Oliver M Norman, Smith Eric, Siadaty Mir, Hauck Fern R, Pickle Linda W
Department of Family Medicine, University of Virginia, Charlottesville, USA.
Am J Prev Med. 2006 Feb;30(2 Suppl):S67-76. doi: 10.1016/j.amepre.2005.09.008.
Racial disparities exist in prostate cancer incidence. An important contributor to these disparities may be socioeconomic status.
Virginia Cancer Registry data, 1990-1999 (37,373 cases) were geocoded to the Census tract and county level. The annualized, age-adjusted incidence rates for African Americans and whites were calculated, and crude and smoothed maps of these rates were produced. Statistical tests for clustering of cases were conducted. Prostate cancer incidence was statistically modeled as a function of area-based measures of poverty, median household income, education, rural status, ratio of physicians to population in each county, percentage of men in each county obtaining prostate cancer screening with the prostate-specific antigen (PSA) test, and percent of households headed by females.
Prostate cancer incidence was elevated in the eastern and central portions of the state. Statistical tests for clustering were highly significant (Tango's test, p<0.008; spatial scan statistic, p<0.001). Poverty and lower education were associated with a decreased incidence among whites but not African Americans. Median household income and urban status were positively associated with incidence for both populations. Among whites, increased percent of female heads of households and ratio of physicians per population were associated with increased incidence. Associations between predictor variables and prostate cancer incidence were seen only in the census tract level analyses.
Overall, the findings support the argument that area measures of poverty and education do not explain the increased incidence of prostate cancer among African Americans. Other factors, such as dietary practices, may help explain racial disparities in prostate cancer incidence. Because of the large differences between tract and county level results, the time and expense of obtaining data geocoded to the tract level seems worthwhile.
前列腺癌发病率存在种族差异。这些差异的一个重要促成因素可能是社会经济地位。
对1990 - 1999年弗吉尼亚癌症登记处的数据（37373例病例）进行地理编码，精确到普查区和县级。计算非裔美国人和白人的年化年龄调整发病率，并绘制这些发病率的原始地图和平滑地图。对病例聚集情况进行统计检验。将前列腺癌发病率作为基于地区的贫困衡量指标、家庭收入中位数、教育程度、农村状况、各县医生与人口比例、各县接受前列腺特异性抗原（PSA）检测进行前列腺癌筛查的男性百分比以及女性户主家庭百分比的函数进行统计建模。
该州东部和中部地区前列腺癌发病率升高。聚集情况的统计检验具有高度显著性（Tango检验，p < 0.008；空间扫描统计，p < 0.001）。贫困和低教育程度与白人发病率降低相关，但与非裔美国人无关。家庭收入中位数和城市状况与这两个人群的发病率均呈正相关。在白人中，女性户主家庭百分比增加和人均医生比例增加与发病率增加相关。预测变量与前列腺癌发病率之间的关联仅在普查区层面分析中可见。
总体而言，研究结果支持这样的观点，即基于地区的贫困和教育衡量指标并不能解释非裔美国人前列腺癌发病率增加的情况。其他因素，如饮食习惯，可能有助于解释前列腺癌发病率的种族差异。由于普查区和县级层面结果存在巨大差异，获取精确到普查区层面数据的时间和费用似乎是值得的。
