Disease Burden And Spatial Epidemiology Of Colorectal Cancer Deaths In Hunan Province From 2017 To 2019

Objective: To understand the mortality and disease burden of colorectal cancer patients in Hunan Province from 2017 to 2019,and analyze the geographical distribution characteristics of colorectal cancer deaths,so as to provide scientific basis for developing colorectal cancer prevention and control strategies and optimizing health resources allocation in Hunan Province.Methods: Cases of colorectal cancer deaths in Hunan province from2017 to 2019 were screened by ICD code of root cause of death from the population registration and Reporting system of Hunan Province,and the mortality rates were calculated by gender and age group.The disease burden of colorectal cancer was calculated using the indicator disability adjusted life years(DALY).Arc GIS 10.2 software was used to analyze the global trend of colorectal cancer crude mortality and map drawing of mortality grade.Geo Da software was used to conduct spatial autocorrelation analysis with global Moran’s INDEX(Moran’s I),Moran scatter plot,local aggregation and outliers(LISA).Sa TScan software was used to conduct temporal and spatial statistical analysis to identify highvalue clusters of colorectal cancer mortality in Hunan Province.Results: 1.From 2017 to 2019,17,854 permanent residents died of colorectal cancer in Hunan Province,with a crude mortality rate of8.64/100,000 and a standardized rate of 6.58/100,000.The crude mortality rate for males was 10.34 per 100,000 and the standardized mortality rate was 7.70 per 100,000.The female crude mortality rate was6.86 per 100,000 and the standardized mortality rate was 5.31 per100,000,with the male mortality rate higher than the female mortality rate.Colorectal cancer death rates increase with age,beginning at age 50 and peaking at age 85 and older.2.The research results of disease burden showed that the YLLs,YLDs and DALYs of colorectal cancer in Hunan province from 2017 to2019 were 215,334.19 person-years,12331.91 person-years and227666.10 person-years respectively.The DALY rate of colorectal cancer was 110.18/100,000,including 129.15/100,000 in male and90.28/100,000 in female.The DALY rates of colorectal cancer from 2017 to 2019 were 106.72/100,000,108.97/100,000 and 114.82/100,000,respectively,with an overall increasing trend.From 2017 to 2019,the disease burden of colorectal cancer was at a low level before the age of50,and showed an upward trend after 50,and reached a peak at the age of70 and above.The disease burden of colorectal cancer was concentrated in the elderly population,and the disease burden of males at all ages was generally higher than that of females.3.The map of colorectal cancer mortality grade showed that the areas with high mortality were mainly distributed in the northeast of Hunan Province,namely most regions and counties of ChangshaZhuzhou-Xiangtan,while the areas with low mortality were mainly distributed in the south of Hunan province.The distribution of crude mortality of colorectal cancer was different between male and female,and the incidence of male crude mortality was higher than that of female.The global trend analysis showed that the crude mortality rate of colorectal cancer in both males and females in Hunan province increased gradually from west to east and from south to north.4.There was a global spatial positive correlation distribution of colorectal death in Hunan Province(Moran’s I=0.2719,P<0.05).Moran scatter plot showed that most of the districts and counties were distributed in the first quadrant(high-high aggregation)and the third quadrant(lowlow aggregation),showing a positive correlation distribution of both high and low aggregation.The results of local spatial autocorrelation analysis showed that there were 28 significant aggregation areas in Hunan province,including 14 high-high areas,9 low-low areas,2 high-low areas and 3 low-high areas.There were 28 male aggregation areas and 27 female aggregation areas,and male high-high aggregation areas were more than female aggregation areas.A total of 6 clusters with high mortality were detected by spatial scanning statistical analysis,including5 male clusters and 4 female clusters.The most likely clustering area was the northeast of Hunan Province,and the clustering year was 2019.Conclusions: 1.The crude mortality rate of colorectal cancer among permanent residents in Hunan province from 2017 to 2019 was8.64/100,000,and the standardized rate was 6.58/100,000.2.In Hunan Province,the mortality and disease burden of colorectal cancer were higher in males than in females,and the mortality and DALY rates began to rise rapidly at the age of 50.The disease burden of colorectal cancer was the largest in people aged 70 and above.3.The mortality rate of colorectal cancer in Hunan province increased gradually from west to east and from south to north,presenting a significant spatial aggregation.That is,the northeast of Hunan Province,namely the Changsha-Zhuzhou-Xiangtan urban agglomeration,was the aggregation area with high mortality rate of colorectal cancer,and the aggregation area with high mortality rate of males was more than that of females.