Geospatial Analysis, Web-Based Mapping and Determinants of Prostate Cancer Incidence in Georgia Counties: Evidence from the 2012-2016 SEER Data.

doi:10.21203/rs.3.rs-50781/v1

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Research article

Geospatial Analysis, Web-Based Mapping and Determinants of Prostate Cancer Incidence in Georgia Counties: Evidence from the 2012-2016 SEER Data.

https://doi.org/10.21203/rs.3.rs-50781/v1

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Background: Prostate cancer (CaP) cases are high in the United States. According to the American Cancer Society, there are an estimated number of 174,650 CaP new cases in 2019. The estimated number of deaths from CaP in 2019 is 31,620, making CaP the second leading cause of cancer deaths among American men with lung cancer been the first. Our goal is to estimate and map prostate cancer relative risk, with the ultimate goal of identifying counties at higher risk where interventions and further research can be targeted.

Methods: The 2012-2016 Surveillance, Epidemiology, and End Results (SEER) Program data was used in this study. Analyses were conducted on 159 Georgia counties. The outcome variable is incident prostate cancer. We employed a Bayesian geospatial model to investigate both measured and unmeasured spatial risk factors for prostate cancer. We visualised the risk of prostate cancer by mapping the predicted relative risk and exceedance probabilities. We finally developed interactive web-based maps to guide optimal policy formulation and intervention strategies.

Results: Number of persons above age 65 years and below poverty, higher median family income, number of foreign born and unemployed were risk factors independently associated with prostate cancer risk in the non-spatial model. Except for the number of foreign born, all these risk factors were also significant in the spatial model with the same direction of effects. Substantial geographical variations in prostate cancer incidence were found in the study. The predicted mean relative risk was 1.20 with a range of 0.53 to 2.92. Individuals residing in Towns, Clay, Union, Putnam, Quitman, and Greene counties were at increased risk of prostate cancer incidence while those residing in Chattahoochee were at the lowest risk of prostate cancer incidence.

Conclusion: Our results can be used as an effective tool in the identification of counties that require targeted interventions and further research by program managers and policy makers as part of an overall strategy in reducing the prostate cancer burden in Georgia State and the United States as a whole.

Cancer Biology

Oncology

Prostate cancer

Geospatial modelling

Mapping prostate cancer

Disease mapping

R-INLA

SEER Program

Georgia

USA

Table 1. Georgia county characteristics and crude prostate cancer incident rates, 2012-2016

