CANCER AND CHANGING TRENDS IN US MORTALITY INEQUITIES: 1960-2004

描述(由申请人提供)： 关于随着总体人口健康状况的改善，社会经济和种族/族裔健康差距的绝对和相对程度是增加、保持不变还是减少，还存在争议。这些辩论具有深刻的政策影响，提出了一些问题，即卫生部门内外的公共和私营机构如何在社会上塑造生活方式、经济趋势、政策和优先事项。值得注意的是，大多数关于社会经济健康不平等趋势的研究都集中在全因死亡率、预期寿命或婴儿死亡率等结果上，分析通常只追溯到20世纪80年代。然而，来自癌症流行病学的证据，以及我们关于“美国过早死亡中不平等现象的消长：1960-2002年”的新研究表明，社会经济不平等在死亡率方面的具体原因和时间模式，特别是在癌症方面，不能进行简单的概括。因此，我们试图检验这一总体假设，即随着时间的推移，癌症死亡率中的社会经济不平等可以不同地扩大、缩小或停滞，不同的死因表现出不同的模式。在我们1960-2002年美国各州按收入水平排名的全国死亡率数据库的基础上，我们的具体目标是：(A)目标1：通过增加：(1)2003-2004年死亡率数据和协调特定原因死亡率的编码(因为编码范围从ICD-7到ICD-10)和(2)1960-2000年县教育和移民数据，来增强我们的二级数据库；(B)目标2：(1)计算1960-2004年按种族/族裔、性别和年龄分层的总人口的总体年龄标准化死亡率和每个县收入五分之一的全因和特定地点癌症死亡率的过早死亡率；具体地点的分析将集中在：肺癌、结直肠癌、乳腺癌、前列腺癌、宫颈癌、胃癌和肝癌[文本删除]，以及(2)创建死亡证书质量代理(DCQP)衡量标准，基于县数据，衡量因癌症定义不清导致的癌症死亡率、因定义不明确的死因造成的全因死亡率以及可通过医疗干预预防的死因死亡率；(C)目标3：通过分析特定人口群体特定死因死亡率的社会经济不平等的时间模式来检验整个研究假设，同时考虑到DCPQ测量方法和县移徙数据，这些数据与以下参数有关：(1)相对和绝对不平等(发病率比率和差额)，(2)五分位数特定死亡率和内部收益率和差额的斜率变化，以及(3)人口可归因率；和(D)目标4：通过发表科学手稿和为调查结果创建网站来传播结果。所获得的知识将：(A)为今后研究观察到的趋势的原因奠定基础；(B)帮助努力消除社会经济和种族/健康差距，这是2010年健康人和国家癌症研究所的首要目标之一。 公共卫生相关性： 相关性/项目叙述我们的目标是对整个假设进行严格的测试，即随着时间的推移，癌症死亡率中的社会经济不平等可能会以不同的方式扩大、缩小或停滞，不同的死因表现出不同的模式。拟议研究产生的知识将与当前改善人口健康和缩小健康差距的努力相关，这是美国卫生与公众服务部2010年健康人的两个首要目标，并为国家卫生研究院和国家癌症研究所减少和消除与癌症有关的和其他健康差距所做的努力提供信息。

DESCRIPTION (provided by applicant): Project Summary Debates exist as to whether, as overall population health improves, the absolute and relative magnitude of socioeconomic and racial/ethnic health disparities increases, stays the same, or decreases. These debates have profound policy implications, raising questions as to how societally-shaped ways of living, economic trends, policies, and priorities of public and private institutions in and outside the health sector shape population health. Notably, most research on trends in socioeconomic health inequities has focused on such outcomes as all-cause mortality, life expectancy, or infant mortality, with analyses typically extending back only to the 1980s. Evidence from cancer epidemiology and also our new study on "The fall and rise of US inequities in premature mortality: 1960-2002," however, indicates that cause-specific and temporal patterns in socioeconomic inequities in mortality, ESPECIALLY FOR CANCER, defy simple generalizations. We accordingly seek to test the overall hypothesis that socioeconomic inequities in CANCER mortality, over time, can variously widen, shrink, or stagnate, with different causes of death exhibiting different patterns. Building on our 1960-2002 national mortality database for US counties ranked by income level, our specific aims are thus: (a) Aim 1: enhance our secondary database by adding: (1) the 2003-2004 mortality data and harmonize the coding of cause-specific mortality (since codes span from ICD-7 to ICD-10) and (2) 1960-2000 COUNTY EDUCATIONAL AND MIGRATION DATA; (b) Aim 2: (1) calculate the 1960-2004 yearly age-standardized cause-specific mortality rates, BOTH OVERALL AND FOR PREMATURE MORTALITY FOR ALL-CAUSE AND SITE-SPECIFIC CANCER MORTALITY for each county income quintile, for the total population, overall and stratified by race/ethnicity, gender, and age; THE SITE-SPECIFIC ANALYSES WILL FOCUS ON: lung, colorectal, breast, prostate, cervix, stomach, AND liver CANCER [TEXT DELETED], AND (2) CREATE A DEATH CERTIFICATE QUALITY PROXY (DCQP) MEASURE, BASED ON THE COUNTY DATA FOR CANCER MORTALITY DUE TO ILL-DEFINED CANCERS, ALL- CAUSE MORTALITY DUE TO ILL-DEFINED CAUSES OF DEATH, AND MORTALITY DUE TO CAUSES OF DEATH PREVENTABLE BY MEDICAL INTERVENTION; (c) Aim 3: test the overall study hypothesis by analyzing the temporal patterning of socioeconomic inequities in cause-specific mortality for the specified population groups, TAKING INTO ACCOUNT THE DCPQ MEASURE AND COUNTY MIGRATION DATA, in relation to the following parameters: (i) relative and absolute inequity (incidence rate ratio (IRR) and difference (IRD)), (ii) change in slopes of the quintile-specific mortality rates and the IRR and IRD, and (iii) the population attributable fraction; and (d) Aim 4: Disseminate results by publishing scientific manuscripts and creating a website for the findings. The knowledge gained will: (a) set the basis for future research on the causes of the observed trends, and (b) aid efforts to eliminate socioeconomic and racial/health disparities, one of the overarching objectives of both Healthy People 2010 and the National Cancer Institute. PUBLIC HEALTH RELEVANCE: Relevance / Project Narrative Our objective is to conduct rigorous tests of the overall hypothesis that socioeconomic inequities in CANCER mortality, over time, can variously widen, shrink, or stagnate, with different causes of death exhibiting different patterns. Knowledge produced by the proposed study would be relevant to current efforts to improve population health and reduce health disparities, which are the two overarching goals of the US Department of Health and Human Services' Healthy People 2010 and inform the efforts of the National Institutes of Health and the National Cancer Institute to reduce and eliminate cancer- related and other health disparities.