0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Geographic Clusters of Basal Cell Carcinoma in a Northern California Health Plan Population ONLINE FIRST

G. Thomas Ray, MBA1; Martin Kulldorff, PhD2; Maryam M. Asgari, MD, MPH3
[+] Author Affiliations
1Division of Research, Kaiser Permanente Northern California, Oakland
2Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
3Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. Published online July 20, 2016. doi:10.1001/jamadermatol.2016.2536
Text Size: A A A
Published online

Importance  Rates of skin cancer, including basal cell carcinoma (BCC), the most common cancer, have been increasing over the past 3 decades. A better understanding of geographic clustering of BCCs can help target screening and prevention efforts.

Objective  Present a methodology to identify spatial clusters of BCC and identify such clusters in a northern California population.

Design, Setting, and Participants  This retrospective study used a BCC registry to determine rates of BCC by census block group, and used spatial scan statistics to identify statistically significant geographic clusters of BCCs, adjusting for age, sex, and socioeconomic status. The study population consisted of white, non-Hispanic members of Kaiser Permanente Northern California during years 2011 and 2012.

Main Outcomes and Measures  Statistically significant geographic clusters of BCC as determined by spatial scan statistics.

Results  Spatial analysis of 28 408 individuals who received a diagnosis of at least 1 BCC in 2011 or 2012 revealed distinct geographic areas with elevated BCC rates. Among the 14 counties studied, BCC incidence ranged from 661 to 1598 per 100 000 person-years. After adjustment for age, sex, and neighborhood socioeconomic status, a pattern of 5 discrete geographic clusters emerged, with a relative risk ranging from 1.12 (95% CI, 1.03-1.21; P = .006) for a cluster in eastern Sonoma and northern Napa Counties to 1.40 (95% CI, 1.15-1.71; P < .001) for a cluster in east Contra Costa and west San Joaquin Counties, compared with persons residing outside that cluster.

Conclusions and Relevance  In this study of a northern California population, we identified several geographic clusters with modestly elevated incidence of BCC. Knowledge of geographic clusters can help inform future research on the underlying etiology of the clustering including factors related to the environment, health care access, or other characteristics of the resident population, and can help target screening efforts to areas of highest yield.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Basal Cell Carcinoma (BCC) High-Incidence Clusters Adjusted for Age and Sex Only, Against Background of Incidence Rate Quintiles by Census Block Group

Kaiser Permanente Northern California, 2011 to 2012. Numbers on Google Earth images indicate clusters in 1, Marin County; 2, west central Contra Costa County; 3, east Contra Costa and west San Joaquin Counties; 4, eastern Sacramento County; 5, southern San Mateo and eastern Santa Clara Counties; 6, central Placer County near Lincoln; 7, eastern Sonoma and northern Napa Counties.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Basal Cell Carcinoma High-Incidence Clusters Adjusted for Age, Sex, and Neighborhood Socioeconomic Status, Against Background of Incidence Rate Quintiles by Census Block Group

Kaiser Permanente Northern California, 2011 to 2012. Numbers on Google Earth images indicate clusters in 1, Marin County; 2, northeast Sacramento County; 3, east Contra Costa and west San Joaquin Counties; 4, west central Contra Costa County; 5, eastern Sonoma and northern Napa Counties.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

266 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();