Geographic Distribution of Lung and Bronchus Cancer Mortality and Elevation in the United States: Exploratory Spatial Data Analysis and Spatial Statistics

Lung and bronchus cancer, collectively called lung cancer, remains one of the most lethal malignancies worldwide, with its incidence and mortality rates continuing to pose significant public health challenges. Numerous studies have explored various risk factors for lung cancer, including smoking, environmental pollutants, genetic predispositions, and occupational hazards. However, emerging research suggests that elevation above sea level may also influence lung and bronchus cancer prevalence and outcomes. We analyzed elevation data for 2662 contiguous U.S. counties to determine if there is a significant relationship between lung cancer and elevation. Moreover, we employed hierarchical multiple regression and a complex sample general linear model (CSGLM) to enhance the understanding of the factors influencing lung and bronchus cancer, with a particular focus on elevation. Using Local Moran’s I cluster analysis, we identified statistically significant hot spots and cold spots for the mortality rate related to lung cancer. In the hierarchical regression model, a significant correlation between lung cancer and elevation remained evident. This suggests that the risk of mortality from lung and bronchus cancer increases with decreasing elevation (R2 = 0.601). Furthermore, within the CSGLM framework, an R2 value of 0.763 highlighted a strong link between lung cancer mortality and elevation. This relationship remained significant even after accounting for complex sample designs and applying weight adjustments. This geographic correlation has not been documented in previous studies. Further research is necessary to elucidate the precise mechanisms through which elevation influences lung cancer biology.