title: Suburbanisation of oral cavity cancers: evidence from a geographically-explicit observational study of incidence trends in British Columbia, Canada, 1981-2010.
abstract: BACKGROUND
  Recent studies have demonstrated an elevated risk of oral cavity cancers (OCC) among socioeconomically deprived populations, whose increasing presence in suburban neighbourhoods poses unique challenges for equitable health service delivery. The majority of studies to date have utilised aspatial methods to identify OCC. In this study, we use high-resolution geographical analyses to identify spatio-temporal trends in OCC incidence, emphasising the value of geospatial methods for public health research.
  
  
  METHODS
  Using province-wide population incidence data from the British Columbia Cancer Registry (1981-2009, N = 5473), we classify OCC cases by census-derived neighbourhood types to differentiate between urban, suburban, and rural residents at the time of diagnosis. We map geographical concentrations by decade and contrast trends in age-adjusted incidence rates, comparing the results to an index of socioeconomic deprivation.
  
  
  RESULTS
  Suburban cases were found to comprise a growing proportion of OCC incidence. In effect, OCC concentrations have dispersed from dense urban cores to suburban neighbourhoods in recent decades. Significantly higher age-adjusted oral cancer incidence rates are observed in suburban neighbourhoods from 2006 to 2009, accompanied by rising socioeconomic deprivation in those areas. New suburban concentrations of incidence were found in neighbourhoods with a high proportion of persons aged 65+ and/or born in India, China, or Taiwan.
  
  
  CONCLUSIONS
  While the aging of suburban populations provides some explanation of these trends, we highlight the role of the suburbanisation of socioeconomically deprived and Asia-born populations, known to have higher rates of risk behaviours such as tobacco, alcohol, and betel/areca consumption. Specifically, betel/areca consumption among Asia-born populations is suspected to be a primary driver of the observed geographical shift in incidence from urban cores to suburban neighbourhoods. We suggest that such geographically-informed findings are complementary to potential and existing place-specific cancer control policy and targeting prevention efforts for high-risk sub-populations, and call for the supplementation of epidemiological studies with high-resolution mapping and geospatial analysis.
authors.affiliation: Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. bwalker@sfu.ca.
authors.forename: Blake Byron
authors.initials: BB
authors.lastname: Walker
authors.affiliation: Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schuurman
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Ajit
authors.initials: A
authors.lastname: Auluck
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.|Division of Cardiology, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.|Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rosin
mesh_terms: D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology; D012111:Residence Characteristics; D012307:Risk Factors; D013383:Suburban Population / Q000706:statistics & numerical data*