Groome P A, Schulze K M, Keller S, Mackillop W J
Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2008 Oct;20(8):647-56. doi: 10.1016/j.clon.2008.05.006. Epub 2008 Jun 26.
Some people diagnosed with cancer die extremely quickly of their disease. We investigated whether certain demographic and geographical characteristics were associated with these early deaths.
The Ontario Cancer Registry enhanced with census data was used to study early death in patients aged 40-69 years, diagnosed between 1990 and 1997 with colorectal, female breast, head and neck, lung, prostate, stomach, or primary cancer of unknown origin. For each site, cases were either those who constituted the quickest 10% of deaths, or those who died within 30 days, whichever was the larger number (n = 5022). Controls were those still alive at 1 year (n = 59 406). Analyses were stratified by disease site and logistic regression identified independent effects. Characteristics included: age, gender, area-level socioeconomic status, county of residence, urban/rural residence, diagnosis year, and distance to a cancer centre.
Lower socioeconomic status (all sites) and increasing age (all sites except prostate and primary of unknown origin) were most strongly and consistently associated with early death. Male gender was a risk factor for early death from lung cancer. Living in urban areas was a risk factor for breast, lung, and unknown primary cancers.
People living in poorer and/or urban areas and the young-elderly are more susceptible to a very late cancer diagnosis. Unequal access to cancer care can lead to devastating consequences for vulnerable sectors of society.
一些被诊断患有癌症的人会很快死于该疾病。我们调查了某些人口统计学和地理特征是否与这些早期死亡有关。
利用安大略癌症登记处与人口普查数据相结合的资料，研究1990年至1997年间被诊断患有结肠直肠癌、女性乳腺癌、头颈癌、肺癌、前列腺癌、胃癌或原发灶不明的癌症的40 - 69岁患者的早期死亡情况。对于每个部位，病例为死亡最快的10%的患者，或在30天内死亡的患者，以数量较多者为准（n = 5022）。对照组为1年后仍存活的患者（n = 59406）。分析按疾病部位分层，逻辑回归确定独立影响因素。特征包括：年龄、性别、地区层面的社会经济地位、居住县、城乡居住情况、诊断年份以及到癌症中心的距离。
社会经济地位较低（所有部位）和年龄增长（前列腺癌和原发灶不明的癌症除外的所有部位）与早期死亡的关联最为强烈且一致。男性是肺癌早期死亡的危险因素。居住在城市地区是乳腺癌、肺癌和原发灶不明癌症的危险因素。
生活在贫困和/或城市地区的人群以及老年中的年轻人更容易在癌症晚期才被诊断出来。获得癌症治疗的机会不平等会给社会弱势群体带来毁灭性后果。