	% 65+ yrs	% black	% bachelor’s degree	% poverty	% foreign born	% rural population	% unemployed	annual family income	mean annual cases	male population	incidence rate
								median	per county	mean	per 100,000 men
All	15.65	31.69	17.53	21.66	4.61	60.48	9.14	$51,116	40	29,743	158.83
	15.52	0.44	11.92	20.64	4.38	71.44	8.46	$46,350	22	9,159	240.20
Appling	15.52	0.44	11.92	20.64	4.38	71.44	8.46	$46,350	22	9,159	240.20
Atkinson	11.47	42.42	6.68	27.56	13.06	100.00	5.91	$35,000	1	4,240	23.58
Bacon	14.35	58.80	13.20	18.30	4.68	69.29	5.29	$46,060	5	5,491	91.06
Baker	19.54	21.48	11.00	15.66	5.05	100.00	3.20	$52,280	3	1,673	179.32
Baldwin	13.78	51.12	18.42	29.70	2.55	35.14	8.20	$50,230	26	22,683	114.62
Banks	16.24	32.81	10.99	15.52	4.85	93.83	7.66	$50,010	8	9,298	86.04
Barrow	11.19	48.78	16.79	14.47	6.91	30.06	8.60	$58,020	42	34,208	122.78
Bartow	12.76	11.24	18.51	14.76	4.68	35.23	7.65	$57,670	59	49,433	119.35
Ben Hill	.	0.21	6.06	.	.	34.00	.	.	12	8,439	142.20
Berrien	16.11	55.09	12.27	25.58	3.13	76.14	10.43	$43,070	15	9,501	157.88
Bibb	13.94	30.36	24.59	27.79	3.61	14.41	11.32	$50,130	115	73,286	156.92
Bleckley	16.92	59.22	17.72	23.02	1.35	51.59	6.58	$49,520	8	6,217	128.68
Brantley	14.42	49.38	9.51	21.18	0.85	99.45	9.15	$43,880	8	9,189	87.06
Brooks	18.34	8.11	12.44	24.71	3.45	71.04	17.67	$44,000	12	7,901	151.88
Bryan	9.99	5.33	33.34	13.27	4.54	52.34	9.26	$76,470	16	14,852	107.73
Bulloch	10.19	46.74	28.25	31.55	3.47	48.28	9.72	$50,350	28	35,030	79.93
Burke	14.02	29.67	10.40	30.50	2.05	75.00	7.30	$39,800	9	11,186	80.46
Butts	14.45	37.61	10.20	20.53	2.99	77.94	8.35	$53,170	19	12,522	151.73
Calhoun	12.53	32.86	10.29	32.71	4.21	100.00	14.41	$33,330	8	3,953	202.38
Camden	11.18	33.55	22.62	13.98	3.74	31.44	9.27	$60,560	35	25,569	136.88
Candler	16.47	55.10	14.23	29.72	4.94	66.97	7.09	$37,140	8	5,437	147.14
Carroll	12.41	38.48	18.19	19.26	3.71	41.83	10.80	$55,020	53	53,793	98.53
Catoosa	15.77	24.11	19.65	11.85	2.41	28.10	7.25	$62,270	39	31,028	125.69
Charlton	12.79	60.83	8.99	20.58	8.98	51.02	12.02	$53,970	7	6,847	102.23
Chatham	13.59	0.28	32.89	17.99	6.18	4.50	9.25	$61,810	153	127,704	119.81
Chattahoochee	3.85	46.88	30.12	14.30	7.45	29.52	15.96	$47,800	3	7,039	42.62
Chattooga	16.16	49.64	8.86	22.40	3.08	57.56	10.06	$41,890	23	13,513	170.21
Cherokee	11.88	44.13	35.50	10.02	8.88	17.10	5.52	$84,420	89	105,874	84.06
Clarke	9.60	25.51	40.75	35.20	10.06	5.86	8.62	$51,160	54	55,388	97.49
Clay	23.89	25.22	7.44	39.81	2.64	100.00	18.94	$35,430	7	1,462	478.80
Clayton	8.18	10.80	19.03	24.28	14.19	0.89	12.18	$47,260	130	124,232	104.64
Clinch	15.13	42.17	14.38	35.30	2.88	60.43	11.27	$37,070	10	3,315	301.66
Cobb	10.58	31.16	44.99	11.64	15.68	0.25	6.78	$82,200	447	334,369	133.68
Coffee	12.57	25.63	13.08	24.50	5.87	66.58	7.27	$43,440	36	21,455	167.79
Colquitt	13.92	36.89	12.92	24.99	10.60	58.95	7.74	$39,510	22	22,576	97.45
Columbia	11.66	17.14	35.10	9.49	6.97	16.23	6.87	$79,820	66	60,328	109.40
Cook	14.71	33.46	13.84	26.23	2.61	59.41	5.37	$39,560	14	8,372	167.22
Coweta	12.47	70.71	28.09	11.98	5.70	32.93	6.57	$74,710	81	62,242	130.14
Crawford	16.62	35.85	13.11	19.08	1.47	100.00	9.64	$48,160	8	6,381	125.37
