Cancer mortality in the united states by education level and race
Cancer mortality in the united states by education level and race
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DOI：
10.1093/jnci/djm127
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发表时间：
2007-09-19
影响因子：
10.3
通讯作者：
Thun, Michael J.
中科院分区：
文献类型：
--
作者：
Albano, Jessica D.;Ward, Elizabeth;Thun, Michael J.
背景虽然众所周知，种族和社会经济地位会影响美国的死亡率模式，但很少有研究探讨这些因素对癌症发病率和死亡率的同时影响。我们研究了种族、教育水平和肺癌、乳腺癌、前列腺癌、结肠癌和直肠癌死亡率之间的关系，以及当代美国人口动态统计中所有部位的死亡率。（95%置信区间（Cls））计算了119376196名25-64岁个体中137708例死亡，使用来自死亡证明的种族和教育信息以及美国人口普查局2001年47个州和华盛顿特区的人口分母数据。相对危险度（FIR）的估计被用来比较癌症死亡率的人与12年或更少的教育与12年以上的education.Results的人的教育程度是强烈的，并与所有癌症的死亡率呈负相关，在黑人和白色男性和白色女性相结合。受教育程度在0-8年的黑人男性和白色男性的癌症死亡率几乎相同（分别为224.2和223.6/10万），比较三个最低的癌症死亡率，（12年）教育类别为2.38（95% CI = 2.33至2.43）黑人男性，2.24（95% CI = 2.23至2.26），黑人女性为1.43（95% CI = 1.41至1.46），白色女性为1.76（95% CI = 1.75至1.78）。对于男性和女性来说，对于所有癌症以及肺癌和结直肠癌，将每个种族内三个最低教育水平与三个最高教育水平进行比较的相对风险大小高于每个种族内与种族相关的相对风险大小教育水平，而对于乳腺癌和前列腺癌，与种族相关的相对风险的大小高于与水平相关的相对风险的大小。每个种族群体的教育。其中最重要和新颖的发现是，完成12年或更少教育的黑人男性的前列腺癌死亡率是受过更多教育的黑人男性的两倍多（每10万人中有10.5人对4.8人; RR = 2.17，95%CI = 1.82 - 2.58），与早期死亡率研究相比，受教育程度较低的女性的乳腺癌死亡率高于受教育程度较高的女性（黑人妇女分别为每10万人37.0人和31.1人，每10万人25.2人和18.6人，白色妇女）。结论癌症死亡率因教育水平而有很大差异。按教育水平和种族确定癌症死亡的高风险群体可能有助于有针对性的干预措施和跟踪癌症差异。
Background Although both race and socioeconomic status are well known to influence mortality patterns in the United States, few studies have examined the simultaneous influence of these factors on cancer incidence and mortality. We examined relationships among race, education level, and mortality from cancers of the lung, breast, prostate, colon and rectum, and all sites combined in contemporary US vital statistics.Methods Age-adjusted cancer death rates (with 95% confidence intervals (Cls]) were calculated for 137708 deaths among 119376196 individuals aged 25-64 years, using race and education information from death certificates and population denominator data from the US Bureau of the Census, for 47 states and Washington, DC, in 2001. Relative risk (FIR) estimates were used to compare cancer death rates in persons with 12 or fewer years of education with those in persons with more than 12 years of education.Results Educational attainment was strongly and inversely associated with mortality from all cancers combined in black and white men and in white women. The all-cancer death rates were nearly identical for black men and white men with 0-8 years of education (224.2 and 223.6 per 100000, respectively), The estimated relative risk for all-cancer mortality comparing the three lowest ( 12 years) education categories was 2.38 (95% Cl = 2.33 to 2.43) for black men, 2.24 (95% Cl = 2.23 to 2.26) for white men, 1.43 (95% Cl = 1.41 to 1.46) for black women, and 1.76 (95% Cl = 1.75 to 1.78) for white women. For both men and women, the magnitude of the relative risks comparing the three lowest educational levels with the three highest within each race for all cancers combined and for lung and colorectal cancers was higher than the magnitude of the relative risks associated with race within each level of education, whereas for breast and prostate cancer the magnitude of the relative risks associated with race was higher than the magnitude of the relative risks associated with level of education within each racial group. Among the most important and novel findings were that black men who completed 12 or fewer years of education had a prostate cancer death rate that was more than double that of black men with more schooling (10.5 versus 4.8 per 100000 men; RR = 2.17, 95% Cl = 1.82 to 2.58) and that, in contrast with studies of mortality rates in earlier time periods, breast cancer mortality rates were higher among women with less education than among women with more education (37.0 and 31.1 per 100000, respectively, for black women and 25.2 versus 18.6 per 100000, respectively, for white women).Conclusion Cancer death rates vary considerably by level of education. Identifying groups at high risk of death from cancer by level of education as well as by race may be useful in targeting interventions and tracking cancer disparities.