title: Myelodysplastic syndromes spatial clusters in disease etiology and outcome.
abstract: The myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic disorders. This study aims to advance the use of spatial modeling in disease etiology and monitoring based on reports on a large population (n = 984) of MDS patients diagnosed in the Eastern United States. The spatial MDS clustering was analyzed using SaTScan, and patient clinical characteristics were analyzed using logistic regression and Cox hazards models adjusting for covariates. One main and five secondary spatial clusters (p-value < 10-17-10-7) were identified. Patients living in high vs. low MDS incidence clusters tended to be older (ORadj= 1.04 [1.004, 1.07]) and smokers (ORadj= 2.9 [1.1, 7.4]). Mortality was associated with hemoglobin (HRadj= 0.7 [0.5, 0.9]), neutrophils (HRadj= 0.7 [0.6, 0.96]), platelets (HRadj= 0.5 [0.4, 0.7]), and blast (HRadj= 1.4 [1.1, 1.8]), but not clusters. The results suggest large geographic variations in MDS incidence rates. The biological aggressiveness of the disease is unlikely to be associated with its spatial distribution.
authors.affiliation: a Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , NY , USA.
authors.forename: Bian
authors.initials: B
authors.lastname: Liu
authors.affiliation: b Department of Population Health , The Feinstein Institute for Medical Research, Hofstra North Shore-LIJ School of Medicine , NY , USA.
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Kerath
authors.affiliation: c Cleveland Clinic Taussig Cancer Institute , OH , USA.
authors.forename: Mikkael A
authors.initials: MA
authors.lastname: Sekeres
authors.affiliation: d EpidStat Institute , Ann Arbor , MI , USA.
authors.forename: Jon P
authors.initials: JP
authors.lastname: Fryzek
authors.affiliation: e Division of Cytogenetics and Molecular Pathology.
authors.forename: Chandrika
authors.initials: C
authors.lastname: Sreekantaiah
authors.affiliation: f Department of Hematologic Oncology , North Shore-LIJ Health System , NY , USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mason
authors.affiliation: f Department of Hematologic Oncology , North Shore-LIJ Health System , NY , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kolitz
authors.affiliation: a Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , NY , USA.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Taioli
keywords: Clustering; MDS; incidence