Crisp	15.45	36.08	15.08	32.93	2.65	47.03	13.93	$37,730	15	11,221	133.68
Dade	16.95	42.47	13.80	16.61	2.27	72.13	5.85	$56,020	12	8,192	146.48
Dawson	18.19	9.72	29.84	13.42	3.42	80.31	7.47	$69,480	21	11,164	188.10
Decatur	10.33	29.67	41.74	18.99	16.28	56.48	9.76	$62,010	17	13,605	124.95
DeKalb	15.50	22.28	16.89	26.48	2.83	0.26	6.65	$45,580	410	331,355	123.73
Dodge	15.01	37.79	13.54	22.21	1.89	72.23	10.53	$46,660	13	11,449	113.55
Dooly	15.61	34.48	11.26	24.26	3.99	53.67	9.42	$45,240	7	8,053	86.92
Dougherty	13.48	35.42	19.77	30.51	2.36	13.96	17.03	$39,890	87	43,927	198.06
Douglas	10.35	29.89	26.15	15.21	8.38	15.76	9.04	$65,010	67	63,772	105.06
Early	18.34	23.10	14.07	31.22	1.50	65.95	7.88	$36,070	10	5,191	192.64
Echols	11.13	31.76	7.87	30.21	14.81	100.00	7.04	$50,860	3	2,040	147.06
Effingham	10.59	59.60	18.28	10.84	2.71	67.05	5.99	$70,710	22	26,017	84.56
Elbert	18.88	42.31	11.69	19.75	2.24	70.62	8.29	$43,470	17	9,656	176.06
Emanuel	15.63	63.49	11.71	29.49	0.98	66.88	11.55	$37,840	25	11,038	226.49
Evans	15.72	27.03	15.10	26.15	4.15	61.28	7.85	$48,520	7	5,387	129.94
Fannin	25.49	35.35	17.72	18.00	1.87	100.00	9.23	$50,730	25	11,547	216.51
Fayette	16.04	39.31	45.78	7.14	9.23	18.18	6.35	$96,220	65	51,505	126.20
Floyd	15.50	16.50	19.80	19.75	6.77	36.82	9.28	$53,410	102	46,640	218.70
Forsyth	11.09	42.40	48.27	6.42	14.74	9.92	4.85	$103,920	114	87,194	130.74
Franklin	19.15	5.29	12.64	25.24	3.18	88.93	7.92	$46,800	11	10,911	100.82
Fulton	10.39	17.53	49.81	16.95	12.52	1.08	8.90	$80,420	593	448,267	132.29
Gilmer	21.64	16.52	17.84	19.45	6.91	87.64	7.75	$51,700	25	14,146	176.73
Glascock	16.90	23.58	8.22	15.19	0.66	100.00	6.85	$51,990	1	1,487	67.25
Glynn	17.48	45.16	28.16	18.71	5.49	20.57	7.79	$56,320	58	37,855	153.22
Gordon	13.40	36.00	12.92	20.60	9.85	51.56	7.73	$45,890	30	27,283	109.96
Grady	16.28	32.73	12.77	29.62	5.69	62.36	9.18	$40,870	16	12,115	132.07
Greene	25.96	0.74	24.75	24.31	4.95	82.75	6.61	$54,440	22	7,809	281.73
Gwinnett	8.59	36.48	34.93	13.02	24.72	0.49	6.85	$69,230	415	397,153	104.49
Habersham	17.70	62.20	17.51	18.33	8.80	58.76	7.22	$50,790	42	20,301	206.89
Hall	13.55	24.21	22.47	17.72	16.54	20.56	5.72	$60,460	134	89,601	149.55
Hancock	19.39	63.74	10.89	31.36	2.66	61.59	10.31	$30,910	11	5,170	212.77
Haralson	15.82	32.82	13.76	20.28	1.39	77.36	10.29	$51,340	10	14,072	71.06
Harris	16.13	62.82	26.60	8.38	2.12	96.68	8.08	$81,000	29	15,975	181.53
Hart	20.38	46.10	13.65	21.22	2.60	74.47	5.59	$47,930	24	12,455	192.69
Heard	15.32	12.82	10.50	17.04	0.65	100.00	9.78	$54,820	8	5,885	135.94
Henry	10.33	40.86	27.48	12.08	7.44	13.85	8.92	$69,640	103	97,859	105.25
Houston	11.80	58.90	24.03	17.95	5.53	9.96	8.80	$63,930	68	68,066	99.90
Irwin	17.70	20.66	11.15	24.89	0.56	64.71	6.92	$44,210	12	4,804	249.79
Jackson	13.42	16.03	19.07	13.52	4.67	60.01	6.77	$62,980	45	30,002	149.99
Jasper	15.29	25.10	10.36	20.06	2.59	81.76	8.77	$45,140	6	6,916	86.76
Jeff Davis	.	38.94	8.35	.	.	69.51	.	.	19	7,464	254.56
Jefferson	16.88	6.44	10.42	28.91	2.01	80.67	13.28	$41,100	12	8,183	146.65
Jenkins	17.74	19.93	13.03	28.32	2.13	66.10	6.22	$41,910	6	3,959	151.55
