Racial Disparities in Stage-Specific Colorectal Cancer Mortality Rates From 1985 to 2008
Racial Disparities in Stage-Specific Colorectal Cancer Mortality Rates From 1985 to 2008
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DOI：
10.1200/jco.2011.37.5527
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发表时间：
2012-02-01
影响因子：
45.3
通讯作者：
Jemal, Ahmedin
中科院分区：
文献类型：
--
作者：
Robbins, Anthony S.;Siegel, Rebecca L.;Jemal, Ahmedin
目的自 20 世纪 80 年代初以来，由于白人死亡率下降较早且幅度较大，美国白人和黑人的结直肠癌 (CRC) 死亡率一直存在差异。我们检查了这种死亡率模式在诊断时是否因阶段而异。方法使用监测、流行病学和最终结果 (SEER) 计划的基于发病率的死亡率数据库来检查来自九个原始 SEER 区域的数据。我们的主要结果指标是按种族划分的阶段特定死亡率的变化。结果从1985年到1987年到2006年到2008年，黑人和白人的CRC死亡率在每个阶段都有所下降，但在每个阶段，黑人的下降幅度较小，特别是远期疾病。对于局部阶段，白人的死亡率下降了 30.3%，而黑人的死亡率下降了 13.2%；在地区阶段，白人的下降幅度为 48.5%，而黑人的下降幅度为 34.0%；在远期阶段，白人的下降幅度为 32.6%，而黑人的下降幅度为 4.6%。结果，局部疾病的黑白比率从 1.17（95% CI，0.98 至 1.39）增加至 1.41（95% CI，1.21 至 1.63），区域疾病的黑白比率从 1.03（95% CI，0.93 至 1.14）增加至 1.30（95% CI，1.17 至 1.44），对于远处疾病，该值从 1.21（95% CI，1.10 至 1.34）至 1.72（95% CI，1.58 至 1.86）。从绝对值来看，晚期死亡率的差异约占黑人和白人总体死亡率差异的 60%。结论 CRC 死亡率的黑人和白人差异在疾病的每个阶段都在增加，但总体死亡率的总体差异主要是由晚期疾病的趋势驱动的。共同努力在黑人早期阶段预防或检测结直肠癌可以改善日益恶化的黑人与白人之间的差异。 J 临床肿瘤杂志 30：401-405。 (C) 2011 年美国临床肿瘤学会
PurposeSince the early 1980s, colorectal cancer (CRC) mortality rates for whites and blacks in the United States have been diverging as a result of earlier and larger reductions in death rates for whites. We examined whether this mortality pattern varies by stage at diagnosis.MethodsThe Incidence-Based Mortality database of the Surveillance, Epidemiology, and End Results (SEER) Program was used to examine data from the nine original SEER regions. Our main outcome measures were changes in stage-specific mortality rates by race.ResultsFrom 1985 to 1987 to 2006 to 2008, CRC mortality rates decreased for each stage in both blacks and whites, but for every stage, the decreases were smaller for blacks, particularly for distant-stage disease. For localized stage, mortality rates decreased 30.3% in whites compared with 13.2% in blacks; for regional stage, declines were 48.5% in whites compared with 34.0% in blacks; and for distant stage, declines were 32.6% in whites compared with 4.6% in blacks. As a result, the black-white rate ratios increased from 1.17 (95% CI, 0.98 to 1.39) to 1.41 (95% CI, 1.21 to 1.63) for localized disease, from 1.03 (95% CI, 0.93 to 1.14) to 1.30 (95% CI, 1.17 to 1.44) for regional disease, and from 1.21 (95% CI, 1.10 to 1.34) to 1.72 (95% CI, 1.58 to 1.86) for distant-stage disease. In absolute terms, the disparity in distant-stage mortality rates accounted for approximately 60% of the overall black-white mortality disparity.ConclusionThe black-white disparities in CRC mortality increased for each stage of the disease, but the overall disparity in overall mortality was largely driven by trends for late-stage disease. Concerted efforts to prevent or detect CRC at earlier stages in blacks could improve the worsening black-white disparities. J Clin Oncol 30: 401-405. (C) 2011 by American Society of Clinical Oncology