Hastert Theresa A, Ruterbusch Julie J, Beresford Shirley A A, Sheppard Lianne, White Emily
Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.
Soc Sci Med. 2016 Jan;148:52-8. doi: 10.1016/j.socscimed.2015.11.023. Epub 2015 Nov 22.
Cancer mortality is higher among residents of low-socioeconomic status (SES) areas than those of high-SES areas; however, the contribution of modifiable risk factors to this disparity is not known. We used data from 54,737 participants in the VITamins And Lifestyle (VITAL) Study, aged 50-76 with no history of cancer at baseline (2000-2002). Of these, 1488 died of cancer over an average of 7.7 years of follow-up. Data on modifiable risk factors including body mass index (BMI), physical activity, diet, alcohol, smoking and screening were taken from baseline questionnaires. We constructed a block group-level SES index using data from the 2000 United States Census and fit Cox proportional hazards models estimating the association between area-level SES and total cancer mortality with and without control for modifiable risk factors. All statistical tests are 2-sided. Cancer mortality was 77% (95% CI: 50%, 111%) higher in the lowest-SES areas compared with the highest. Modifiable risk factors accounted for 45% (95% CI: 34%, 62%) of this association. Smoking explained the greatest proportion (29%; 95% CI: 22%, 40%) of the observed association, followed by diet (11%; 95% CI: 7%, 17%), physical activity (10%; 95% CI: 7%, 16%), screening (9%; 6%, 13%), and BMI (5%; 95% CI: 1%, 10%). Results were similar in models controlling for individual education and income. The association between area-level SES and cancer mortality is partially explained by modifiable risk factors, which could suggest the appropriate targets to reduce socioeconomic disparities.
社会经济地位较低（SES）地区居民的癌症死亡率高于社会经济地位较高地区的居民；然而，可改变的风险因素对这种差异的影响尚不清楚。我们使用了维生素与生活方式（VITAL）研究中54737名参与者的数据，这些参与者年龄在50 - 76岁之间，基线时（2000 - 2002年）无癌症病史。其中，1488人在平均7.7年的随访期内死于癌症。包括体重指数（BMI）、身体活动、饮食、饮酒、吸烟和筛查等可改变风险因素的数据来自基线调查问卷。我们使用2000年美国人口普查数据构建了街区组层面的SES指数，并拟合Cox比例风险模型，估计在控制和不控制可改变风险因素的情况下，地区层面SES与总癌症死亡率之间的关联。所有统计检验均为双侧检验。与最高SES地区相比，最低SES地区的癌症死亡率高77%（95%CI：50%，111%）。可改变风险因素占这种关联的45%（95%CI：34%，62%）。吸烟解释了观察到的关联中最大的比例（29%；95%CI：22%，40%），其次是饮食（11%；95%CI：7%，17%）、身体活动（10%；95%CI：7%，16%）、筛查（9%；6%，13%）和BMI（5%；95%CI：1%，10%）。在控制个人教育和收入的模型中，结果相似。地区层面SES与癌症死亡率之间的关联部分可由可改变风险因素解释，这可能为减少社会经济差异指明了合适的目标。
