Tehranifar Parisa, Goyal Abhishek, Phelan Jo C, Link Bruce G, Liao Yuyan, Fan Xiaozhou, Desai Manisha, Terry Mary Beth
Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA.
Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
Cancer Causes Control. 2016 Apr;27(4):553-60. doi: 10.1007/s10552-016-0729-2. Epub 2016 Mar 12.
Racial disparities in cancer mortality may be greater for cancers that are amenable to available early detection and treatment (amenability level). We investigated whether these patterns vary by age at cancer diagnosis.
Using 5-year relative survival rates (5Y-RSR), we classified 51 cancer sites into least amenable, partly amenable, and mostly amenable cancers (<40%, 40-69%, ≥70% 5-YRS, respectively). We examined whether racial disparities in mortality rates (African-Americans, Asian/Pacific Islanders, Hispanics, whites), as estimated through Cox regression models, were modified by age at diagnosis and amenability level in 516,939 cancer cases diagnosed in 1995-1999.
As compared with whites, all racial minority groups experienced higher cancer mortality rates in the youngest age group of 20-34 years. African-Americans and Hispanics diagnosed with partly and mostly amenable cancers had higher mortality rates relative to whites with cancers of the same amenability levels; further, these differences decreased in magnitude or reversed in direction with increasing age. In contrast, the racial differences in mortality were smaller and remained fairly constant across age groups for least amenable cancers. For example, in the youngest (20-34) and oldest (80-99) age groups, the adjusted hazard ratios (HRs) for African-Americans versus whites with least amenable cancers were, respectively, 1.26 (95% CI 1.02, 1.55) and 0.90 (95% CI 0.85, 0.96), while the HRs for African-Americans versus whites with mostly amenable cancers were 2.77 (95% CI 2.38, 3.22) and 1.07 (95% CI 0.98, 1.17).
Cancer survival disadvantage for racial minorities is larger in younger age groups for cancers that are more amenable to medical interventions.
对于适合进行早期检测和治疗的癌症（可及性水平），癌症死亡率的种族差异可能更大。我们调查了这些模式是否因癌症诊断时的年龄而异。
使用5年相对生存率（5Y-RSR），我们将51个癌症部位分为最难治疗、部分可治疗和最易治疗的癌症（5年生存率分别<40%、40 - 69%、≥70%）。我们通过Cox回归模型估计了1995 - 1999年诊断的516,939例癌症病例中，死亡率的种族差异（非裔美国人、亚裔/太平洋岛民、西班牙裔、白人）是否因诊断时的年龄和可及性水平而有所改变。
与白人相比，所有少数种族群体在20 - 34岁的最年轻年龄组中癌症死亡率更高。被诊断为部分可治疗和最易治疗癌症的非裔美国人和西班牙裔相对于具有相同可及性水平癌症的白人死亡率更高；此外，随着年龄增长，这些差异的幅度减小或方向逆转。相比之下，对于最难治疗的癌症，死亡率的种族差异较小，且在各年龄组中保持相当稳定。例如，在最年轻（20 - 34岁）和最年长（80 - 99岁）年龄组中，患有最难治疗癌症的非裔美国人与白人的调整后风险比（HR）分别为1.26（95%CI 1.02, 1.55）和0.90（95%CI 0.85, 0.96），而患有最易治疗癌症的非裔美国人与白人的HR分别为2.77（95%CI 2.38, 3.22）和1.07（95%CI 0.98, 1.17）。
对于更适合医学干预的癌症，少数种族在较年轻年龄组中的癌症生存劣势更大。
