Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Oral Oncol. 2012 Mar;48(3):253-61. doi: 10.1016/j.oraloncology.2011.10.002. Epub 2011 Oct 29.
This population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and oral cancer mortality. A population-based follow-up study was conducted of 3607 oral cancer patients (predominantly male) who were diagnosed between 2004 and 2005. Each patient was traced to death or for 2 years. Individual SES was defined by enrollee category. Neighborhood SES was defined by income, and numbers of doctors, and neighborhoods were grouped into advantaged and disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rate between the different SES groups after adjusting for possible confounding and risk factors. In oral cancer patients aged below 65 years, death rates among those with low SES were highest in disadvantaged neighborhoods. After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score, urbanization, and area of residence), tumor extent, treatment modalities (operation, adjuvant therapy), hospital characteristics (ownership, teaching level, caseload), and year of diagnosis, oral cancer patients with low individual SES in disadvantaged neighborhoods conferred a 1.46- to 1.64-fold higher risk for death, compared with patients with high individual SES in advantaged neighborhoods. No statistically significant difference was found in risk of death between different SES groups in patients aged 65 and above. Our findings indicate that oral cancer patients with low individual SES have the highest risk of mortality even under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.
本基于人群的研究调查了个体和邻里社会经济地位（SES）与口腔癌死亡率之间的关系。对 2004 年至 2005 年间诊断出的 3607 名（主要为男性）口腔癌患者进行了基于人群的随访研究。每位患者都被追踪到死亡或随访 2 年。个体 SES 通过参保类别来定义。邻里 SES 通过收入和医生数量来定义，社区被分为优势和劣势区域。采用 Cox 比例风险模型，在调整可能的混杂因素和风险因素后，比较不同 SES 组的无死亡生存率。在年龄低于 65 岁的口腔癌患者中，低 SES 者在劣势社区的死亡率最高。在调整了患者特征（年龄、性别、Charlson 合并症指数评分、城市化程度和居住地区）、肿瘤范围、治疗方式（手术、辅助治疗）、医院特征（所有权、教学水平、病例量）和诊断年份后，与高 SES 者在优势社区的患者相比，处于劣势社区且 SES 较低的口腔癌患者的死亡风险增加了 1.46-1.64 倍。在年龄 65 岁及以上的患者中，不同 SES 组之间的死亡风险无统计学差异。我们的研究结果表明，即使在全民医保体系下，SES 较低的口腔癌患者的死亡率仍然最高。公共卫生策略和福利政策必须继续关注这一弱势群体。
