Persistent area socioeconomic disparities in US incidence of cervical cancer, mortality, stage, and survival, 1975-2000
Persistent area socioeconomic disparities in US incidence of cervical cancer, mortality, stage, and survival, 1975-2000
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DOI：
10.1002/cncr.20467
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发表时间：
2004-09-01
期刊：
影响因子：
6.2
通讯作者：
Edwards, BK
中科院分区：
文献类型：
--
作者：
Singh, GK;Miller, BA;Edwards, BK
背景时间宫颈癌的发病率和死亡率模式和种族差异的患者生存和诊断阶段的社会经济剥夺措施尚未在美国得到很好的研究。本文分析了美国宫颈癌发病率、死亡率、分期和生存率的时间区域社会经济不平等。1990年人口普查的县和人口普查区贫困和教育变量与1975年至2000年美国死亡率和监测，流行病学和最终结果癌症发病率数据有关。计算了每个社会经济群体的经统计学校正的发病率和死亡率以及5年病因特异性生存率，并在0.05水平上对比率差异进行了统计学显著性检验。在发病率和死亡率方面观察到了相当大的地区社会经济梯度，在发病率下降的背景下，宫颈癌的不平等现象持续存在。宫颈癌发病率和死亡率随着总人口以及非西班牙裔白色、黑人、美洲印第安人、亚洲/太平洋岛民和西班牙裔妇女的贫困程度增加和教育水平下降而增加。低社会经济人口普查区的患者有显着较高的晚期癌症诊断率和较低的癌症生存率。即使在控制了分期后，存活率仍存在显著差异。在低社会经济普查区，诊断为远期宫颈癌的妇女的5年生存率比高社会经济普查区低约30%。基于普查的社会经济措施，如地区贫困和教育水平，可以作为重要的监测工具，用于监测与癌症有关的健康不平等的时间趋势和有针对性的干预措施。2004年由美国癌症协会出版。
BACKGROUND. Temporal cervical cancer incidence and mortality patterns and ethnic disparities in patient survival and stage at diagnosis in relation to socioeconomic deprivation measures have not been well studied in the United States. The current article analyzed temporal area socioeconomic inequalities in U.S. cervical cancer incidence, mortality, stage, and survival.METHODS. County and census tract poverty and education variables from the 1990 census were linked to U.S. mortality and Surveillance, Epidemiology, and End Results cancer incidence data from 1975 to 2000. Age-adjusted incidence and mortality rates and 5-year cause-specific survival rates were calculated for each socioeconomic group and differences in rates were tested for statistical significance at the 0.05 level.RESULTS. Substantial area socioeconomic gradients in both incidence and mortality were observed, with inequalities in cervical cancer persisting against a backdrop of declining rates. Cervical cancer incidence and mortality rates increased with increasing poverty and decreasing education levels for the total population as well as for non-Hispanic white, black, American Indian, Asian/Pacific Islander, and Hispanic women. Patients in lower socioeconomic census tracts had significantly higher rates of late-stage cancer diagnosis and lower rates of cancer survival. Even after controlling for stage, significant differences in survival remained. The 5-year survival rate among women diagnosed with distant-stage cervical cancer was approximately 30% lower in low than in high socioeconomic census tracts.CONCLUSIONS. Census-based socioeconomic measures such as area poverty and education levels could serve as important surveillance tools for monitoring temporal trends in cancer-related health inequalities and targeting interventions. Published 2004 by the American Cancer Society.*