Geographic variations in breast cancer survival among older women: Implications for quality of breast cancer care
Geographic variations in breast cancer survival among older women: Implications for quality of breast cancer care
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DOI：
10.1093/gerona/57.6.m401
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发表时间：
2002-06-01
影响因子：
5.1
通讯作者：
Nattinger, AB
中科院分区：
文献类型：
--
作者：
Goodwin, JS;Freeman, JL;Nattinger, AB
背景乳腺癌护理，如筛查程序的使用和接受的治疗类型。美国的地理区域差异很大。然而，很少有人知道乳腺癌生存的变化。我们研究了监测、流行病学和最终结果（SEER）计划覆盖的66个卫生服务区中65岁及以上女性的乳腺癌发病率、生存率和死亡率。发病率和生存率数据来自SEER，而乳腺癌死亡率数据来自生命统计数据。66个卫生服务区的乳腺癌生存率有相当大的差异（卡方（2）= 202.7，p <0.0001）。乳腺癌的发病率和死亡率也有显著差异。在按卫生服务区面积加权的偏相关中，发病率（r = 0.812）和5年生存率（r =-0.587）与死亡率相关。在Poisson回归分析中，发病率变化和生存率变化的组合解释了90.9%的死亡率变化。老年妇女乳腺癌的生存率存在相当大的地理差异，这导致了乳腺癌死亡率的差异。随着乳腺癌护理质量变得更加标准化，乳腺癌死亡率的地理差异应该会减少。
Background. Breast cancer care, such as utilization of screening procedures and types of treatment received. varies substantially by geographic region of the United States. However, little is known about variations in survival with breast cancer.Methods. We examined breast cancer incidence, survival, and mortality in the 66 health service areas covered by the Surveillance, Epidemiology, and End Results (SEER) program for women aged 65 and older at diagnosis. Incidence and survival data were derived from SEER, while breast cancer mortality data were from Vital Statistics data.Results. There was considerable variation in breast cancer survival among the 66 health service areas (chi(2) = 202.7, p < .0001). There was also significant variation in incidence and mortality from breast cancer. In a partial correlation weighted for the size of the health service area, both incidence (r = .812) and percent 5-year survival (r = -.587) correlate with mortality. In a Poisson regression analysis, the combination of variation in incidence and variation in survival explains 90.9% of the variation in mortality.Conclusions. There is considerable geographic variation in survival from breast cancer among older women, and this contributes to variation in breast cancer mortality. Geographic variations in breast cancer mortality should diminish as the quality of breast cancer care becomes more standardized.