County-level characteristics associated with incidence, late-stage incidence, and mortality from screenable cancers.
County-level characteristics associated with incidence, late-stage incidence, and mortality from screenable cancers.
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DOI：
10.1016/j.canep.2021.102033
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发表时间：
2021-12
影响因子：
2.6
通讯作者：
Onega T
中科院分区：
文献类型：
--
作者：
Moss JL;Wang M;Liang M;Kameni A;Stoltzfus KC;Onega T
癌症筛查因农村和种族居住隔离而异，但这些县级特征之间的关系尚未得到充分研究。了解这种关系及其对癌症结果的影响可以为减少癌症差异的干预措施提供信息。我们将国家数据来源的县级信息联系起来：2008-2012年癌症发病率、晚期发病率和死亡率（乳腺癌、宫颈癌和结肠直肠癌）来自美国癌症统计和国家死亡指数;大都市地位来自美国农业部;居住隔离来自美国社区调查;以及国家癌症研究所小区域评估的癌症筛查流行率。我们使用多变量稀疏泊松广义线性混合模型来评估县级特征的癌症发病率、晚期发病率和死亡率，控制医生密度和家庭收入中位数。乳腺癌和结直肠癌的发病率、晚期发病率和死亡率在大都市县低6-18%，在隔离程度较高的县低2-4%。一般来说，与居住隔离相关的癌症减少仅限于非大都市县。癌症发病率、晚期发病率和死亡率与筛查相关，在乳腺癌和结直肠癌筛查较多的地区，相应癌症的发病率高2-9%，但在宫颈癌筛查较多的地区，相应癌症的发病率低2-15%。在大都市和隔离程度更高的县，观察到癌症负担较低。大都市地位和县级居住隔离观察到的效果修改，表明居住隔离可能会影响不同类型的县不同的医疗服务。需要更多的研究来提供干预措施，以减少县级癌症发病率，晚期发病率和死亡率的差异。
Cancer screening differs by rurality and racial residential segregation, but the relationship between these county-level characteristics is understudied. Understanding this relationship and its implications for cancer outcomes could inform interventions to decrease cancer disparities. We linked county-level information from national data sources: 2008-2012 cancer incidence, late-stage incidence, and mortality rates (for breast, cervical, and colorectal cancer) from U.S. Cancer Statistics and the National Death Index; metropolitan status from U.S. Department of Agriculture; residential segregation derived from American Community Survey; and prevalence of cancer screening from National Cancer Institute’s Small Area Estimates. We used multivariable, sparse Poisson generalized linear mixed models to assess cancer incidence, late-stage incidence, and mortality rates by county-level characteristics, controlling for density of physicians and median household income. Cancer incidence, late-stage incidence, and mortality rates were 6-18% lower in metropolitan counties for breast and colorectal cancer, and 2-4% lower in more segregated counties for breast and colorectal cancer. Generally, reductions in cancer associated with residential segregation were limited to non-metropolitan counties. Cancer incidence, late-stage incidence, and mortality rates were associated with screening, with rates for corresponding cancers that were 2-9% higher in areas with more breast and colorectal screening, but 2-15% lower in areas with more cervical screening. Lower cancer burden was observed in counties that were metropolitan and more segregated. Effect modification was observed by metropolitan status and county-level residential segregation, indicating that residential segregation may impact healthcare access differently in different county types. Additional studies are needed to inform interventions to reduce county-level disparities in cancer incidence, late-stage incidence, and mortality.
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影响因子：
5.5
作者：
Kramer MR;Hogue CR
通讯作者：
Hogue CR
影响因子：
6.2
作者：
Fang CY;Tseng M
通讯作者：
Tseng M
DOI：
10.1177/1077558711420263
发表时间：
2012-04
期刊：
Medical care research and review : MCRR
影响因子：
--
作者：
Gaskin DJ;Dinwiddie GY;Chan KS;McCleary R
通讯作者：
McCleary R
影响因子：
5.4
作者：
Chang, Virginia W.
通讯作者：
Chang, Virginia W.
影响因子：
6.2
作者：
Haas, Jennifer S.;Earle, Craig C.;Williams, David R.
通讯作者：
Williams, David R.