Liu L, Cozen W, Bernstein L, Ross R K, Deapen D
Department of Preventive Medicine, Keck School of Medicine of the University of Southern California , and USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA.
J Natl Cancer Inst. 2001 May 2;93(9):705-9. doi: 10.1093/jnci/93.9.705.
Understanding the relationship between socioeconomic status (SES) and prostate cancer incidence could identify populations that should be targeted for intervention and prevention programs. We examined this relationship within the major racial/ethnic groups during the period 1972 through 1997, which spans the introduction of prostate-specific antigen (PSA) testing.
We used data from the population-based Los Angeles Cancer Surveillance Program to examine age-adjusted prostate cancer incidence rates in five SES groups over three specific calendar periods by racial/ethnic subpopulation (white, black, Asian, and Hispanic) and by stage of disease at diagnosis. Linear regression analysis was used to test for trends in the age-adjusted incidence rates that were associated with increasing levels of SES. All P values were two-sided.
For men diagnosed with prostate cancer before 1987, when the test for PSA was not widely available, we found no association between SES and the incidence of prostate cancer in any of four racial/ethnic subpopulations or between SES and the stage of disease at diagnosis. In contrast, among men who were diagnosed with prostate cancer after 1987, SES was statistically significantly and positively associated with prostate cancer incidence in men from all racial/ethnic subpopulations except Asians (P =.01 for white men, P =.001 for black men, P =.02 for Hispanic men, P =.06 for Asian men, and P =.01 for all men combined). Higher SES was statistically significantly associated with cancers of earlier stage (P =.01 for localized cancer and P =.00 for regional cancer) for men who were diagnosed with prostate cancer after 1987.
The association between SES and prostate cancer incidence after 1987 may reflect more prevalent PSA screening in populations with higher SES due to their greater access to health care. SES should, therefore, be considered an important factor in interpreting variations and time trends in prostate cancer incidence.
了解社会经济地位（SES）与前列腺癌发病率之间的关系，有助于确定哪些人群应成为干预和预防计划的目标对象。我们在1972年至1997年期间对主要种族/族裔群体进行了此项关系的研究，该时间段涵盖了前列腺特异性抗原（PSA）检测方法的引入。
我们使用基于人群的洛杉矶癌症监测项目的数据，按种族/族裔亚人群（白人、黑人、亚裔和西班牙裔）以及诊断时的疾病阶段，在三个特定日历时间段内，对五个社会经济地位组的年龄调整后前列腺癌发病率进行了研究。采用线性回归分析来检验与社会经济地位水平升高相关的年龄调整发病率趋势。所有P值均为双侧检验。
对于在1987年之前被诊断为前列腺癌的男性，当时PSA检测尚未广泛应用，我们发现在四个种族/族裔亚人群中，社会经济地位与前列腺癌发病率之间均无关联，且社会经济地位与诊断时的疾病阶段之间也无关联。相比之下，在1987年之后被诊断为前列腺癌的男性中，除亚裔男性外，所有种族/族裔亚人群的社会经济地位与前列腺癌发病率在统计学上均呈显著正相关（白人男性P = 0.01，黑人男性P = 0.001，西班牙裔男性P = 0.02，亚裔男性P = 0.06，所有男性合并后P = 0.01）。对于1987年之后被诊断为前列腺癌的男性，较高的社会经济地位与早期癌症在统计学上呈显著相关（局限性癌症P = 0.01，区域性癌症P = 0.00）。
1987年之后社会经济地位与前列腺癌发病率之间的关联，可能反映了社会经济地位较高人群因更易获得医疗保健服务而使PSA筛查更为普遍。因此，在解释前列腺癌发病率的差异和时间趋势时，应将社会经济地位视为一个重要因素。
