Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996
Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996
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DOI：
10.1503/cmaj.1031528
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发表时间：
2004-05-11
影响因子：
14.6
通讯作者：
Berthelot, JM
中科院分区：
文献类型：
--
作者：
Ng, E;Wilkins, R;Berthelot, JM
背景资料：减少健康方面的社会经济不平等是加拿大卫生政策的一个明确目标，但众所周知，社会经济地位低的妇女的宫颈癌死亡率高于社会经济地位高的妇女。为了评估世界卫生组织“人人享有健康”目标的进展情况，我们研究了1971年至1996年宫颈癌死亡率中与收入相关的差异是否减少。方法：1971年、1986年、1991年和1996年加拿大人口普查大都市地区的死亡登记数据通过邮政编码分配到人口普查区，这些小块土地又被分配到收入五分位数，这是基于他们在加拿大统计局低收入截止值以下的人口比例。我们比较了年龄标准化死亡率（采用1966年世界人口标准）（不包括机构中的人）和计算出的五分之一收入之间的比率（最穷者对最富者）和五分之一之间的比率差异（最穷减去最富）。从1971年到1996年，按每十万名妇女计算的整体年龄标准化子宫颈癌死亡率（和95%置信区间）从5.0（4.5-5.6）至1.9（1.7-2.1），五分之一间比率从2.7（1.8-4.2）至1.7（1.1-2.6），五分位数间比率差异从4.6（2.8-6.4）至1.1（0.2-1.9）.解释：收入-在加拿大城市，宫颈癌死亡率的相关差异（以比率和比率差异衡量）明显减少，从1971年到1996年。在可能导致下降的众多因素中（包括生育能力下降和饮食改善），一个重要因素可能是实施有效的筛查计划。
Background: The reduction of socioeconomic inequalities in health is an explicit objective of health policy in Canada, yet rates of death from cervical cancer are known to be higher among women of low socioeconomic status than among those of higher socioeconomic status. To evaluate progress toward the World Health Organization's goal of "Health for All," we examined whether income-related differentials in cervical cancer mortality diminished from 1971 to 1996.Methods: Death registration data for Canada's census metropolitan areas in 1971, 1986, 1991 and 1996 were assigned to census tracts through postal code, and the tracts were in turn assigned to income quintiles based on their proportion of the population below the Statistics Canada low-income cutoff values. We compared age-standardized death rates (using the 1966 world population standard) in the female population (excluding those in institutions) across the 5 income quintiles and calculated interquintile rate ratios (poorest over richest) and interquintile rate differences (poorest minus richest).Results: From 1971 to 1996, the overall age-standardized cervical cancer death rate per 100 000 women (and 95% confidence interval) declined from 5.0 (4.5-5.6) to 1.9 (1.7-2.1), the interquintile rate ratio diminished from 2.7 (1.8-4.2) to 1.7 (1.1-2.6), and the interquintile rate difference decreased from 4.6 (2.8-6.4) to 1.1 (0.2-1.9).Interpretation: The income-related disparity in rates of death from cervical cancer as measured by rate ratios and rate differences diminished markedly in urban Canada from 1971 to 1996. Among the numerous factors that may have contributed to the decline (including decline in fertility and improvement in diet), one important factor was probably the implementation of effective screening programs.