Armstrong Lori R, Thompson Trevor, Hall H Irene, Coughlin Steven S, Steele Brooke, Rogers Joe D
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Cancer. 2004 Dec 15;101(12):2851-8. doi: 10.1002/cncr.20667.
Colorectal carcinoma screening can reduce mortality, but residents of poor or medically underserved areas may face barriers to screening. The current study assessed colorectal carcinoma mortality in Appalachia, a historically underserved area, from 1969 to 1999.
All counties within the 13-state Appalachian region, which stretches from southern New York to northern Mississippi, were used to calculate annual death rates for the 31-year period. Joinpoint regression analysis was used to examine trends by age and race for the Appalachian region and the remainder of the United States. Five-year rates for 1995-1999 age-adjusted to the 2000 U.S. standard population were calculated by race and age group for the Appalachian region and elsewhere in the United States.
Trend analysis showed that colorectal carcinoma death rates among both racial and gender groups studied had declined in recent years. Despite this, the rates for white males and white females were still significantly higher in Appalachia than in the rest of the country at the end of the study period, 1999. Five-year colorectal carcinoma death rates among white males (ages < 50, 50-59, and 70-79 years) and white females (ages < 50, 50-59, 70-79, > or = 80 years) were significantly higher in Appalachia than elsewhere in the United States, whereas rates among black females 60-69 and 70-79 years old were significantly lower in Appalachia.
The Appalachian region may benefit from targeted prevention efforts to eliminate disparities in the colorectal carcinoma death rates among subgroups. Further studies are needed to determine whether the higher death rates in specific Appalachian subgroups are related to a higher incidence of the disease, the cancer being at a later stage at diagnosis, poorer treatment, or other factors.
结直肠癌筛查可降低死亡率，但贫困地区或医疗服务不足地区的居民可能面临筛查障碍。本研究评估了1969年至1999年阿巴拉契亚地区（一个历史上医疗服务不足的地区）的结直肠癌死亡率。
从纽约州南部延伸至密西西比州北部的13个州的阿巴拉契亚地区内的所有县，用于计算31年期间的年死亡率。采用连接点回归分析来研究阿巴拉契亚地区以及美国其他地区按年龄和种族划分的趋势。按种族和年龄组计算了阿巴拉契亚地区及美国其他地区1995 - 1999年经年龄调整至2000年美国标准人口的五年死亡率。
趋势分析表明，近年来所研究的种族和性别组中的结直肠癌死亡率均有所下降。尽管如此，在研究期结束的1999年，阿巴拉契亚地区白人男性和白人女性的死亡率仍显著高于美国其他地区。阿巴拉契亚地区白人男性（年龄<50岁、50 - 59岁和70 - 79岁）和白人女性（年龄<50岁、50 - 59岁、70 - 79岁、≥80岁）的五年结直肠癌死亡率显著高于美国其他地区，而阿巴拉契亚地区60 - 69岁和70 - 79岁黑人女性的死亡率则显著较低。
阿巴拉契亚地区可能会从有针对性的预防措施中受益，以消除亚组之间结直肠癌死亡率的差异。需要进一步研究来确定阿巴拉契亚特定亚组中较高的死亡率是否与疾病发病率较高、癌症在诊断时处于较晚期、治疗较差或其他因素有关。
