Changing area socioeconomic patterns in US cancer mortality, 1950-1998: Part II - Lung and colorectal cancers
Changing area socioeconomic patterns in US cancer mortality, 1950-1998: Part II - Lung and colorectal cancers
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DOI：
10.1093/jnci/94.12.916
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发表时间：
2002-06-19
影响因子：
10.3
通讯作者：
Hankey, BF
中科院分区：
文献类型：
--
作者：
Singh, GK;Miller, BA;Hankey, BF
背景：肺癌和结直肠癌是美国癌症死亡率的主要原因。由于许多癌症的死亡率因社会经济特征而异，我们使用地区社会经济指数来检查1950年至1998年美国肺癌和结直肠癌死亡率的模式。研究方法：基于因素的地区社会经济指数与1950-1998年县死亡率数据相关联，以生成每个地区社会经济群体的年度肺癌和结直肠癌死亡率。联合点回归分析用于建模和识别死亡率趋势的统计学显著变化。结果：1950年至1998年，美国肺癌死亡率的地区社会经济模式发生了巨大变化。在1950-1964年和1950-1980年期间，25-64岁的男性和65岁或以上的男性在较高的社会经济地区通常比较低的社会经济地区有较高的肺癌死亡率。肺癌死亡率的地区社会经济差异在20世纪70年代初开始逆转和扩大，年轻男性和老年男性在20世纪80年代中期。1998年，与最高地区社会经济群体中的相同年龄组相比，最低地区社会经济群体中的年轻男性肺癌死亡率高56%（95%置信区间[CI] = 49%至64%），老年男性高38%（95% CI = 34%至43%）。1950年至1998年期间，所有社会经济群体中老年妇女的肺癌死亡率增加了7至8倍，较高地区社会经济群体的死亡率更高。随着时间的推移，结直肠癌死亡率的正社会经济梯度大幅下降。尽管所有地区社会经济群体中妇女的结直肠癌死亡率均呈持续下降趋势，但低地区社会经济群体中男性的结直肠癌死亡率呈上升趋势，而高地区社会经济群体中男性的结直肠癌死亡率则没有上升趋势。结论：男性肺癌死亡率的社会经济梯度在1950年至1998年之间发生了逆转，而结直肠癌死亡率的社会经济梯度在此期间缩小了。区域措施可能有助于监测癌症死亡率的社会经济差异，并确定潜在的癌症控制干预措施的领域。
Background: Lung cancer and colorectal cancer are leading causes of U.S. cancer mortality. Because mortality rates for many cancers vary by socioeconomic characteristics, we used area socioeconomic indices to examine patterns in U.S. lung and colorectal cancer mortality between 1950 and 1998. Methods: A factor-based area socioeconomic index was linked to 1950-1998 county mortality data to generate annual lung and colorectal cancer mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model and identify statistically significant changes in the mortality trends. Results: Area socioeconomic patterns in U.S. lung cancer mortality changed dramatically between 1950 and 1998. Men aged 25-64 years and those aged 65 years or older in higher socioeconomic areas generally had higher lung cancer mortality than did those in lower socioeconomic areas during 1950-1964 and 1950-1980, respectively. Area socioeconomic differences in lung cancer mortality began to reverse and widen by the early 1970s for younger men and by the mid-1980s for older men. In 1998, lung cancer mortality was 56% (95% confidence interval [CI] = 49 % to 64 %) higher for younger men and 38 % higher (95% CI = 34% to 43%) for older men in the lowest area socioeconomic group than for the same age groups in the highest area socioeconomic group. Lung cancer mortality among older women in all socioeconomic groups increased sevenfold to eightfold between 1950 and 1998, with higher mortality in higher area socioeconomic groups. The positive socioeconomic gradient in colorectal cancer mortality diminished substantially over time. Although colorectal cancer mortality among women in all area socioeconomic groups showed a consistent downward trend, colorectal cancer mortality among men in low area socioeconomic groups, but not in high area socioeconomic groups, showed an upward trend. Conclusions: Socioeconomic gradients in male lung cancer mortality reversed between 1950 and 1998, and those in colorectal cancer mortality narrowed over that time. Area measures may be useful for monitoring socioeconomic disparities in cancer mortality and for identifying areas for potential cancer control interventions.