Disparities in cancer incidence and mortality by area-level socioeconomic status: a multilevel analysis
Disparities in cancer incidence and mortality by area-level socioeconomic status: a multilevel analysis
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DOI：
10.1136/jech-2014-204417
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发表时间：
2015-02-01
影响因子：
6.3
通讯作者：
White, Emily
中科院分区：
文献类型：
--
作者：
Hastert, Theresa A.;Beresford, Shirley A. A.;White, Emily
背景：通过衡量地区层面的社会经济地位（SES），已经观察到癌症发病率和死亡率的差异；然而，这些差异在多大程度上可以由个体的社会经济地位来解释尚不清楚。方法参与者包括维生素和生活方式（VITAL）研究队列中的60756名男性和女性，基线年龄为50-76岁（2000-2002年），随访至2010年。我们使用2000年美国人口普查构建了一个块组SES指数，并拟合Cox比例风险模型，以估计区域水平SES（按五分位数）与总癌症发病率和特定地点癌症发病率和总癌症死亡率之间的关系，模型中有或没有家庭收入和个人教育程度。结果低区域SES水平与较高的癌症总发病率和较低的前列腺癌风险呈弱相关，与乳腺癌风险无相关性。与社会经济地位最高的地区相比，生活在社会经济地位最低的地区与更高的肺癌（相对危险度：2.21,95% CI 1.69至2.90）和结直肠癌发病率（相对危险度：1.52,95% CI 1.11至2.09）和总癌症死亡率（相对危险度：1.68,95% CI 1.47至1.93）相关。控制个人教育程度和家庭收入削弱了观察到的相关性，但没有消除它们（肺癌HR: 1.43, 95% CI 1.07至1.91；结直肠癌HR: 1.35, 95% CI 0.97至1.88；癌症死亡率HR: 1.28, 95% CI 1.11至1.48）。结论：几种癌症结局存在地区层面的社会经济差异。这些差异并不能完全由个体的社会地位来解释，这表明区域水平的因素可能起作用。
Background Disparities in cancer incidence and mortality have been observed by measures of area-level socioeconomic status (SES); however, the extent to which these disparities are explained by individual SES is unclear.Methods Participants included 60 756 men and women in the VITamins And Lifestyle (VITAL) study cohort, aged 50-76 years at baseline (2000-2002) and followed through 2010. We constructed a block group SES index using the 2000 US Census and fit Cox proportional hazards models to estimate the association between area-level SES (by quintile) and total and site-specific cancer incidence and total cancer mortality, with and without household income and individual education in the models.Results Lower area-level SES was weakly associated with higher total cancer incidence and lower prostate cancer risk, but was not associated with risk of breast cancer. Compared with the highest-SES areas, living in the lowest-SES areas was associated with higher lung (HR: 2.21, 95% CI 1.69 to 2.90) and colorectal cancer incidence (HR: 1.52, 95% CI 1.11 to 2.09) and total cancer mortality (HR: 1.68, 95% CI 1.47 to 1.93). Controlling for individual education and household income weakened the observed associations, but did not eliminate them (lung cancer HR: 1.43, 95% CI 1.07 to 1.91; colorectal cancer HR: 1.35, 95% CI 0.97 to 1.88; cancer mortality HR: 1.28, 95% CI 1.11 to 1.48).Conclusions Area-level socioeconomic disparities exist for several cancer outcomes. These differences are not fully explained by individual SES, suggesting area-level factors may play a role.