Syndemic Geographic Patterns of Cancer Types in a Health Deprived Area of England: a new Paradigm for Public Health Cancer Interventions?

Cancer poses a significant public health challenge, and accurate tools are crucial for effective intervention, especially in high-risk areas. The North West of England, historically identified as a region with high cancer incidence, has become a focus for public health initiatives. This study aims to analyse cancer risk factors, demographic trends and spatial patterns in this region by employing a novel spatial joint modelling framework designed to account for large frequencies of left-censored data. Cancer diagnoses were collected at the postcode sector level. The dataset was left-censored due to confidentiality issues, and categorised as interval censored. Demographic and behavioural factors, alongside socio-economic variables, both at individual and geographic unit levels, were obtained from the linkage of primary and secondary health data and various open source datasets. An ecological investigation was conducted using joint spatial modelling on nine cancer types (breast, colorectal, gynaecology, haematology, head and neck, lung, skin, upper GI, urology), for which explanatory factors were selected by employing an accelerated failure model with lognormal distribution. Post-processing included principal components analysis and hierarchical clustering to delineate geographic areas with similar spatial patterns of different cancer types. The study included 15,506 cancer diagnoses from 2017 to 2022, with the highest incidence in skin, breast and urology cancers. Preliminary censoring adjustments reduced censored records from 86% to 60%. Factors such as age, ethnicity, frailty and comorbidities were associated with cancer risk. The analysis identified 22 relevant variables, with comorbidities and ethnicity being prominent. The spatial distribution of the risk and cumulative risk of the cancer types revealed regional variations, with five clusters identified. Rural areas were the least affected by cancer and Barrow-in-Furness was the area with the highest cancer risk. This study emphasizes the need for targeted interventions addressing health inequalities in different geographical regions. The findings suggest the need for tailored public health interventions, considering specific risk factors and socio-economic disparities. Policymakers can utilize the spatial patterns identified to allocate resources effectively and implement targeted cancer prevention programmes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement AB, AK, KH, JAM, LS, PA, and TK are supported by the North West Cancer Research UK Strategic Funding programme (LI2021SEDDA). The views expressed are those of the author(s) and not necessarily those of North West Cancer Research or NHS England. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Project data management and analyses were approved by the Faculty of Health and Medicine Research Ethics Committee at Lancaster University (UK) with reference number FHM-2022-0899-IRAS-2, and by the HRA and Health and Care Research Wales (314994 SL45) under Lancaster University sponsorship. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes To guarantee the confidentiality of personal and health information of patients, only the named authors have had full access to the data during the study, in accordance with the relevant licence agreements. Data is not publicly available but request under ethical approval can be made to Kelly Heys (kelly.heys@mbhci.nhs.uk).