Associations between community income and cancer survival in Ontario, Canada, and the United States
Associations between community income and cancer survival in Ontario, Canada, and the United States
复制标题
DOI：
10.1200/jco.1999.17.7.2244
复制
发表时间：
1999-07-01
影响因子：
45.3
通讯作者：
Mackillop, WJ
中科院分区：
文献类型：
--
作者：
Boyd, C;Zhang-Salomons, JY;Mackillop, WJ
目的：本研究的目的如下：（1）比较加拿大安大略省与美国（U.S.）的社会经济地位（SES）与癌症生存率之间的关联程度，方法：安大略省癌症登记处提供了1987年至1992年安大略省诊断的所有浸润性癌症病例的信息，监测、流行病学和最终结果登记处（SEER）提供了同一时期美国SEER地区诊断的所有病例的信息。人口普查数据提供了社区一级社会经济状况的信息。用乘积限法描述死因特异生存率，用考克斯比例风险模型描述SES与癌症死亡风险的关系。在美国和安大略，SES与大多数癌症部位的生存率之间存在显著关联，但在美国，这种关联的程度通常更大。在安大略的许多疾病组中，包括肺癌、头颈部癌、宫颈癌和子宫癌，癌症患者的生存率有明显的优势。然而，在中高收入社区，对于所有合并病例和几种单独疾病，包括乳腺癌、结肠癌和直肠癌、前列腺癌和膀胱癌，美国有显著的生存优势。在安大略，社会经济地位和癌症生存率之间的联系比在美国弱。这是由于最贫困地区患者的生存率更高。与美国相比，安大略富裕社区的患者生存率更低（C）1999年，美国临床肿瘤学会。
Purpose: The objectives of this study were as follows: (1) to compare the magnitude of the association between socioeconomic status (SES) and cancer survival in the Canadian province of Ontario with that in the United States (U.S.), and (2) to compare cancer survival in communities with similar SES in Ontario and in the U.S.Methods: The Ontario Cancer Registry provided information about all cases of invasive cancer diagnosed in Ontario from 1987 to 1992, and the Surveillance, Epidemiology and End Results Registry (SEER) provided information about all cases diagnosed in the SEER regions of the U.S. during the same time period. Census data provided information about SES at the community level. The product-limit method was used to describe cause-specific survival, Cox proportional hazards models were used ta describe the association between SES and the risk of death from cancer.Results: There were significant associations between SES and survival for most cancer sites in both the U.S. and Ontario, but the magnitude of the association was usually larger in the U.S. In the poorest communities, there were significant survival advantages in favor of cancer patients in Ontario for many disease groups, including cancers of the lung, head and neck region, cervix, and uterus. However, in upper- and middle-income communities, there were significant survival advantages in favor of the U.S, for all cases combined and for several individual diseases, including cancers of the breast colon and rectum, prostate, and bladder.Conclusion: The association between SES and cancer survival is weaker in Ontario than it is in the U.S. This is due to a combination of better survival among patients in the poorest communities and worse survival among patients in the wealthier communities of Ontario relative to those in the U.S. (C) 1999 by American Society of Clinical Oncology.