title: Incidence of differentiated thyroid cancer in Canada by City of residence.
abstract: BACKGROUND
  Thyroid cancer incidence in Canada is increased in high socioeconomic groups, and in urban compared with rural areas. The objective of this study was to analyze patterns in thyroid cancer incidence across Canada, particularly with respect to the major urban areas across the country, to identify whether there are any discrepancies in thyroid cancer incidence between Canadian cities.
  
  
  METHODS
  Cases were drawn from the Canadian Cancer Registry. Demographic and socioeconomic information were extracted from the Canadian Census of Population data. We linked cases to income quintiles (InQs) by patients' postal codes, and categorized residence by census metropolitan area ((CMA), population >100,000). Within the Toronto CMA we further classified by census subdivision (CSD).
  
  
  RESULTS
  There were a total of 33 CMAs across the country. After controlling for demographic and socio-economic factors, we found that the Toronto CMA had an IRR of thyroid cancer that was significantly higher than all other CMAs across the country. For 70% of CMAs and CAs across Canada, the IRR for thyroid cancer was less than half of the IRR for thyroid cancer in the Toronto CMA. As Toronto is one of the largest CMAs, we then subdivided the Toronto area into CSDs to examine how incidence of thyroid cancer varies within this large area. The Toronto City core was used as the reference category and all other areas were compared directly to it. In doing so, we found that a contiguous area of three CSDs North of Toronto had higher IRRs compared with the Toronto city core: Markham, Vaughan and Richmond Hill.
  
  
  CONCLUSIONS
  After controlling for demographic and socioeconomic factors, we found that the Toronto CMA has the highest incidence of thyroid cancer nationwide. Several explanations could account for this discrepancy including increased detection due to increased access to imaging, differences in ethnicity or environmental exposures.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Aurora St. Luke's Hospital, Suite 630, 2801W Kinnickkinnik River Parkway, Milwaukee, WI, 53215, USA. mjcorsten@gmail.com.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Corsten
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, S3 - 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. matthewjvhearn@gmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hearn
authors.affiliation: Department of Economics, University of New Brunswick, PO box 4400, Fredericton, NB, E3B6C4, Canada. tedmcdon@unb.ca.
authors.forename: James Ted
authors.initials: JT
authors.lastname: McDonald
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, S3 - 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. sjohnsonobaseki@gmail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Johnson-Obaseki
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology*; D002170:Canada / Q000453:epidemiology; D002947:Cities; D006801:Humans; D015994:Incidence; D009367:Neoplasm Staging; D012042:Registries; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D014505:Urban Population