| Objective:Based on the data of breast cancer screening in rural areas aged 35-64 years in the national public health service program,the spatial epidemiological study method was used to study and analyze the spatial-temporal aggregation and dispersion characteristics in time,space,and time,and to accurately identify the risk areas,thus providing a basis for decision-making on the intervention and treatment of breast cancer and breast diseases,the adjustment of women’s public health policies and the regulation of medical resources.Methods:The data of free breast cancer screening for rural women aged 35-64 years in2019,2020,2021 and the second screening cycle(2019-2021)in Zibo City were summarized by townships(streets)in small geographical spatial zones,and the collected data were organized and analyzed using SPSS26.0,SAS9.4 and office software to calculate the number of screenings and breast cancer detection rates.Arc GIS and Sa TScan software were used for trend analysis,spatial auto correlation,cluster and outlier analysis,Kriging interpolation and spatio-temporal scan statistics to describe the regional distribution and other spatio-temporal characteristics of the risk of breast cancer detection.Results:1.In the second screening cycle(2019-2021),446906 women aged 35-64 in Zibo were screened for free for breast cancer,with a screening rate of 84.91%.75.00%,85.12%and 94.62%were screened year by year in 2019,2020 and 2021.80,114 and 119breast cancers were detected in 2019,2020 and 2021 respectively,with detection rates of60.80/100,000,76.34/100,000and71.68/100,000,respectively,with a significant difference in the three-year comparison of detection rates(X~2=8.633,p<0.05).The second screening cycle(2019-2021)detected 313 cases of breast cancer,with the highest detection rate of97.78/100,000 in the 60-64 age group,followed by the 50-54 age group(81.93/100,000)and the 55-59 age group(80.02/100,000).The screening results showed that the highest percentage of breast cancer detectors in Zibo was engaged in agriculture(62.70%)and the highest percentage of people with junior high school education(53.20%).2.Trend analysis showed more significant changes in breast cancer detection rate in2020,showing higher east-west than central in the east-west direction,higher central than north-south in the north-south direction,and higher south than north in the south side.Spatial auto correlation analysis yielded a spatial aggregation of detection rates(Moran’s I=0.118,P<0.05)in the second screening cycle(2019-2021),with 36 of 78townships(streets)having a higher breast cancer detection rate(70.03/100,000)than the city’s detection rate.The results of the hot spot analysis showed that there were three breast cancer hotspot areas in Zibo in the second screening cycle(2019-2021),distributed in Kunlun Town,Xihe Town,Zichuan District,Shima Town,Chi Shang Town,Baita Town and Domain Town in Boshan District,showing that breast cancer has a high aggregation feature in the region and surrounding areas.The second screening cycle(2019-2021)has three townships(Kunlun Town,Zichuan District,Baita Town and Shantou Street,Boshan District)that are high value clusters(H-H),one township(Jinsan Town,Linzi District)that is an outlier with low value clusters around high values(H-L),and two townships(Lingzi Town,Zichuan District and Boshan Regional Town)that are an outlier with high value clusters around low values(L-H).3.Kriging spatial interpolation and trend analysis showed that the breast cancer detection rate in Zibo city generally showed a gradual decrease from southwest to northeast toward both sides;the higher areas were mainly located in the central Boshan and the central-eastern Zichuan regions.Spatio-temporal scan statistic analysis showed that there was one statistically significant aggregation area in 2020 in spatio-temporal statistics,involving 11 townships(RR=3.29,LLR=14.97,P<0.01),distributed in a 22.39km radius area in the central-eastern region of Zibo.Conclusion:1.Through screening,it was found that the high incidence of breast cancer in Zibo is between 50 and 64 years old,and the highest percentage of diagnosed cases are among those who are engaged in agriculture and those with junior high school education respectively,which should be used as a basis to strengthen health education for this group and improve personal health care awareness and level.2.There are 36 towns(streets)in the second screening cycle(2019-2021)in Zibo where the detection rate of breast cancer is higher than the detection rate of breast cancer in the city.The areas with higher detection rate of breast cancer are mainly located in the central-eastern part of Zichuan and the central part of Boshan,which should further analyze the causes and countermeasures leading to the high incidence of breast cancer and control the incidence of breast cancer.3.The change of breast cancer detection rate in the second screening cycle(2019-2021)in Zibo city is mainly from the southwest to the northeast gradually decreasing to both sides,the detection rate of breast cancer in the northern and southern regions is lower,which should be used as a basis to tilt public health resources to areas with high breast cancer detection rate in the third screening cycle and even in the future period. |
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