Johnson	15.48	52.27	8.69	25.17	0.68	65.41	9.27	$43,700	7	5,592	125.18
Jones	15.77	31.51	20.23	13.69	1.03	67.71	8.05	$64,010	21	13,870	151.41
Lamar	15.95	18.24	17.16	22.17	2.31	60.87	13.04	$51,290	20	8,852	225.94
Lanier	12.37	35.79	15.40	28.22	1.56	71.13	13.89	$44,600	9	5,084	177.03
Laurens	16.30	36.51	15.24	27.75	2.17	56.64	5.94	$42,940	25	23,066	108.38
Lee	10.64	38.35	24.16	11.91	3.93	36.23	6.93	$72,360	19	14,097	134.78
Liberty	7.49	52.55	18.90	16.93	6.00	23.16	13.00	$46,500	13	30,962	41.99
Lincoln	20.51	0.76	13.15	25.36	1.40	100.00	9.06	$47,840	7	3,896	179.67
Long	8.60	1.82	15.24	16.19	6.41	81.34	16.32	$54,780	7	7,162	97.74
Lowndes	10.82	47.04	23.86	24.98	4.22	27.20	10.97	$50,800	48	53,285	90.08
Lumpkin	15.72	31.18	26.99	21.64	3.49	83.94	6.79	$51,680	27	14,894	181.28
Macon	14.39	11.11	8.53	32.56	2.59	53.19	16.93	$38,120	9	7,973	112.88
Madison	15.88	17.56	15.47	16.10	3.84	91.88	8.01	$53,000	31	13,898	223.05
Marion	17.41	32.91	11.08	25.23	2.38	100.00	14.45	$44,250	12	4,305	278.75
McDuffie	15.78	5.49	14.18	26.06	2.74	60.96	8.59	$45,190	18	10,250	175.61
McIntosh	20.12	57.78	13.77	20.13	2.09	74.31	9.93	$54,360	10	6,989	143.08
Meriwether	18.40	12.50	10.15	23.71	0.60	83.28	11.18	$46,610	20	10,492	190.62
Miller	19.86	35.23	11.40	25.14	0.10	100.00	7.85	$47,530	11	2,929	375.55
Mitchell	14.84	58.54	11.99	29.86	2.63	54.51	16.63	$37,780	27	12,186	221.57
Monroe	16.70	55.71	22.18	13.25	2.19	80.23	9.04	$60,030	13	13,271	97.96
Montgomery	15.54	58.77	15.55	22.82	5.42	98.71	5.77	$47,480	7	4,695	149.09
Morgan	18.01	19.52	20.77	13.27	1.79	75.37	6.95	$58,750	18	8,636	208.43
Murray	12.97	20.51	10.86	18.83	7.60	70.13	8.89	$46,560	28	19,652	142.48
Muscogee	12.00	12.96	25.00	20.91	5.51	2.98	10.05	$53,730	167	90,870	183.78
Newton	11.78	35.61	19.81	17.04	6.05	31.24	10.57	$57,230	79	47,626	165.88
Oconee	13.49	55.26	46.56	7.14	6.32	50.32	4.22	$85,780	22	16,007	137.44
Oglethorpe	17.30	34.38	16.62	17.91	2.33	99.25	5.61	$52,680	11	7,385	148.95
Paulding	9.37	32.32	24.63	10.74	5.17	20.05	6.76	$69,820	73	69,578	104.92
Peach	13.07	25.00	20.15	21.02	5.34	38.22	10.45	$53,280	24	13,416	178.89
Pickens	20.28	59.26	24.76	10.27	2.99	73.10	7.20	$65,680	24	14,440	166.20
Pierce	15.54	31.91	12.90	19.94	2.45	79.35	8.30	$50,720	13	9,202	141.27
Pike	14.51	57.78	15.31	12.13	0.91	98.96	10.01	$62,520	14	8,742	160.15
Polk	14.88	26.79	12.98	20.14	7.05	51.42	8.73	$48,100	41	20,518	199.82
Pulaski	18.25	37.87	11.81	23.75	1.48	66.70	5.92	$46,830	8	5,191	154.11
Putnam	21.31	44.37	18.29	17.76	5.72	80.95	8.03	$56,540	43	10,331	416.22
Quitman	25.49	14.91	8.56	25.68	1.62	73.10	18.53	$34,690	3	1,200	250.00
Rabun	25.47	12.50	26.34	21.77	5.75	79.28	6.75	$53,470	18	8,025	224.30
Randolph	18.29	56.68	13.35	28.66	2.39	50.63	9.75	$35,570	6	3,552	168.92
Richmond	12.56	10.48	21.04	25.19	3.50	9.22	11.48	$46,840	137	97,015	141.22
Rockdale	12.57	5.95	25.96	17.16	9.61	14.93	10.26	$57,620	59	40,533	145.56
Schley	15.31	21.68	14.86	21.87	1.61	100.00	12.96	$47,760	2	2,407	83.09
Screven	16.72	40.45	14.38	25.00	1.01	78.92	8.49	$42,460	10	7,116	140.53
Seminole	21.30	45.34	14.92	19.08	1.38	68.55	8.74	$43,540	7	4,139	169.12
