US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA.
J Community Health. 2013 Oct;38(5):926-40. doi: 10.1007/s10900-013-9703-z.
This study examined unemployment and racial/ethnic disparities in liver cancer mortality, incidence, survival, and risk factors in the United States between 1969 and 2011. Census-based unemployment rates were linked to 1969-2009 county-level mortality and incidence data, whereas 2006-2011 National Health Interview Surveys were used to examine variations in hepatitis infection and alcohol consumption. Age-adjusted mortality rates, risk-ratios, and rate-differences were calculated by year, sex, race, and county-unemployment level. Log-linear, Poisson, and logistic regression and disparity indices were used to model trends and differentials. Although liver-cancer mortality rose markedly for all groups during 1969-2011, higher unemployment levels were associated with increased mortality and incidence rates in each time period. Both absolute and relative inequalities in liver cancer mortality according to unemployment level increased over time for both males and females and for those aged 25-64 years. Compared to the lowest-unemployment group, those aged 25-64 in the highest-unemployment group had 56 and 115 % higher liver-cancer mortality in 1969-1971 and 2005-2009, respectively. Regardless of unemployment levels, Asian/Pacific Islanders and Hispanics had the highest mortality and incidence rates. The adjusted odds of hepatitis infection and heavy drinking were 38-39 % higher among the unemployed than employed. Liver-cancer mortality and incidence have risen steadily among all racial/ethnic, sex, and socioeconomic groups. Faster increases in mortality among the highest-unemployment group have led to a widening gap in mortality over time. Disparities in mortality and incidence are consistent with similar inequalities in hepatitis infection and alcohol consumption.
本研究考察了 1969 年至 2011 年期间美国的失业状况以及肝癌死亡率、发病率、生存率方面的种族/民族差异及其相关因素。以普查为基础的失业率与 1969-2009 年县一级死亡率和发病率数据相关联，而 2006-2011 年全国健康访谈调查则用于研究肝炎感染和酗酒情况的差异。通过年龄调整死亡率、风险比和率差按年份、性别、种族和县城失业率级别计算。对数线性、泊松和逻辑回归和差异指数用于对趋势和差异进行建模。虽然在 1969-2011 年期间所有群体的肝癌死亡率都显著上升，但在每个时期，较高的失业率都与死亡率和发病率的上升有关。男性和女性以及 25-64 岁人群中，根据失业率划分的肝癌死亡率的绝对和相对不平等状况均随时间推移而增加。与失业率最低的群体相比，在失业率最高的群体中，25-64 岁人群在 1969-1971 年和 2005-2009 年的肝癌死亡率分别高出 56%和 115%。无论失业率高低如何，亚裔/太平洋岛民和西班牙裔的死亡率和发病率最高。与就业人群相比，失业人群的肝炎感染和酗酒的调整后几率高 38-39%。所有种族/民族、性别和社会经济群体的肝癌死亡率和发病率都在稳步上升。在失业率最高的群体中，死亡率的上升速度更快，导致死亡率的差距随时间扩大。死亡率和发病率方面的差异与肝炎感染和酗酒方面的类似不平等情况一致。
