Klassen Ann C, Curriero Frank C, Hong Jean Hee, Williams Chyvette, Kulldorff Martin, Meissner Helen I, Alberg Anthony, Ensminger Margaret
Department of Health Policy and Management, The Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
Prev Med. 2004 Sep;39(3):441-8. doi: 10.1016/j.ypmed.2004.04.031.
This research explores area-level social influences on prostate cancer, to test whether area-level influences explain disparities in U.S. prostate cancer burden.
The authors geocoded 23,993 1992-1997 Maryland prostate cancer cases, and linked cases to 1990 census data. The authors examined the effect of 17 area-level social variables, measured at block group, tract, and county, modeling individual and multilevel predictors of later stage and higher tumor grade.
Younger age, black race, higher grade or ungraded tumors, and earlier year of diagnosis were associated with later stage. Block group percentage of white-collar workers (O.R. = 0.93, 95% C.I. = 0.89, 0.98), and county resources (O.R. = 0.94, 95% C.I. = 0.89, 0.98), were protective of later stage. Older age, black race, and earlier year of diagnosis were associated with higher grade. Block group income was protective for white men (O.R. = 0.92, 95% C.I. = 0.87, 0.96), but for all men, county resources increased risk of higher grade (O.R. = 1.23, 95% C.I. = 1.16, 1.31).
Social resources did not significantly reduce racial differences. Results suggest tumor biology is related to relative resources, with better outcomes associated with greater small-area wealth in low-resource counties, but stage at diagnosis is associated with absolute resources, with better outcomes associated with higher small-area social class in high-resource counties.
本研究探讨地区层面的社会因素对前列腺癌的影响，以检验地区层面的因素是否能解释美国前列腺癌负担的差异。
作者对1992 - 1997年马里兰州的23993例前列腺癌病例进行地理编码，并将病例与1990年的人口普查数据相链接。作者研究了在街区组、普查区和县级层面测量的17个地区层面社会变量的影响，对晚期和高肿瘤分级的个体及多层面预测因素进行建模。
年龄较小、黑人种族、肿瘤分级较高或未分级以及诊断年份较早与晚期相关。街区组白领工人百分比（比值比 = 0.93，95%置信区间 = 0.89，0.98）和县级资源（比值比 = 0.94，95%置信区间 = 0.89，0.98）对晚期有保护作用。年龄较大、黑人种族和诊断年份较早与高分级相关。街区组收入对白人男性有保护作用（比值比 = 0.92，95%置信区间 = 0.87，0.96），但对所有男性而言，县级资源会增加高分级的风险（比值比 = 1.23，95%置信区间 = 1.16，1.31）。
社会资源并未显著减少种族差异。结果表明肿瘤生物学与相对资源有关，在资源匮乏的县，较小区域财富越多预后越好，但诊断时的分期与绝对资源有关，在资源丰富的县，较小区域社会阶层越高预后越好。
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