Disparities in Cancer Incidence, Stage, and Mortality at Boston Health Care for the Homeless Program
Disparities in Cancer Incidence, Stage, and Mortality at Boston Health Care for the Homeless Program
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DOI：
10.1016/j.amepre.2015.03.038
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发表时间：
2015-11-01
影响因子：
5.5
通讯作者：
Rigotti, Nancy A.
中科院分区：
文献类型：
--
作者：
Baggett, Travis P.;Chang, Yuchiao;Rigotti, Nancy A.
前言：无家可归者的癌症风险因素负担高，癌症筛查率不理想，但这一人群的癌症流行病学尚未得到很好的描述。我们相对于一般人群标准评估了无家可归的成年人的癌症发病率、分期和死亡率。方法：我们将2003-2008年在波士顿无家可归者医疗保健项目就诊的28,033名成年人与马萨诸塞州癌症登记和生命登记记录进行了交叉关联。我们计算了年龄标准化癌症发病率和死亡率（SIRs和SMRs）。我们检查了事故病例中的烟草使用情况，并估计了吸烟归因部分。趋势测试用于比较癌症分期分布与马萨诸塞州成年人的分布。分析时间为2012-2015年。结果：在90450人年的观察中，男性中有361例癌症（SIR=1.13, 95% CI=1.02, 1.25）和168例癌症死亡（SMR=1.88, 95% CI=1.61, 2.19），女性中有98例癌症（SIR=0.93, 95% CI=0.76, 1.14）和38例癌症死亡（SMR=1.61, 95% CI=1.14, 2.20）。无论男女，支气管和肺癌都是主要的癌症和癌症死亡类型，超过马萨诸塞州估计的两倍多。口咽癌和肝癌病例和死亡在男性中过多，而宫颈癌病例和死亡在女性中过多。大约三分之一的癌症是由吸烟引起的。结直肠癌、女性乳腺癌和口咽癌的诊断阶段比马萨诸塞州的成年人要晚。结论：减少无家可归者癌症差异的努力应包括解决烟草使用问题和加强参与循证筛查。(C) 2015年美国预防医学杂志
Introduction: Homeless people have a high burden of cancer risk factors and suboptimal rates of cancer screening, but the epidemiology of cancer has not been well described in this population. We assessed cancer incidence, stage, and mortality in homeless adults relative to general population standards.Methods: We cross-linked a cohort of 28,033 adults seen at Boston Health Care for the Homeless Program in 2003-2008 to Massachusetts cancer registry and vital registry records. We calculated age-standardized cancer incidence and mortality ratios (SIRs and SMRs). We examined tobacco use among incident cases and estimated smoking-attributable fractions. Trend tests were used to compare cancer stage distributions with those in Massachusetts adults. Analyses were conducted in 2012-2015.Results: During 90,450 person-years of observation, there were 361 incident cancers (SIR=1.13, 95% CI=1.02, 1.25) and 168 cancer deaths (SMR=1.88, 95% CI=1.61, 2.19) among men, and 98 incident cancers (SIR=0.93, 95% CI=0.76, 1.14) and 38 cancer deaths (SMR=1.61, 95% CI=1.14, 2.20) among women. For both sexes, bronchus and lung cancer was the leading type of incident cancer and cancer death, exceeding Massachusetts estimates more than twofold. Oropharyngeal and liver cancer cases and deaths occurred in excess among men, whereas cervical cancer cases and deaths occurred in excess among women. About one third of incident cancers were smoking-attributable. Colorectal, female breast, and oropharyngeal cancers were diagnosed at more-advanced stages than in Massachusetts adults.Conclusions: Efforts to reduce cancer disparities in homeless people should include addressing tobacco use and enhancing participation in evidence-based screening. (C) 2015 American Journal of Preventive Medicine