title: Spatial Clustering and Local Risk Factors of Chronic Obstructive Pulmonary Disease (COPD).
abstract: Chronic obstructive pulmonary disease (COPD) mortality has been steadily increasing in Taiwan since 2009. In order to understand where the hotspot areas are and what the local risk factors are, we integrated an ecological and a case-control study. We used a two-stage approach to identify hotspots and explore the possible risk factors for developing COPD. The first stage used the annual township COPD mortality from 2000 to 2012 and applied the retrospective space-time scan statistic to calculate the local relative risks in each township. In the second stage, we conducted a case-control study, recruiting 200 patients from one local hospital within the one identified hotspot area located in southern Taiwan. Logistic regression was applied for analyzing the personal risk factors of COPD. The univariate analyses showed that higher percentages of aborigines, patients with tuberculosis (TB) history, and those with smoking history had COPD (p < 0.05). After controlling for demographic variables, aboriginal status (adjusted odds ratios (AORs): 3.01, 95% CI: 1.52-5.93) and smoking history (AORs: 2.64, 95% CI: 1.46-4.76) were still the two significant risk factors. This two-stage approach might be beneficial to examine and cross-validate the findings from an aggregate to an individual scale, and can be easily extended to other chronic diseases.
authors.affiliation: Research Center for Humanities and Social Sciences, Academia Sinica, Taipei 115, Taiwan. dachianpig@gmail.com.
authors.forename: Ta-Chien
authors.initials: TC
authors.lastname: Chan
authors.affiliation: Division of Family Medicine, Fangliao General Hospital, Pingtung 940, Taiwan. jackysour@gmail.com.
authors.forename: Hsuan-Wen
authors.initials: HW
authors.lastname: Wang
authors.affiliation: Research Center for Humanities and Social Sciences, Academia Sinica, Taipei 115, Taiwan. j_lucy1002@yahoo.com.tw.|Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan. j_lucy1002@yahoo.com.tw.
authors.forename: Tzu-Jung
authors.initials: TJ
authors.lastname: Tseng
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan 350, Taiwan. chiangp@nhri.org.tw.|Department of Public Health, China Medical University, Taichung 400, Taiwan. chiangp@nhri.org.tw.
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Chiang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D062305:Geographic Mapping; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: COPD; SaTScan; Taiwan; aborigines; smoking