• Muzahem Al-Hashimi Department of Statistics and Informatics, College of Computer science & Mathematics, University of Mosul, Mosul, Iraq
  • Safwan Nathem Rashed Department of Statistics and Informatics, College of Computer science & Mathematics, University of Mosul, Mosul, Iraq
Keywords: Cold spots, hotspots, , spatial outliers, cervical cancer, Iraq


Cervical cancer is the most common cancer in Iraq. This study aimed to examine the spatial pattern and high-risk clusters of cervical cancer in different areas of Iraq (except the Kurdish region) during the period 2010-2015. The age-adjusted incidence rates (AAIRs), age-specific incidence rates (ASIRs), and annual percent changes (APCs) were calculated for 2010–2015. We used three techniques of spatial statistical analysis which are Global spatial autocorrelation, Getis-Ord Gi* statistic, and Anselin Local Moran’s  statistic to investigate spatial clustering and outliers. Over the period 2000-2015, 1037 cases were diagnosed with AAIR of incidence of (3.521 per 100,000). Depending on AAIRs, we found cervical cancer incidence was highest (8.212 per 100,000) in the age group of 60-69 years old. The APC of cervical cancer age-specific rates has significantly risen for the age groups 60-69 only. We identified spatial high-risk clusters for incidence. The cluster was mainly located in the center of Iraq (Baghdad, Najaf, Kerbala, and Babil provinces), the central-eastern part of Iraq (Diyala province), and the southern part of Iraq (Basrah province). While the provinces in the northern and northeastern parts of Iraq, as well as the western province, had relatively lower AAIRs from cervical cancer. A spatial cluster pattern for the incidence of cervical cancer in Iraq was revealed, which will be valuable for improving the allocation of health resources in Iraq.


Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020; 8(2):e191-203.

Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.

Ibp I. Iraq country study guide, Volume 1. Strategic information and developments.

Su SC, Kanarek N, Fox MG, et al. Spatial analyses identify the geographic source of patients at a National Cancer Institute Comprehensive Cancer Center. Clin. Cancer Res. 2010;16(3):1065-72.

Ruankaew N. GIS and epidemiology. J. Med. Assoc. Thail. = Chotmaihet thangphaet. 2005;88(11):1735-8.

Boscoe FP, Ward MH, Reynolds P. Current practices in spatial analysis of cancer data: data characteristics and data sources for geographic studies of cancer. Int. J. Health Geogr. 2004;3(1):28.

Annual Statistical Report 2015. Planning Directorate, Ministry of Health/ Environment, Republic of Iraq 2016: 4-5.

Wong DW. Statistical analysis of geographic information with ArcView GIS and ArcGIS, 2005.

Anselin L. Local indicators of spatial association—LISA. Geogr. Anal. 1995;27(2):93-115.

Khan D, Rossen LM, Hamilton BE, et al. Hot spots, cluster detection and spatial outlier analysis of teen birth rates in the US, 2003–2012. Spat. Spatio-temporal Epidemiol. 2017;21:67-75.

Levine N. Hot spot analysis of zones. N Levine, CrimeStat: Spatial Statistics Program for the Analysis of Crime Incident Locations, Version. 2013;4:242960-95.

E.S.R. Institute. ArcGIS desktop: release 10. Redlands CA: Environmental Systems Research Institute; 2011.

Alkhalawi E, Al-Madouj A, Al-Zahrani A. Cervical Cancer Incidence and Trends among Nationals of the Gulf Cooperation Council States, 1998-2012. Gulf J. Oncol. 2019;1(31):7-13.

Riahi S, Mokhtari AM, Vali M, et al. Incidence and mortality rate of cervix cancer in Iran from 1990 to 2016: A systematic review and meta-analysis. J. contemp. med. sci. 2019;5(1):1-7.

Hassan MR, Gatea AA, Hassan HR. Prevalence of cervical cancer and associated factors among women in Baghdad/Iraq. World J Pharm Res. 2018;7(11):178-86.

Ameen NS, Helmi ZR. The characteristics women with cervical cancer referred for radiotherapy and/or chemotherapy. Iraqi Postgrad Med J. 2013;12:321-8.

Hull R, Mbele M, Makhafola T, et al. Cervical cancer in low and middle income countries. Oncology Letters. 2020;20(3):2058-74.

Al Niyazee AA, Abedalrahman SK, Saleh LA. Prevalence of cytological abnormality of cervical papanicolaou smear. Middle East J. Fam. Med. 2019;7(10):16.

Abdul-Samad MN, Kandala NJ. The molecular detection of HPV infection in samples of Iraqi women with abnormal cervical smears. Iraqi Journal of Science. 2018;1995-2004.

How to Cite
Al-Hashimi, M., & Safwan Nathem Rashed. (2021). SPATIAL ANALYSIS OF CERVICAL CANCER INCIDENCE IN IRAQ DURING 2010-2015. Malaysian Journal of Public Health Medicine, 21(3), 209-216.