Jemal Ahmedin, Ward Elizabeth, Wu Xiaocheng, Martin Howard J, McLaughlin Colleen C, Thun Michael J
Epidemiology and Cancer Surveillance Research, American Cancer Society, Atlanta, GA 30329-4251, USA.
Cancer Epidemiol Biomarkers Prev. 2005 Mar;14(3):590-5. doi: 10.1158/1055-9965.EPI-04-0522.
Striking geographic variation in prostate cancer death rates have been observed in the United States since at least the 1950s; reasons for these variations are unknown. Here we examine the association between geographic variations in prostate cancer mortality and regional variations in access to medical care, as reflected by the incidence of late-stage disease, prostate-specific antigen (PSA) utilization, and residence in rural counties.
We analyzed mortality data from the National Center for Health Statistics, 1996 to 2000, and incidence data from 30 population-based central cancer registries from the North American Association of Central Cancer Registries, 1995 to 2000. Ecological data on the rate of PSA screening by registry area were obtained from the 2001 Behavioral Risk Factor Surveillance System. Counties were grouped into metro and nonmetro areas according to Beale codes from the Department of Agriculture. Pearson correlation analyses were used to examine associations.
Significant correlations were observed between the incidence of late-stage prostate cancer and death rates for Whites (r = 0.38, P = 0.04) and Blacks (r = 0.53, P = 0.03). The variation in late-stage disease corresponded to about 14% of the variation in prostate cancer death rates in White men and 28% in Black men. PSA screening rate was positively associated with total prostate cancer incidence (r = 0.42, P = 0.02) but inversely associated with the incidence of late-stage disease (r = -0.58, P = 0.009) among White men. Nonmetro counties generally had higher death rates and incidence of late-stage disease and lower prevalence of PSA screening (53%) than metro areas (58%), despite lower overall incidence rates.
These ecological data suggest that 10% to 30% of the geographic variation in mortality rates may relate to variations in access to medical care.
至少自20世纪50年代以来，美国前列腺癌死亡率存在显著的地理差异；这些差异的原因尚不清楚。在此，我们研究前列腺癌死亡率的地理差异与医疗服务可及性的区域差异之间的关联，这种差异通过晚期疾病发病率、前列腺特异性抗原（PSA）的使用情况以及农村县的居住情况来反映。
我们分析了1996年至2000年美国国家卫生统计中心的死亡率数据，以及1995年至2000年北美中央癌症登记协会30个基于人群的中央癌症登记处的发病率数据。通过2001年行为危险因素监测系统获得按登记地区划分的PSA筛查率的生态数据。根据美国农业部的比尔编码，将县分为都市和非都市地区。采用Pearson相关分析来检验关联。
观察到晚期前列腺癌发病率与白人（r = 0.38，P = 0.04）和黑人（r = 0.53，P = 0.03）的死亡率之间存在显著相关性。晚期疾病的差异分别对应白人男性前列腺癌死亡率差异的约14%和黑人男性的28%。在白人男性中，PSA筛查率与前列腺癌总发病率呈正相关（r = 0.42，P = 0.02），但与晚期疾病发病率呈负相关（r = -0.58，P = 0.009）。尽管总体发病率较低，但非都市县的死亡率和晚期疾病发病率通常高于都市地区，PSA筛查率（53%）低于都市地区（58%）。
这些生态数据表明，死亡率的地理差异中10%至30%可能与医疗服务可及性的差异有关。
