Characteristics of colorectal cancers among Alaska Native people before and after implementing programs to promote screening.
Characteristics of colorectal cancers among Alaska Native people before and after implementing programs to promote screening.
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DOI：
10.1016/j.jcpo.2021.100293
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发表时间：
2021-09
影响因子：
1.3
通讯作者：
Redwood D
中科院分区：
文献类型：
--
作者：
Nash SH;Britton C;Redwood D
阿拉斯加原住民(AN)的结直肠癌(CRC)发病率是全球最高的。增加结直肠癌筛查在其他人群中有效地降低了结直肠癌相关的发病率和死亡率。研究人群中近期的描述性流行病学和较长期的结直肠癌趋势。在筛查患病率增加的同时，确定人群中结直肠癌描述性流行病学的任何变化。我们估计了2000-2017年间特定年龄段的结直肠癌发病率和死亡率。为了检验1990-2017年间发病率和死亡率的长期趋势，我们对三年滚动平均发病率和死亡率进行了连接点回归分析。我们计算了两个时期的描述性统计数据：2000-2008年和2009-2017年。最后，我们检查了五年的生存概率。随着时间的推移(1990-2017)，50岁以下人群的CRC发病率有所上升，而自2000年以来，50岁以上人群的发病率略有下降。总体而言，1990至2004年间，CRC死亡率有所下降，但自那时以来一直在稳步上升。比较2000-2008年和2009-2017年，我们没有观察到结直肠癌的发病率和死亡率、确诊年龄、肿瘤大小、肿瘤位置或分期分布方面的差异。生存分析表明，2004-2008年和2009-2017年间死亡风险没有变化(HR 1.02，95%CI：0.74，1.38，P=0.93)。整个阿拉斯加部落卫生系统的结直肠癌预防和控制努力尚未降低死亡率，或导致早期移民。必须加紧努力，在这一高危人群中减轻儿童权利公约的负担。有必要继续加强对初级和二级预防工作的重视。
Alaska Native (AN) people have the highest rates of colorectal cancer (CRC) globally. Increasing CRC screening has been effective in reducing CRC-related morbidity and mortality in other populations. To examine recent descriptive epidemiology and longer-term CRC trends among AN people. To determine any changes in the descriptive epidemiology of CRC among AN people concurrent with increases in screening prevalence. We estimated age-specific CRC incidence and mortality rates 2000-2017. To examine longer-term trends in incidence and mortality 1990-2017, we conducted Joinpoint regression analyses of three-year rolling average incidence and mortality rates. We calculated descriptive statistics for two time-periods: 2000-2008, and 2009-2017. Finally, we examined five-year survival probability. CRC incidence increased over time (1990-2017) among AN people aged less than 50 years, while there were modest declines in AN people older than 50 years old since 2000. Overall, AN CRC mortality rates declined between 1990 and 2004, but have been increasing steadily since that time. Comparing 2000-2008 with 2009-2017 we observed no difference in CRC incidence and mortality, age at diagnosis, tumor size, tumor location, or stage distribution. Survival analyses indicated no change in hazard of death between 2004-2008 and 2009-2017 (HR 1.02, 95% CI: 0.74, 1.38, P = 0.93). Colorectal cancer prevention and control efforts across the Alaska Tribal Health System have not yet resulted in reduced mortality rates, or induced earlier stage migration. Intensified efforts will be necessary to reduce the burden of CRC among this high-risk population. Continued and increased focus on primary and secondary prevention efforts is warranted.