癌症高风险区域的确定，即空间聚集，能够为癌症控制的有针对性政策提供信息。虽然癌症聚集检测可能受到各种地理特征的影响，包括社会人口学和环境因素，其影响也可能随着时间的推移而变化，但目前有关考虑该影响的研究仍然有限。本研究旨在评估地理特征在肺癌和胃癌空间聚集检测中的作用， 并对较长时间进行研究。我们获取了韩国全国233个地区1999年至2013年三个五年期间的性别特定年龄标化肺癌和胃癌发病率和死亡率，以及地理特征。我们将每个地区的地理特征划分为四个类别：人口统计学、社会经济地位、行为和物理环境。具体而言，我们使用绿度、颗粒物和二氧化氮的浓度以及空气污染排放量来量化物理环境。最后，我们使用带有多元回归分析残差的加权正态空间扫描统计方法进行聚类检测分析。研究发现，随着地理协变量的逐步调整，聚集的大小减小。在四个类别中，物理环境对肺癌的聚集减少或消失产生了最大影响，并且这种情况在时间上是一致的。而老年人口在早期对肺癌聚集的减少有影响，而教育在近期的影响较大。与肺癌相比，胃癌的影响不太明确。我们的研究结果强调了地理特征在解释现有癌症聚集并确定新的聚集中的重要性，为癌症控制提供实际指导。版权所有©2023 Elsevier Inc. 发布。

Identification of high-risk areas of cancer, referred to as spatial clusters, can inform targeted policies for cancer control. Although cancer cluster detection could be affected by various geographic characteristics including sociodemographic and environmental factors which impacts could also vary over time, studies accounting for such influence remain limited. This study aims to assess the role of geographic characteristics in the spatial cluster detection for lung and stomach cancer over an extended period.We obtained sex-specific age-standardized incidence and mortality rates of lung and stomach cancer as well as geographic characteristics across 233 districts in South Korea for three five-year periods between 1999 and 2013. We classified geographic characteristics of each district into four categories: demography, socioeconomic status, behaviors, and physical environments. Specifically, we quantified physical environments using measures of greenness, concentrations of particulate matter and nitrogen dioxide, and air pollution emissions. Finally, we conducted cluster detection analyses using weighted normal spatial scan statistics with the residuals from multiple regression analyses performed with the four progressive sets of geographic attributes.We found that the size of clusters reduced as we progressively adjusted for geographic covariates. Among the four categories, physical environments had the greatest impact on the reduction or disappearance of clusters particularly for lung cancer consistently over time. Whereas older population affected a decrease of lung cancer clusters in the early period, the contribution of education was large in the recent period. The impact was less clear in stomach cancer than lung cancer.Our findings highlight the importance of geographic characteristics in explaining the existing cancer clusters and identifying new clusters, which jointly provides practical guidance to cancer control.Copyright © 2023. Published by Elsevier Inc.