RACIAL DISPARITIES IN RECTAL CANCER

直肠癌存在很大的种族差异。1973年至1995年间，白人直肠癌发病率下降了20.2%，而黑人直肠癌发病率仅下降了2.0%。目前白人的五年相对存活率为63.0%，而黑人的五年相对存活率仅为52.5%。令人惊讶的是，很少有研究调查直肠癌的种族差异。这项拟议的研究的主要目标是检查可能的暴露、易感性和医疗保健因素，这些因素可能解释黑人和白人的不同发病率和死亡率趋势。这项拟议的项目是一项在北卡罗来纳州33个县地区进行的基于人群的病例对照研究，目的如下：(1)评估可能导致黑人直肠癌死亡率较高的因素，包括收入/贫困、保险、交通、获得护理的机会、对医疗保健系统的态度和诊断延迟。(2)确定环境和生活方式可能与直肠癌有关，包括：个人特征、家族史、体力活动、阿司匹林/非类固醇的使用和膳食补充剂，特别强调可干预的暴露(例如适度的体力活动、饮食和维生素补充剂)。病例将使用北卡罗来纳州中央癌症登记中心的快速确定计划进行识别。65岁以下的控制措施将来自北卡罗来纳州机动车管理局的数据磁带，65岁及以上的控制措施将来自HCFA。病例和对照人员将就一系列饮食和生活方式因素通过电话进行采访。这项拟议研究的一个主要优势是它建立在为正在进行的基于人群的结肠癌研究创建的基础设施上。拟议的直肠癌研究将扩展这项研究，以深入了解老鼠混合、城市-农村-郊区混合人口的风险因素和健康准入。

There are substantial racial disparities in rectal cancer. Between 1973 and 1995 the incidence of rectal cancer decreased 20.2% in whites but only 2.0% in blacks. The five year relative survival is currently 63.0% in whites but only 52.5% in blacks. Surprisingly, there have been few studies that have investigated the racial differences in rectal cancer. The primary goal of the proposed research is to examine possible exposure, susceptibility, and health care factors that might explain diverging incidence and mortality trends in blacks and whites. The proposed proj4ect is a population-based case-control study in a 33-county area of North Carolina with the following aims: (1) To evaluate factors that might account for the higher rectal cancer mortality among blacks including income/poverty, insurance, transportation, access to care, attitudes about the medical care system and diagnostic delay. (2) To identify environmental and lifestyle may be related to rectal cancer including: personal characteristics, family history, physical activity, aspirin/non-steroidal use, and dietary supplements, with special emphasis on exposures that are amenable to intervention (e.g. moderate physical activity, diet, vitamin supplements). Cases will be identified using the rapid ascertainment program of the North Carolina Central Cancer Registry. Controls under age 65 will be drawn from data tapes from the North Carolina Department of Motor Vehicles and those 65 and older from HCFA. Cases and controls will be interviewed by telephone about a range of dietary and lifestyle factors. A major strength of the proposed study is the fact that it builds upon the infrastructure created for an ongoing population-based study of colon cancer. The proposed study of rectal cancer will extend this research to provide insight into risk factors and health access in a mixed-mice, mixed urban-rural-suburban population.