SEER RRSS Improving SES Data: Linkage State Vital Records, Birth Certificate Data

大量研究发现，社会经济地位较低与某些部位发生癌症的风险增加以及许多癌症部位的存活率降低有关。一个例外是女性乳腺癌，较高的社会经济地位与更高的风险和更好的生存率相关。然而，证明社会经济地位影响的证据是有限的，因为社会经济地位通常是在总体或地区一级衡量的（例如，邮政编码或人口普查区的平均家庭收入，街区群体中的贫困比例）。该提案将实施一项战略，允许通过与犹他州人口数据库中可用的州出生证明记录的记录联系，在个人层面上直接测量社会经济地位。在可能与其他SEER注册中心合作的情况下，本提案将评估将犹他州的关联方法应用于1997年或之后出生的加利福尼亚州儿童癌症病例的可行性，并将结果与犹他州可比的儿童人群进行比较和对比。这一策略可以更好地了解社会经济地位方面的健康和癌症差异。对于社会经济地位如何影响这些风险的理解仍然令人惊讶地欠发达。这种文献上的不足部分是由于社会经济地位通常是在总体或地区水平上衡量的（例如，邮政编码或人口普查区的平均家庭收入，街区群体中的贫困比例）。毫无疑问，社会经济地位的空间指标很重要，但它们不能代替个人或家庭层面的社会经济地位衡量。此外，空间指标被视为静态度量，因此不考虑SES的上升或下降变化。最后，空间数据通常基于诊断、死亡或调查时的社会经济地位，此时感兴趣的社会经济地位值可能来自生命早期。对124项调查SES对癌症风险影响的研究的回顾表明，虽然只有约25%的研究收集了个人SES数据，但其中大多数是基于小样本（N<5000），并且在调查时只测量一次SES。

Numerous studies have observed that lower SES is associated with increased risk of incident cancer for some sites and reduced survival for many cancer sites. One exception is for female breast cancer as higher SES is associated with increased risk and better survival. However, evidence of the impact of SES is limited in the fact that SES is often measured at an aggregate or area level (e.g., mean household income for a zip code or census tract, proportion poor in a block group). This proposal will implement a strategy that permits a direct measurement of SES at the individual level through record linkage to state birth certificate records available in the Utah Population Database. In possible collaboration with other SEER registries, this proposal will assess the feasibility of applying Utah¿s linkage methodologies to a California population of pediatric cancer cases born on or after 1997, and compare and contrast results with the comparable pediatric population in Utah. This strategy may provide a better understanding of health and cancer disparities in terms of SES. The understanding of how SES affects these risks remains surprisingly underdeveloped. This deficiency in the literature is partly attributable to the fact that SES is often measured at an aggregate or area level (e.g., mean household income for a zip code or census tract, proportion poor in a block group). While there is no question that spatial indicators of SES are important, they are not substitutes for individual or family level measures of SES. Moreover, spatial indicators are treated as a static measure so that upward or downward changes in SES are not considered. Finally, the spatial data are often based on SES at the time of diagnosis, death, or at the time of a survey when it is likely that the SES value of interest could be from earlier in life. A review of 124 studies examining SES effects on cancer risk shows that while only about 25 percent collected individual SES data, most of these were based on small samples (N<5000) and where SES was measured once at the time of the survey.