Excess incidence of squamous cell esophageal cancer among US black men: Role of social class and other risk factors
Excess incidence of squamous cell esophageal cancer among US black men: Role of social class and other risk factors
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DOI：
10.1093/aje/153.2.114
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发表时间：
2001-01-15
影响因子：
5
通讯作者：
Fraumeni, JF
中科院分区：
文献类型：
--
作者：
Brown, LM;Hoover, R;Fraumeni, JF
一项基于人群的病例对照研究的数据被用来评估社会阶层因素与鳞状细胞食道癌的关系，以及酒精、烟草、饮食和低收入在多大程度上导致美国黑人男性的发病率高于白人男性。共有347名男性患者(119名白人，228名黑人)和1354名男性对照组(743名白人，611名黑人)从美国三个地理区域(亚特兰大、佐治亚州、底特律、密歇根州和新泽西州)中挑选出来。病例为研究区居民，年龄30~79岁，1986年至期间经组织学确诊为食道癌。年收入低于10,000美元的受试者与年收入25,000美元或以上的受试者调整后的优势比白人为4.3(95%可信区间：2.1，8.7)，黑人为8.0(95%可信区间：4.3，15.0)。在白人(98%)和黑人(99%)中，所有四个主要风险因素--低收入、中/重度酒精摄入、吸烟以及不经常食用生果和蔬菜--几乎是所有鳞状细胞食道癌的原因，黑人男性中99%的额外发病率也是由这四个因素共同造成的。因此，改变生活方式，特别是减少酒精饮料的摄入量，将显著降低两个种族群体的鳞状细胞食道癌的发生率，并缩小风险的种族差异。对社会阶层决定因素的进一步研究可能有助于确定这种肿瘤的一组新的暴露，这些暴露是可以干预的。
Data from a population-based case-control study were used to evaluate the relation between social class factors and squamous cell esophageal cancer and the extent to which alcohol, tobacco, diet, and low income contribute to the higher incidence among Black men than among White men in the United States. A total of 347 male cases (119 White, 228 Black) and 1,354 male controls (743 White, 611 Black) were selected from three US geographic areas (Atlanta, Georgia, Detroit, Michigan, and New Jersey). Cases were residents of the study areas aged 30-79 years who had been diagnosed with histologically confirmed esophageal cancer between 1986 and 1989. The adjusted odds ratios for subjects with annual incomes less than $10,000 versus incomes of $25,000 or more were 4.3 (95% confidence interval: 2.1, 8.7) for Whites and 8.0 (95% confidence interval: 4.3, 15.0) for Blacks. The combination of all four major risk factors-low income, moderate/heavy alcohol intake, tobacco use, and infrequent consumption of raw fruits and vegetables-accounted for almost all of the squamous cell esophageal cancers in Whites (98%) and Blacks (99%) and for 99% of the excess incidence among Black men. Thus, lifestyle modifications, especially a lowered intake of alcoholic beverages, would markedly decrease the incidence of squamous cell esophageal cancer in both racial groups and would narrow the racial disparity in risk. Further studies on the determinants of social class may help to identify a new set of exposures for this tumor that are amenable to intervention.