Sarfati Diana, Blakely Tony, Shaw Caroline, Cormack Donna, Atkinson June
Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand.
Cancer Causes Control. 2006 Jun;17(5):671-8. doi: 10.1007/s10552-005-0583-0.
To test whether trends in breast cancer mortality varied by ethnicity and socio-economic position during the 1980s and '90s in New Zealand.
Four cohorts of the entire New Zealand population for 1981-84; 86-89; 91-94 and 96-99 allowed direct determination of socio-economic trends in breast cancer mortality. For ethnicity, unlinked routine census and mortality data were used with adjustment factors for undercounting of Māori and Pacific deaths.
Māori and non-Māori non-Pacific mortality rates changed little until mid-1990s with Māori experiencing 25% higher mortality. In 1996-99, Māori rates increased notably to become 68% higher than non-Māori non-Pacific (SRR 1.68; 95% CI: 1.49-1.90). Pacific women experienced an approximate three-fold increase in breast cancer mortality over time. There appeared to be reducing mortality among higher income and education groups but trends within socio-economic groups were not statistically significant. Nevertheless, by 1996-99, there was a significant 22% excess mortality (SRR 1.22; 95% CI: 1.01-1.49) for low compared with high-income groups.
Widening ethnic, and probably, socio-economic disparities in breast cancer mortality are likely due to both underlying incidence and differential survival trends. Disparities are likely to increase once the full differential mortality benefits of screening impact on the population.
检验20世纪80年代和90年代新西兰乳腺癌死亡率趋势是否因种族和社会经济地位而异。
对1981 - 1984年、1986 - 1989年、1991 - 1994年和1996 - 1999年的四组新西兰全体人口进行研究，以直接确定乳腺癌死亡率的社会经济趋势。对于种族，使用未关联的常规人口普查和死亡率数据，并采用调整因子来校正毛利人和太平洋岛民死亡人数的漏报情况。
直到20世纪90年代中期，毛利人和非毛利非太平洋岛民的死亡率变化不大，毛利人的死亡率高出25%。在1996 - 1999年，毛利人的死亡率显著上升，比非毛利非太平洋岛民高出68%（标准化死亡比1.68；95%可信区间：1.49 - 1.90）。随着时间的推移，太平洋岛民女性的乳腺癌死亡率大约增加了两倍。高收入和高教育群体的死亡率似乎在下降，但社会经济群体内部的趋势在统计学上并不显著。然而，到1996 - 1999年，与高收入群体相比，低收入群体的死亡率显著高出22%（标准化死亡比1.22；95%可信区间：1.01 - 1.49）。
乳腺癌死亡率在种族间以及可能在社会经济方面的差距不断扩大，这可能是由于潜在发病率和不同的生存趋势共同导致的。一旦筛查对人群的全部死亡率差异益处显现，差距可能会进一步加大。
