Analysis of the distribution characteristics of prostate cancer and its environmental factors in China

The high incidence and mortality and the increasing trend of prostate cancer has been one of the public health issues in many countries and regions. Meanwhile, the spatio-temporal heterogeneity of prostate cancer implies that lifestyle and ecological changes may be associated with prostate cancer, however, sufficient evidence is still lacking. This paper tried to reveal the spatial and temporal distribution characteristics of prostate cancer in China and explore the potential associations with related socioeconomic and natural condition factors. Data on prostate cancer incidence and mortality in 182 counties ( districts) in mainland China from 2014-2016 were collected, and the distribution characteristics of prostate cancer were analyzed using spatiotemporal scan statistic. Spatial regression models and geodetector method were used to analyze the potential associations between meteorological conditions, socioeconomic development, and prostate cancer incidence and mortality. SaTScan, GeoDa, and GeoDetector were used for the above statistical analyses. The high-risk clusters for prostate cancer incidence and mortality were located in southeastern China, and the low-risk clusters were located in north- central China. Spatial regression models showed that the number of industrial enterprises/km2 (incidence: beta = 0.322, P < 0.001; mortality: beta = 0.179, P < 0.001), GDP (incidence:beta = 0.553, P < 0.001; mortality: beta = 0.324, P < 0.001), number of beds in medical and health institutions/1000 persons (incidence: beta = 0.111, P = 0.005; mortality: beta = 0.068, P = 0.021), and urbanization rate (incidence: beta = 0.156, P < 0.001; mortality: beta = 0.100, P < 0.001) were positively associated with the incidence and mortality of prostate cancer. The urbanization rate (incidence: q = 0.185, P < 0.001; mortality: q = 0.182, P < 0.001) has the greatest explanatory power, and the interaction of all factors was bivariate enhanced or nonlinearly enhanced. The distribution of prostate cancer in China has obvious spatial heterogeneity. The incidence and mortality rate of prostate cancer are on the rise, and special plans should be formulated in each region according to local conditions.