The Increasing Incidence of Thyroid Cancer: The Influence of Access to Care
The Increasing Incidence of Thyroid Cancer: The Influence of Access to Care
复制标题
DOI：
10.1089/thy.2013.0045
复制
发表时间：
2013-07-01
期刊：
影响因子：
6.6
通讯作者：
Davies, Louise
中科院分区：
文献类型：
--
作者：
Morris, Luc G. T.;Sikora, Andrew G.;Davies, Louise
背景：乳头状甲状腺癌发病率的迅速上升可能是由于对亚临床疾病的过度诊断。结论是过度诊断正在发生，获得医疗保健和癌症发病率之间的关联的证据是必要的。S. 30年来医保年龄组和非医保年龄组的甲状腺乳头状癌发病率趋势。我们对美国497个州进行了生态分析。S.县，检查九个县级社会经济指标的卫生保健访问和乳头状甲状腺cancer.Results的发病率的关联：乳头状甲状腺癌的发病率上升最迅速的美国人年龄超过65岁（年百分比变化，8.8%），谁拥有广泛的医疗保险覆盖范围通过医疗保险。在65岁以下的人群中，健康保险覆盖率并不普遍，其增长速度较慢（年变化率为6.4%）。三十多年来，甲状腺癌的死亡率没有变化。在美国各地。S.各县的发病率范围很广，从0/10万到29.7/10万。县乳头状甲状腺癌的发病率与所有九个社会人口学指标的医疗保健访问显着相关：它是正相关的大学教育率，白领就业，和家庭收入;和负相关的居民谁是没有保险的百分比，在贫困，失业，非白人种族，非英语，和缺乏高中教育。社会人口学和年龄因素中，较高水平的医疗保健获取的标志与较高的乳头状甲状腺癌发病率相关。更多的乳头状甲状腺癌被诊断出人群中更广泛的医疗保健。尽管发病率在30年中增加了三倍，但死亡率保持不变。连同大量的隐性甲状腺乳头状癌的亚临床水库，这些数据提供了支持性证据，这种实体的广泛过度诊断。
Background: The rapidly rising incidence of papillary thyroid cancer may be due to overdiagnosis of a reservoir of subclinical disease. To conclude that overdiagnosis is occurring, evidence for an association between access to health care and the incidence of cancer is necessary.Methods: We used Surveillance, Epidemiology, and End Results (SEER) data to examine U. S. papillary thyroid cancer incidence trends in Medicare-age and non-Medicare-age cohorts over three decades. We performed an ecologic analysis across 497 U. S. counties, examining the association of nine county-level socioeconomic markers of health care access and the incidence of papillary thyroid cancer.Results: Papillary thyroid cancer incidence is rising most rapidly in Americans over age 65 years (annual percentage change, 8.8%), who have broad health insurance coverage through Medicare. Among those under 65, in whom health insurance coverage is not universal, the rate of increase has been slower (annual percentage change, 6.4%). Over three decades, the mortality rate from thyroid cancer has not changed. Across U. S. counties, incidence ranged widely, from 0 to 29.7 per 100,000. County papillary thyroid cancer incidence was significantly correlated with all nine sociodemographic markers of health care access: it was positively correlated with rates of college education, white-collar employment, and family income; and negatively correlated with the percentage of residents who were uninsured, in poverty, unemployed, of nonwhite ethnicity, non-English speaking, and lacking high school education.Conclusion: Markers for higher levels of health care access, both sociodemographic and age-based, are associated with higher papillary thyroid cancer incidence rates. More papillary thyroid cancers are diagnosed among populations with wider access to healthcare. Despite the threefold increase in incidence over three decades, the mortality rate remains unchanged. Together with the large subclinical reservoir of occult papillary thyroid cancers, these data provide supportive evidence for the widespread overdiagnosis of this entity.