Ecological associations of environmental and behavioral factors with provincial urinary system mortality trajectories in Türkiye

To characterize province-level mortality trajectories for bladder cancer, prostate cancer, and renal failure in Turkiye and to explore ecological associations between mortality-profile membership and environmental, meteorological, and behavioral markers. Annual crude province-level mortality rates for 81 provinces from 2010 through 2019 were modeled using group-based trajectory analysis in SAS PROC TRAJ. For each outcome, province-level profile membership was related to 33 markers using separate univariable proportional-odds models, with false-discovery-rate control across marker-specific tests. The analyses were ecological and exploratory. Three mortality profiles were identified for each outcome. For bladder cancer, higher-profile membership showed positive ecological associations with median air pressure, ever-alcohol-use prevalence, ever-smoking prevalence, and median humidity, whereas PM10 and multiple meteorological-variability measures showed inverse associations. Prostate-cancer profiles showed positive associations with ever-alcohol-use prevalence, ever-smoking prevalence, and median humidity; household second-hand smoke exposure, PM10, and several variability measures showed inverse associations. For renal failure, median air pressure, ever-alcohol-use prevalence, ever-smoking prevalence, and median humidity showed positive associations, whereas PM10 and several variability measures showed inverse associations. Estimates came from separate univariable models and should not be interpreted as independent or individual-level effects. The study identified heterogeneous ten-year provincial mortality profiles and several exploratory ecological associations. Because the rates were crude, exposures were summarized concurrently with the mortality period, and major demographic, socioeconomic, healthcare, and diagnostic factors were unavailable, the findings do not establish causality or biological protection. They are most appropriately used to generate hypotheses and to guide better-adjusted surveillance and longitudinal studies.