The University of Cambridge, Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK.
Maturitas. 2011 Nov;70(3):234-45. doi: 10.1016/j.maturitas.2011.07.019. Epub 2011 Sep 1.
Globally, health inequities between Indigenous and non-Indigenous populations exist. The disparity in health outcomes between Indigenous and non-Indigenous Australians is exemplified by cervical cancer. Current evidence suggests that Indigenous women have higher age standardised incidence and mortality than non-Indigenous women when adjusted for stage at diagnosis and co-morbidities; however, there is little information pertaining to national estimates of cervical cancer in Indigenous women. In this paper we review available evidence on the difference in occurrence and case fatality of cervical cancer among Indigenous and non-Indigenous Australian women. The Australian Bureau of Statistics, Australian Institute of Health and Welfare, and State- or Territory-based Cancer Registries were utilised to collect surveillance data. To corroborate existing data, further available journal literature was identified through Medline and Embase. All papers selected for review were cross-referenced to identify further relevant studies. The most recent national estimate of age-standardised cervical cancer incidence rate was 16.9 and 7.1 per 100,000 women-years in Indigenous and non-Indigenous women respectively (incidence ratio 2.4). The Indigenous age-standardised mortality rate was 9.9 per 100,000 women years (95% CI 7.1-13.3), over 5 times the non-Indigenous rate. Cervical cancer incidence, in both Indigenous and non-Indigenous women, has decreased since 1991. Despite the decline, age-standardised incidence among Indigenous women is still higher than non-Indigenous women. The pattern of cervical cancer incidence and survival corroborates the health inequities that exist in Australia. Indigenous women are more likely than non-Indigenous women to develop cervical cancer and are less likely to survive it. Similar patterns exist in Indigenous populations worldwide, such as New Zealander Maoris and Canadian Aboriginals, suggesting that high rates of cervical cancer incidence and mortality may be a symptom of social and economic inequity.
全球范围内，原住民和非原住民之间存在健康不平等现象。在澳大利亚，原住民和非原住民在健康结果方面存在差异，宫颈癌就是一个例证。现有证据表明，在调整诊断时的分期和合并症后，土著妇女的年龄标准化发病率和死亡率高于非土著妇女；然而，关于全国范围内土著妇女宫颈癌发病率的信息很少。本文综述了现有的关于澳大利亚土著和非土著妇女宫颈癌发病率和病死率差异的证据。利用澳大利亚统计局、澳大利亚卫生与福利研究所和州或地区癌症登记处收集监测数据。为了证实现有数据，通过 Medline 和 Embase 进一步确定了可获得的期刊文献。对所选综述文章进行了交叉引用，以确定其他相关研究。最近全国估计的年龄标准化宫颈癌发病率分别为土著妇女每 10 万妇女年 16.9 例和非土著妇女每 10 万妇女年 7.1 例（发病率比 2.4）。土著妇女的年龄标准化死亡率为每 10 万妇女年 9.9 例（95%CI 7.1-13.3），是非土著妇女的 5 倍多。自 1991 年以来，无论是在土著妇女还是非土著妇女中，宫颈癌的发病率都有所下降。尽管有所下降，但土著妇女的年龄标准化发病率仍然高于非土著妇女。宫颈癌发病率和生存率的模式证实了澳大利亚存在的健康不平等现象。与非土著妇女相比，土著妇女更有可能患上宫颈癌，且更不可能存活下来。新西兰毛利人和加拿大原住民等世界各地的土著人群中也存在类似的模式，这表明宫颈癌发病率和死亡率高可能是社会和经济不平等的症状。
