Early-Onset Colorectal Cancer Survival Differences and Potential Geographic Determinants Among Men and Women in Utah.
Early-Onset Colorectal Cancer Survival Differences and Potential Geographic Determinants Among Men and Women in Utah.
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DOI：
10.1200/edbk_350241
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发表时间：
2022-04
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到2030年，早发性结直肠癌(EOCRC)预计将成为20至49岁人群与癌症相关的主要死亡原因。为了更好地了解这一现象，我们通过检测县级发病率和死亡率，分析了犹他州EOCRC的地理决定因素。我们将犹他州人口数据库的数据与犹他州癌症登记处的数据联系起来，以确定2000年至2020年期间被诊断为EOCRC的居民(年龄18-49岁)，并使用空间经验贝叶斯平滑来确定县级热点。我们确定了1867例EOCRC诊断(52.7%的男性患者，69.2%的非西班牙裔白人患者)。有10个县(34%)被列为高发地区，原发癌发病率或死亡率较高。非西班牙裔少数族裔男性(发病率比1.49；95%CI，1.15-1.91)、西班牙裔白人男女(发病率比2.24；95%CI，2.00-2.51)和西班牙裔少数族裔男性和女性(发病率比4.59；95%CI，3.50-5.91)更有可能被诊断为EOCRC。在调整了收入和肥胖因素后，生活在热点地区的成年人死亡风险增加了31%(HR，1.31；95%CI，1.02-1.69)。生活在热点地区的晚期确诊患者的存活率最低(卡方检验(1)=4.0；p=.045)。已婚或有终身伴侣的成年人的死亡风险低于单身成年人(HR，0.73；95%CI，0.58-0.92)。在犹他州34%的县，EOCRC的风险增加，这证明了未来的研究和干预措施，旨在增加18至49岁人口的筛查和存活率。
By 2030, early-onset colorectal cancer (EOCRC) is expected to become the leading cancer-related cause of death for people age 20 to 49. To improve understanding of this phenomenon, we analyzed the geographic determinants of EOCRC in Utah by examining county-level incidence and mortality. We linked data from the Utah Population Database to the Utah Cancer Registry to identify residents (age 18–49) diagnosed with EOCRC between 2000 and 2020, and we used spatial empirical Bayes smoothing to determine county-level hotspots. We identified 1,867 EOCRC diagnoses (52.7% in male patients, 69.2% in non-Hispanic White patients). Ten counties (34%) were classified as hotspots, with high EOCRC incidence or mortality. Hotspot status was unrelated to incidence rates, but non-Hispanic ethnic-minority men (incidence rate ratio, 1.49; 95% CI, 1.15–1.91), Hispanic White men and women (incidence rate ratio, 2.24; 95% CI, 2.00–2.51), and Hispanic ethnic-minority men and women (incidence rate ratio, 4.59; 95% CI, 3.50–5.91) were more likely to be diagnosed with EOCRC. After adjustment for income and obesity, adults living in hotspots had a 31% higher hazard for death (HR, 1.31; 95% CI, 1.02–1.69). Survival was poorest for adults with a late-stage diagnosis living in hotspots (chi square (1) = 4.0; p = .045). Adults who were married or who had a life partner had a lower hazard for death than single adults (HR, 0.73; 95% CI, 0.58–0.92). The risk for EOCRC is elevated in 34% of Utah counties, warranting future research and interventions aimed at increasing screening and survival in the population age 18 to 49.