Surveillance Research Program, American Cancer Society, Atlanta, GA 30303, USA.
Cancer. 2012 Oct 15;118(20):5110-6. doi: 10.1002/cncr.27606. Epub 2012 Jun 15.
Despite substantial declines in cervical cancer mortality because of widespread screening, socioeconomic status (SES) disparities persist. The authors examined trends in cervical cancer mortality rates and the risk of late-stage diagnoses by SES.
Using data from the National Vital Statistics System, trends in age-standardized mortality rates among women ages 25 to 64 years (1993-2007) by education level (≤12 years, 13-15 years, and ≥16 years) and race/ethnicity for non-Hispanic white (NHW) women and non-Hispanic black (NHB) women in 26 states were assessed using log-linear regression. Rate ratios (RRs) and 95% confidence intervals (CIs) were used to assess disparities between those with ≤12 years versus ≥16 years of education during 1993 to 1995 and 2005 to 2007. Avertable deaths were calculated by applying mortality rates from the most educated women to others in 48 states. Trends in the risk of late-stage diagnosis by race/ethnicity and insurance status were evaluated in the National Cancer Data Base.
Declines in mortality were steepest for those with the highest education levels (3.2% per year among NHW women and 6.8% per year among NHB women). Consequently, the education disparity widened between the periods 1993 to 1995 and 2005 to 2007 from 3.1 (95% CI, 2.4-3.9) to 4.4 (95% CI, 3.5-5.6) for NHW women and from 3.8 (95% CI, 2.0-7.0) to 5.6 (95% CI, 3.1-10.0) for NHB women. The risk of late-stage diagnosis increased for uninsured versus privately insured women over time. During 2007, 74% of cervical cancer deaths in the United States may have been averted by eliminating SES disparities.
SES disparities in cervical cancer mortality and the risk of late-stage diagnosis increased over time. Most deaths in 2007 may have been averted by eliminating SES disparities.
尽管由于广泛的筛查，宫颈癌死亡率大幅下降，但社会经济地位（SES）的差异仍然存在。作者研究了 SES 与宫颈癌死亡率和晚期诊断风险的趋势。
使用国家生命统计系统的数据，评估了 26 个州的非西班牙裔白人（NHW）和非西班牙裔黑人（NHB）女性年龄在 25 至 64 岁之间（1993-2007 年）的按教育水平（≤12 年，13-15 年和≥16 年）和种族/族裔划分的标准化死亡率趋势，使用对数线性回归。使用率比（RR）和 95％置信区间（CI）来评估 1993 年至 1995 年和 2005 年至 2007 年期间接受≤12 年教育与接受≥16 年教育之间的差异。在 48 个州，通过将死亡率应用于最高学历的女性来计算可避免的死亡人数。在国家癌症数据库中评估了种族/族裔和保险状况对晚期诊断风险的趋势。
接受最高教育水平的女性死亡率下降最快（NHW 女性每年下降 3.2％，NHB 女性每年下降 6.8％）。因此，1993 年至 1995 年至 2005 年至 2007 年期间，NHW 女性之间的教育差异从 3.1（95％CI，2.4-3.9）扩大到 4.4（95％CI，3.5-5.6），而 NHB 女性从 3.8（95％CI，2.0-7.0）扩大到 5.6（95％CI，3.1-10.0）。随着时间的推移，未参保女性与私人参保女性相比，晚期诊断的风险增加。2007 年，美国 74％的宫颈癌死亡病例可能通过消除 SES 差异而得到避免。
SES 对宫颈癌死亡率和晚期诊断风险的差异随时间增加。通过消除 SES 差异，2007 年的大多数死亡可能会被避免。
