Rural-Urban Trends and Patterns in Cervical Cancer Mortality, Incidence, Stage, and Survival in the United States, 1950-2008
Rural-Urban Trends and Patterns in Cervical Cancer Mortality, Incidence, Stage, and Survival in the United States, 1950-2008
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DOI：
10.1007/s10900-011-9439-6
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发表时间：
2012-02-01
影响因子：
5.9
通讯作者：
Singh, Gopal K.
中科院分区：
文献类型：
--
作者：
Singh, Gopal K.
这项研究考察了1950至2007年间美国大都市和非大都市地区女性宫颈癌死亡率的差异。分析了2000-2008年间发病率、确诊时的疾病阶段和患者存活率的不平等。计算了大都市和非大都市地区女性的年龄调整死亡率、发病率和5年相对生存率，并对相对风险的差异进行了统计学意义的检验。使用对数线性回归分析死亡率随时间的年变化率。在过去的50年里，非大都市地区的妇女宫颈癌死亡率显著高于大都市地区的妇女。在死亡率持续下降的背景下，差距依然存在。在整个1969-2007年间，非大都市地区的白人和黑人女性的宫颈癌死亡率都明显高于大都市女性。在黑人女性中，大都市的宫颈癌死亡率下降速度快于非大都市地区。在大都市和非大都市地区，黑人女性的死亡率都是白人女性的两倍。在2000-2008年间，非大都市地区的白人、黑人和美国印第安人女性的宫颈癌发病率显著高于大都市女性。非大都市地区的存活率明显较低，特别是在农村黑人妇女中。在非大都市地区，被诊断患有宫颈癌的黑人女性的5年存活率为50.8%，相比之下，大都市地区黑人女性和白人女性的5年存活率分别为60.2%和71.0%。在控制了疾病阶段后，存活率存在差异。尽管发病率和死亡率急剧下降，但宫颈癌的城乡差异依然存在。
This study examined disparities in cervical cancer mortality rates among US women in metropolitan and non-metropolitan areas from 1950 through 2007. Inequalities in incidence, stage of disease at diagnosis, and patient survival were analyzed during 2000-2008. Age-adjusted mortality, incidence, and 5-year relative survival rates were calculated for women in metropolitan and non-metropolitan areas, and differences in relative risks were tested for statistical significance. Log-linear regression was used to analyze annual rates of change in mortality over time. During the last five decades, women in non-metropolitan areas had significantly higher cervical cancer mortality than those in metropolitan areas. Disparities persisted against a backdrop of consistently declining mortality rates. Throughout 1969-2007, both white and black women in non-metropolitan areas maintained significantly higher cervical cancer mortality rates than their metropolitan counterparts. Among black women, cervical cancer mortality declined at a faster pace in metropolitan than in non-metropolitan areas. In both metropolitan and non-metropolitan areas, black women had twice the mortality rate of white women. During 2000-2008, white, black, and American Indian women in non-metropolitan areas had significantly higher cervical cancer incidence rates than their metropolitan counterparts. Survival rates were significantly lower in non-metropolitan areas, particularly among rural black women. The 5-year survival rate for black women diagnosed with cervical cancer was 50.8% in non-metropolitan areas, compared with 60.2% for black women and 71.0% for white women in metropolitan areas. Disparities in survival existed after controlling for disease stage. Rural-urban disparities in cervical cancer have persisted despite steep declines in incidence and mortality rates.