Many investigators have examined urbanization gradients in cancer rates. The authors used incidence data for 1986 through 1990 from the Illinois State Cancer Registry, a large, population-based incidence registry, to identify race-specific, urban-rural trends in cancer rates. Using population density, they categorized an urbanization gradient into four groups. Five-year, average annual age-adjusted, site-specific incidence rates were calculated for all sex-race strata within each population density group. Monotonic and statistically significant cancer incidence trends across all race-sex groups were found for cancers of the esophagus, liver, lung, female breast and cervix, male prostate, nervous system, non-Hodgkin's lymphomas, and all cancers combined. No trend was observed for blacks that was not also seen for whites; however, significant trends for cancer of the pancreas and Hodgkin's disease were seen for whites but not for blacks. Colon cancer in males was the only sex-specific trend in cancer that can occur in both sexes. Analytic studies for sites with consistent urban-rural trends across all race-sex groups may be fruitful in identifying the aspect of population density, or other unmeasured factor, that contribute to these trends.
A series of case-control studies using subjects from the Illinois State Cancer Registry have been conducted. Logistic regression was used to control for age and history of tobacco and alcohol use. Construction workers were consistently found to be younger than other subjects and to have used alcohol and tobacco more often. Significant positive associations between cancer of the stomach and welding (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.09, 4.09), lung cancer and employment in the construction industry (OR = 1.18, 95% CI = 1.02, 1.26), and lung cancer and welding (OR = 1.68, 95% CI = 1.03, 2.76) were found. Significant negative associations between cancer of the colon and welding (OR = .54, 95% CI = .29, 1.00), cancer of the prostate and employment in the construction industry (OR = .76, 95% CI = .65, .89), cancer of the prostate and plumbing (OR = .44, 95% CI = .38, .50), cancer of the prostate and metal working (OR = .43, 95% CI = .19, .93), and bladder cancer and employment as an electrician (OR = .60, 95% CI = .36, 1.00) suggests that construction workers did not consistently experience excesses of cancers known to be associated with tobacco use, and an overall excess of sites not known to be related to tobacco use may have occurred.
The expense of collecting primary data, coupled with limited authority to mandate reporting, requires alternative methods of implementing an occupational disease registry in Illinois. One alternative data source for surveillance of some occupational diseases is hospital discharge records. Because these records lack personal identifiers, it has been impossible historically to match records belonging to the same individual and obtain reliable case estimates. To circumvent this difficulty, an algorithm has been developed to match anonymous hospital discharge records collected from all Illinois hospitals. The algorithm was based on the assumption that specific combinations of occupational disease code, sex, zip code, and date of birth would identify an individual to whom multiple hospitalizations belong. Matching with the algorithm reduced the 1986 case estimates from 597 to 499 for all cases of coal workers' pneumoconiosis, asbestosis, and silicosis.
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