title: Bayesian spatial analysis of the surgical incidence rate of human cystic echinococcosis in north-eastern Iran.
abstract: BACKGROUND
  Cystic echinococcosis (CE) is a zoonotic disease that presents a public health challenge and a socioeconomic burden on developing areas in the Middle East. This study used spatial methods to assess the distribution of surgically managed CE cases in an endemic region of north-eastern Iran.
  
  
  METHODS
  For the years 2001-2007, a case series of all 446 patients that were surgically treated for CE in a referral hospital in north-eastern Iran was evaluated. Patients seen at the referral hospital represent 35 counties in three provinces (Razavi Khorasan, North Khorasan, and South Khorasan). A Besag, York and Mollie (BYM) spatial model was used to produce smoothed standardized incidence ratios (SIRs) for surgically managed cases of CE for the 35 counties represented in this study.
  
  
  RESULTS
  Out of 446 surgically managed patients, 54% were male. County-level crude incidence rates ranged from 0 to 3.27 cases per 100,000 population. The highest smoothed SIR (3.46) was for Sarakhs County in the province of Razavi Khorasan, while the lowest smoothed SIR (0.05) was for Birjand County, located in the province of South Khorasan.
  
  
  CONCLUSIONS
  SIRs for CE were highest for the province of Razavi Khorasan, which has large ranching and agricultural industries. Additional studies are needed to better evaluate the role of climate, land cover, and livestock rearing on local Echinococcus granulosus transmission in Iran.
authors: Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors: Mohammad
authors: M
authors: Ebrahimipour
authors: Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States.
authors: Christine M
authors: CM
authors: Budke
authors: Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Ghaem Educational, Research and Treatment Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Mohsen
authors: M
authors: Najjari
authors: Department of Animal Medicine, Production and Health, University of Padova, Legnaro PD, Italy.
authors: Rudi
authors: R
authors: Cassini
authors: Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: Ns.asmarian@gmail.com.
authors: Naeimehossadat
authors: N
authors: Asmarian
mesh_terms: D001499:Bayes Theorem; D004443:Echinococcosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D062206:Spatial Analysis
keywords: BYM model; Cystic echinococcosis; Incidence; Iran; Spatial analysis