结直肠癌结局不平等：人口密度、种族与社会经济地位之间的关联。
Colorectal cancer outcome inequalities: association between population density, race, and socioeconomic status.
作者信息
Fitzgerald Timothy L, Lea C S, Brinkley Jason, Zervos Emmanuel E
机构信息
East Carolina Uinversity, Greenville, North Carolina, USA.
出版信息
Rural Remote Health. 2014;14(3):2668. Epub 2014 Jul 22.
INTRODUCTION
Conflicting data exists regarding the influence of population density on colorectal cancer (CRC) outcomes; to better understand this, the present study evaluated outcomes along an urban-rural continuum.
METHODS
Colorectal patients aged ≥40 years from 1992 to 2002 were identified in the SEER (Surveillance, Epidemiology, and End Results) Registries of the National Cancer Institute in the USA.
RESULTS
A total of 176 011 patients were identified, with median age 71; most lived in populous counties and were white (90%). Patients from large metropolitan counties were more often African-American, and those in rural counties were more likely to be white and have low socioeconomic status (SES). Patients from large metropolitan (>1 million) and rural counties were more likely to have metastatic disease and decreased survival compared to smaller metropolitan counties (<1 million). Late stage of presentation and diminished survival were also associated with African-American race, male sex and lower SES.
CONCLUSIONS
Metropolitan counties with populations <1 million had superior CRC outcomes, in part secondary to race and SES.
引言
关于人口密度对结直肠癌（CRC）预后的影响，存在相互矛盾的数据；为了更好地理解这一点，本研究评估了城乡连续体上的预后情况。
方法
在美国国立癌症研究所的监测、流行病学和最终结果（SEER）登记处中，确定了1992年至2002年期间年龄≥40岁的结直肠癌患者。
结果
共确定了176011名患者，中位年龄为71岁；大多数患者居住在人口众多的县，且为白人（90%）。来自大都市县的患者中非洲裔美国人较多，而农村县的患者更可能是白人且社会经济地位（SES）较低。与较小的大都市县（<100万人口）相比，来自大都市（>100万人口）和农村县的患者更有可能患有转移性疾病且生存率降低。就诊时处于晚期以及生存率降低也与非洲裔美国人种族、男性性别和较低的SES有关。
结论
人口<100万的大都市县的结直肠癌预后较好，部分原因是种族和SES。
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