Spalding	16.23	1.69	15.39	23.57	3.45	41.62	10.16	$50,060	63	31,046	202.92
Stephens	18.30	51.67	17.62	20.04	2.10	58.56	10.55	$50,870	19	12,528	151.66
Stewart	15.23	48.43	10.42	41.41	29.13	100.00	13.89	$22,500	3	3,682	81.48
Sumter	14.88	22.67	19.95	33.62	3.13	41.78	12.70	$42,090	20	15,627	127.98
Talbot	19.61	20.36	12.65	20.69	0.97	93.88	9.31	$44,730	11	3,245	338.98
Taliaferro	22.32	19.69	8.77	31.38	3.41	100.00	11.65	$41,630	2	841	237.81
Tattnall	12.16	0.00	11.37	27.68	3.58	68.24	5.07	$46,550	18	14,860	121.13
Taylor	18.02	61.97	11.32	28.39	1.22	100.00	17.91	$31,880	7	4,301	162.75
Telfair	15.20	32.20	9.12	28.70	12.61	46.99	4.28	$30,470	13	9,452	137.54
Terrell	17.56	32.26	12.08	34.72	0.59	51.00	12.13	$37,260	15	4,479	334.90
Thomas	16.50	16.13	19.53	21.30	2.79	46.02	9.80	$46,330	32	21,179	151.09
Tift	13.67	41.55	17.52	27.48	6.42	40.78	5.09	$45,620	23	19,210	119.73
Toombs	14.99	26.02	17.02	26.56	6.16	51.06	10.83	$44,700	16	12,928	123.76
Towns	33.12	18.20	25.13	15.07	2.76	100.00	8.91	$48,720	19	4,996	380.30
Treutlen	17.30	2.07	16.49	18.67	1.24	58.87	6.19	$55,410	3	3,449	86.98
Troup	13.58	35.38	18.76	21.32	4.04	44.30	10.74	$52,120	52	32,215	161.42
Turner	18.35	42.67	12.28	27.65	4.31	49.73	9.13	$42,630	6	4,358	137.68
Twiggs	19.53	69.23	11.64	30.32	1.08	100.00	7.74	$41,150	12	4,398	272.85
Union	31.21	32.04	22.37	13.12	2.15	100.00	9.06	$53,700	26	10,397	250.07
Upson	17.56	38.54	13.35	22.94	1.34	46.91	12.47	$47,500	22	13,024	168.92
Walker	16.57	11.18	15.02	18.44	1.15	43.85	6.99	$51,320	43	33,781	127.29
Walton	14.17	2.97	18.58	13.20	3.86	42.66	7.81	$62,470	66	40,763	161.91
Ware	15.92	55.26	12.83	28.07	3.39	29.44	5.65	$42,150	32	18,069	177.10
Warren	20.48	2.69	12.09	26.38	1.98	100.00	12.54	$39,890	5	2,694	185.60
Washington	15.88	46.51	12.30	26.40	1.67	65.60	10.70	$46,630	20	10,812	184.98
Wayne	14.51	32.56	13.32	20.58	2.82	57.94	12.83	$50,680	21	15,719	133.60
Webster	17.51	23.68	9.42	22.41	0.26	100.00	5.20	$51,370	4	1,362	293.69
Wheeler	12.96	1.94	4.94	27.41	1.53	100.00	7.53	$36,210	5	4,580	109.17
White	19.95	1.06	20.79	19.29	2.75	83.79	4.81	$50,120	18	13,269	135.65
Whitfield	12.71	28.43	13.55	19.63	18.31	29.08	9.63	$49,450	69	51,118	134.98
Wilcox	16.06	1.64	9.53	20.87	2.39	100.00	7.89	$45,350	7	5,436	128.77
Wilkes	21.37	9.02	13.79	26.74	3.57	67.37	8.62	$47,480	10	5,169	193.46
Wilkinson	17.77	34.09	8.64	20.79	0.77	100.00	7.38	$50,130	8	4,582	174.60
Worth	16.90	47.81	10.21	18.44	1.65	69.16	8.23	$45,340	17	10,397	163.51

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Review #2 received at journal
25 Dec, 2020
Review #1 received at journal
06 Dec, 2020
Reviewer #2 agreed at journal
02 Dec, 2020
Reviewer #1 agreed at journal
29 Nov, 2020
Reviewers invited by journal
27 Nov, 2020
Editor assigned by journal
08 Nov, 2020
Editor invited by journal
08 Nov, 2020
Submission checks completed at journal
14 Aug, 2020

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Geospatial Analysis, Web-Based Mapping and Determinants of Prostate Cancer Incidence in Georgia Counties: Evidence from the 2012-2016 SEER Data.

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