Geographic Variation in Colorectal Cancer Incidence and Mortality, Age of Onset, and Stage at Diagnosis Among American Indian and Alaska Native People, 1990-2009
Geographic Variation in Colorectal Cancer Incidence and Mortality, Age of Onset, and Stage at Diagnosis Among American Indian and Alaska Native People, 1990-2009
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DOI：
10.2105/ajph.2013.301654
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发表时间：
2014-06-01
影响因子：
12.7
通讯作者：
Provost, Ellen
中科院分区：
文献类型：
--
作者：
Perdue, David G.;Haverkamp, Donald;Provost, Ellen
目标.我们使用一种联系方法来改善美国印第安人/阿拉斯加原住民（AI/AN）在发病率和死亡率数据中的分类，并将其与白人进行比较，以评估其结直肠癌（CRC）的特征。我们将发病率和死亡率数据与印度卫生服务登记记录联系起来。我们的分析仅限于合同卫生服务提供地区的县。我们分析了1999年至2009年6个地区AI/AN人和白人CRC的死亡率和发病率。使用线性模型描述趋势。AI/AN结直肠癌的发病率比白人高21%，死亡率高39%。虽然发病率和死亡率显着下降白人，AI/AN发病率没有显着变化，死亡率下降，只有在北方平原。AI/AN患者在所有年龄段的CRC发病率均高于白人，且更常被诊断为晚期CRC。与白人相比，许多地区的AI/AN个体具有更高的CRC负担和稳定或增加的CRC死亡率。了解导致这些地区差异的因素可以为预防和控制计划提供重要的见解。
Objectives. We characterized estimates of colorectal cancer (CRC) in American Indians/Alaska Natives (AI/ANs) compared with Whites using a linkage methodology to improve AI/AN classification in incidence and mortality data.Methods. We linked incidence and mortality data to Indian Health Service enrollment records. Our analyses were restricted to Contract Health Services Delivery Area counties. We analyzed death and incidence rates of CRC for AI/AN persons and Whites by 6 regions from 1999 to 2009. Trends were described using linear modeling.Results. The AI/AN colorectal cancer incidence was 21% higher and mortality 39% higher than in Whites. Although incidence and mortality significantly declined among Whites, AI/AN incidence did not change significantly, and mortality declined only in the Northern Plains. AI/AN persons had a higher incidence of CRC than Whites in all ages and were more often diagnosed with late stage CRC than Whites.Conclusions. Compared with Whites, AI/AN individuals in many regions had a higher burden of CRC and stable or increasing CRC mortality. An understanding of the factors driving these regional disparities could offer critical insights for prevention and control programs.