Spatial and spatio-temporal clusters of lung cancer incidence by stage of disease in Michigan, United States 1985-2018

Submitted: 30 June 2023
Accepted: 15 January 2024
Published: 14 February 2024
Abstract Views: 5802
PDF: 579
Supplementary Materials: 66
HTML: 74
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Lung cancer is the most common cause of cancer-related death in Michigan. Most patients are diagnosed at advanced stages of the disease. There is a need to detect clusters of lung cancer incidence over time, to generate new hypotheses about causation and identify high-risk areas for screening and treatment. The Michigan Cancer Surveillance database of individual lung cancer cases, 1985 to 2018 was used for this study. Spatial and spatiotemporal clusters of lung cancer and level of disease (localized, regional and distant) were detected using discrete Poisson spatial scan statistics at the zip code level over the study time period. The approach detected cancer clusters in cities such as Battle Creek, Sterling Heights and St. Clair County that occurred prior to year 2000 but not afterwards. In the northern area of the lower peninsula and the upper peninsula clusters of late-stage lung cancer emerged after year 2000. In Otter Lake Township and southwest Detroit, late-stage lung cancer clusters persisted. Public and patient education about lung cancer screening programs must remain a health priority in order to optimize lung cancer surveillance. Interventions should also involve programs such as telemedicine to reduce advanced stage disease in remote areas. In cities such as Detroit, residents often live near industry that emits air pollutants. Future research should therefore, continue to focus on the geography of lung cancer to uncover place-based risks and in response, the need for screening and health care services.



PlumX Metrics


Download data is not yet available.


Alberg AJ, Brock MV, Ford JG, Samet JM, Spivack SD, 2013. Epidemiology of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e1S-e29S. DOI:
American Cancer Society, 2023a. Key Statistics for Lung Cancer. Retrieved January 25, 2023. Available from:,men%20and%2059%2C910%20in%20women.
American Cancer Society, 2023b, January. What is Lung Cancer? Retrieved January 26, 2023a Available from:,(outlook)%20are%20often%20similar
Amin R, Bohnert A, Holmes L, Rajasekaran A, Assanasen C, 2010. Epidemiologic mapping of Florida Childhood Cancer Clusters. Pediatr. Blood Cancer 54:511-8. DOI:
Barta J.A, Powell CA, Wisnivesky JP, 2019. Global Epidemiology of Lung Cancer. Ann Glob Health 85:2419. DOI:
Camina N, McWilliams TL, McKeon TP, Penning TM, Hwang WT, 2022. Identification of spatio-temporal clusters of lung cancer cases in Pennsylvania, USA: 2010-2017. BMC Cancer 22:555. DOI:
Centers for Disease Control and Prevention (CDC) United States Cancer Statistics 2023. Retrieved on February 9, 2024. Available from
De Groot PM, Wu CC, Carter BW, Munden RF, 2018. The epidemiology of Lung Cancer. Transl. Lung Cancer Res 7:220-33. DOI:
Demographic Data Northeast Prosperity Alliance, 2023. Retrieved on June 21, 2023. Available from
Eldridge L, 2022. Which countries have the highest rate of lung cancer? Latest data from the Global Burden of Disease Study. Verywell Health. Available from:
Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, Fan L, Li J, Chavarri-Guerra Y, Liedke PE, Pramesh CS, Badovinac-Crnjevic T, Sheikine Y, Chen Z, 2014. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol 15:489-538. DOI:
Javid SH, Varghese TK, Morris AM, Porter MP, He H, Buchwald D, Flum DR, 2014. Guideline-concordant cancer care and survival among American Indian/Alaskan Native patients. Cancer 120:2183-90. DOI:
Landsdorp-Vogelaar I, Kuntz KM, Knudsen AB, Van Ballegooijen M, Zauber AG, Jemal A, 2012. Contribution of screening and survival differences to racial disparities in colorectal cancer rates. Cancer Epidemiol. Biomarkers Prev 21:728-36. DOI:
Lawson AB, 2006. Disease cluster detection: a critique and a Bayesian proposal. Statistics Medicine 25(5):897-916. DOI:
Lee YJ, Kim J, Kim SK, Ha S, Mok TS, Mitsudomi T, Cho BC 2011. Lung cancer in never smokers: Change of a mindset in the molecular era. Lung Cancer 72:9-15. DOI:
Lovly CM, 2022. Expanding Horizons for Treatment of Early-Stage Lung Cancer. N Engl J Med 386:2050-1. DOI:
Nguyen CT, Song I, Jung I, Choi YJ, Kim SY, 2023. Changes in spatial clusters of cancer incidence and mortality over 15 years in South Korea: implication to cancer control. Cancer Med 12(:17418—27. DOI:
Pui DY, Chen S, Zuo Z, 2014. PM 2.5 in China: Measurements, sources, visibility and health effects, and mitigation. Particuology 13:1-26. DOI:
Siegel RL, Miller KD, Jemal A, 2018. Cancer statistics, 2018. CA Cancer J Clin 68;7-30. DOI:
Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, Lopez AD, Hartge P, Gapstur SM, 2013. 50-year trends in smoking-related mortality in the United States. N. Engl. J. Med., 368:351-64. DOI:
Torabi M, Galloway K, 2018. Examining the impact of the number of regions used in cluster detection methods: An application to childhood asthma visits to a hospital in Manitoba, Canada. Geospat. Health 13:696. DOI:
Torre LA, Siegel RL, Jemal A, 2016. Lung Cancer Statistics. Adv Exp Med Biol 893:1-19. DOI:
U.S. Bureau of the Census, 2022. Retrieved on June 21, 2023. Available from
Van der Heyden JH, Schaap MM, Kunst AE, Esnaola S, Borrell C, Cox B, Leinsalu M, Stirbu I, Kalediene R, Deboosere P, Mackenbach JP, 2009. Socioeconomic inequalities in lung cancer mortality in 16 European populations. Lung Cancer 63:322-330. DOI:
Walters S, Maringe C, Coleman MP, Peake MD, Butler J, Young N, Bergström S, Hanna L, Jakobsen E, Kölbeck K, Sundstrøm S, 2013. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: A population-based study, 2004–2007. Thorax 68:551-564. DOI:
Wang Q, Shen JJ, Sotero M, Li CA, Hou Z, 2018. Income, occupation and education: Are they related to smoking behaviors in China? PLoS One 13:e0192571. DOI:
World Cancer Research Fund International, 2022, April 14. Lung cancer statistics. Retrieved January 28, 2023. Available from:
Zhang X, Wang L, Wang W, Cao D, Wang X, Ye D, 2015. Long-term trend and spatiotemporal variations of haze over China by satellite observations from 1979 to 2013. Atmos Environ 119:362-73. DOI:

How to Cite

Zhang, Q., Zhu, S., Grady, S. C., Wang, A., Hutchings, H., Cox, J., Popoff, A., & Okereke, I. (2024). Spatial and spatio-temporal clusters of lung cancer incidence by stage of disease in Michigan, United States 1985-2018. Geospatial Health, 19(1).