation, although there were exceptional areas with higher mortality rates. The regional variation in lung cancer mortality rate appeared to be due to heterogeneous factors. These findings and the analysis performed in the present study will contribute to both nationwide and region-specific cancer prevention strategies.
authors.affiliation: Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan. fukuda.hlth@tmd.ac.jp
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Umezaki
authors.forename: Keiko
authors.initials: K
authors.lastname: Nakamura
authors.forename: Takehito
authors.initials: T
authors.lastname: Takano