1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
1] Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA [2] Cancer Prevention Institute of California, Fremont, California, USA.
Am J Gastroenterol. 2014 Apr;109(4):579-88. doi: 10.1038/ajg.2013.488. Epub 2014 Feb 4.
OBJECTIVES: Heritable and environmental factors may contribute to differences in colorectal cancer (CRC) incidence across populations. We capitalized on the resources of the California Cancer Registry (CCR) and California's diverse Asian population to perform a cohort study exploring the relationships between CRC incidence, nativity, and neighborhood-level factors across Asian subgroups. METHODS: We identified CRC cases in the CCR from 1990 to 2004 and calculated age-adjusted CRC incidence rates for non-Hispanic Whites and US-born vs. foreign-born Asian ethnic subgroups, stratified by neighborhood socioeconomic status (SES) and "ethnic enclave." Trends were studied with joinpoint analysis. RESULTS: CRC incidence was lowest among foreign-born South Asians (22.0/100,000; 95% confidence interval (CI): 19.7-24.5/100,000) and highest among foreign-born Japanese (74.6/100,000; 95% CI: 70.1-79.2/100,000). Women in all Asian subgroups except Japanese, and men in all Asian subgroups except Japanese and US-born Chinese, had lower CRC incidence than non-Hispanic Whites. Among Chinese men and Filipino women and men, CRC incidence was lower among foreign-born than US-born persons; the opposite was observed for Japanese women and men. Among non-Hispanic Whites, but not most Asian subgroups, CRC incidence decreased over time. CRC incidence was inversely associated with neighborhood SES among non-Hispanic Whites, and level of ethnic enclave among Asians. CONCLUSIONS: CRC incidence rates differ substantially across Asian subgroups in California. The significant associations between CRC incidence and nativity and residence in an ethnic enclave suggest a substantial effect of acquired environmental factors. The absence of declines in CRC incidence rates among most Asians during our study period may point to disparities in screening compared with Whites.
目的:遗传和环境因素可能导致不同人群的结直肠癌(CRC)发病率存在差异。我们利用加利福尼亚癌症登记处(CCR)和加利福尼亚多样化的亚洲人群资源,开展了一项队列研究,探索 CRC 发病率、出生地和社区层面因素在亚洲人群亚组中的关系。
方法:我们从 1990 年至 2004 年在 CCR 中确定了 CRC 病例,并计算了非西班牙裔白人和美国出生与外国出生的亚洲族裔亚组的年龄调整后 CRC 发病率,按社区社会经济地位(SES)和“族裔飞地”分层。使用联合点分析研究趋势。
结果:CRC 发病率最低的是外国出生的南亚人(22.0/100000;95%置信区间[CI]:19.7-24.5/100000),最高的是外国出生的日本人(74.6/100000;95%CI:70.1-79.2/100000)。除了日本人之外,所有亚洲族裔亚组的女性以及除了日本人、美国出生的中国人之外的所有亚洲族裔亚组的男性,CRC 发病率均低于非西班牙裔白人。在中国男性和菲律宾男性和女性中,外国出生的 CRC 发病率低于美国出生的人;而日本的情况则相反。在非西班牙裔白人中,但不是在大多数亚洲族裔亚组中,CRC 发病率随时间呈下降趋势。CRC 发病率与非西班牙裔白人的社区 SES 呈负相关,与亚洲人的族裔飞地水平呈负相关。
结论:在加利福尼亚州,亚洲人群的 CRC 发病率存在显著差异。CRC 发病率与出生地和居住在族裔飞地之间的显著关联表明,后天环境因素的影响很大。在我们的研究期间,大多数亚洲人的 CRC 发病率没有下降,这可能表明与白人相比,筛查方面存在差异。
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