Cervical Cancer Incidence and Mortality Among American Indian and Alaska Native Women, 1999-2009
Cervical Cancer Incidence and Mortality Among American Indian and Alaska Native Women, 1999-2009
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DOI：
10.2105/ajph.2013.301681
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发表时间：
2014-06-01
影响因子：
12.7
通讯作者：
Becker, Thomas
中科院分区：
文献类型：
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作者：
Watson, Meg;Benard, Vicki;Becker, Thomas
目标。我们分析了美洲印第安人和阿拉斯加原住民(AI/AN)妇女与其他种族妇女的宫颈癌发病率和死亡率数据。我们使用印度卫生服务(IHS)患者记录改进了AI/AN种族、宫颈癌发病率和死亡率数据的识别；我们的分析重点是IHS合同卫生服务交付地区(CHSDA)县的居民。计算1999-2009年AI/AN和白人妇女的年龄调整发病率和死亡率。CHSDA县的AI/AN妇女的宫颈癌死亡率为4.2，几乎是白人妇女(2.0；发病率比[RR]=2.11)的两倍。AI/AN妇女的宫颈癌发病率也高于白人妇女(11.0vs7.1；RR=1.55)，且更容易被诊断为晚期疾病(区域分期RR=1.84，远期RR=1.74)。1990年至1993年，AI/AN妇女死亡率下降(-25.8%/年)，此后保持稳定。虽然发病率随着时间的推移而下降，但AI/AN妇女的宫颈癌发病率和死亡率高得不成比例。AI/AN妇女的发病率持续高于白人妇女，这要求在识别和治疗宫颈癌和癌前病变方面继续改进。
Objectives. We analyzed cervical cancer incidence and mortality data in American Indian and Alaska Native (AI/AN) women compared with women of other races.Methods. We improved identification of AI/AN race, cervical cancer incidence, and mortality data using Indian Health Service (IHS) patient records; our analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. Age-adjusted incidence and death rates were calculated for AI/AN and White women from 1999 to 2009.Results. AI/AN women in CHSDA counties had a death rate from cervical cancer of 4.2, which was nearly twice the rate in White women (2.0; rate ratio [RR] = 2.11). AI/AN women also had higher incidence rates of cervical cancer compared with White women (11.0 vs 7.1; RR = 1.55) and were more often diagnosed with later-stage disease (RR = 1.84 for regional stage and RR = 1.74 for distant stage). Death rates decreased for AI/AN women from 1990 to 1993 (-25.8%/year) and remained stable thereafter.Conclusions. Although rates decreased over time, AI/AN women had disproportionately higher cervical cancer incidence and mortality. The persistently higher rates among AI/AN women compared with White women require continued improvements in identifying and treating cervical cancer and precancerous lesions.