Singh Gopal K, Miller Barry A, Hankey Benjamin F, Edwards Brenda K
Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-8316, USA.
Cancer. 2004 Sep 1;101(5):1051-7. doi: 10.1002/cncr.20467.
Temporal cervical cancer incidence and mortality patterns and ethnic disparities in patient survival and stage at diagnosis in relation to socioeconomic deprivation measures have not been well studied in the United States. The current article analyzed temporal area socioeconomic inequalities in U.S. cervical cancer incidence, mortality, stage, and survival.
County and census tract poverty and education variables from the 1990 census were linked to U.S. mortality and Surveillance, Epidemiology, and End Results cancer incidence data from 1975 to 2000. Age-adjusted incidence and mortality rates and 5-year cause-specific survival rates were calculated for each socioeconomic group and differences in rates were tested for statistical significance at the 0.05 level.
Substantial area socioeconomic gradients in both incidence and mortality were observed, with inequalities in cervical cancer persisting against a backdrop of declining rates. Cervical cancer incidence and mortality rates increased with increasing poverty and decreasing education levels for the total population as well as for non-Hispanic white, black, American Indian, Asian/Pacific Islander, and Hispanic women. Patients in lower socioeconomic census tracts had significantly higher rates of late-stage cancer diagnosis and lower rates of cancer survival. Even after controlling for stage, significant differences in survival remained. The 5-year survival rate among women diagnosed with distant-stage cervical cancer was approximately 30% lower in low than in high socioeconomic census tracts.
Census-based socioeconomic measures such as area poverty and education levels could serve as important surveillance tools for monitoring temporal trends in cancer-related health inequalities and targeting interventions.
在美国，宫颈癌的发病率和死亡率随时间的变化模式，以及患者生存率和诊断时分期方面的种族差异与社会经济剥夺措施之间的关系尚未得到充分研究。本文分析了美国宫颈癌发病率、死亡率、分期和生存率方面随时间变化的地区社会经济不平等情况。
将1990年人口普查中的县和普查区贫困及教育变量与1975年至2000年美国的死亡率以及监测、流行病学和最终结果癌症发病率数据相关联。计算每个社会经济群体的年龄调整发病率、死亡率和5年特定病因生存率，并对率的差异进行0.05水平的统计学显著性检验。
在发病率和死亡率方面均观察到显著的地区社会经济梯度，在发病率下降的背景下，宫颈癌的不平等现象依然存在。总体人群以及非西班牙裔白人、黑人、美国印第安人、亚裔/太平洋岛民和西班牙裔女性的宫颈癌发病率和死亡率随着贫困程度的增加和教育水平的降低而上升。社会经济普查区较低的患者晚期癌症诊断率显著更高，癌症生存率更低。即使在控制分期后，生存率仍存在显著差异。在低社会经济普查区被诊断为远处期宫颈癌的女性中，其5年生存率比高社会经济普查区的女性低约30%。
基于人口普查的社会经济指标，如地区贫困和教育水平，可作为监测癌症相关健康不平等的时间趋势和确定干预目标的重要监测工具。
