Beavis Anna L, Gravitt Patti E, Rositch Anne F
Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland.
Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC.
Cancer. 2017 May 15;123(6):1044-1050. doi: 10.1002/cncr.30507. Epub 2017 Jan 23.
The objectives of this study were to determine the age-standardized and age-specific annual US cervical cancer mortality rates after correction for the prevalence of hysterectomy and to evaluate disparities by age and race.
Estimates for deaths due to cervical cancer stratified by age, state, year, and race were derived from the National Center for Health Statistics county mortality data (2000-2012). Equivalently stratified data on the prevalence of hysterectomy for women 20 years old or older from the Behavioral Risk Factor Surveillance System survey were used to remove women who were not at risk from the denominator. Age-specific and age-standardized mortality rates were computed, and trends in mortality rates were analyzed with Joinpoint regression.
Age-standardized rates were higher for both races after correction. For black women, the corrected mortality rate was 10.1 per 100,000 (95% confidence interval [CI], 9.6-10.6), whereas the uncorrected rate was 5.7 per 100,000 (95% CI, 5.5-6.0). The corrected rate for white women was 4.7 per 100,000 (95% CI, 4.6-4.8), whereas the uncorrected rate was 3.2 per 100,000 (95% CI, 3.1-3.2). Without the correction, the disparity in mortality between races was underestimated by 44%. Black women who were 85 years old or older had the highest corrected rate: 37.2 deaths per 100,000. A trend analysis of corrected rates demonstrated that white women's rates decreased at 0.8% per year, whereas the annual decrease for black women was 3.6% (P < .05).
A correction for hysterectomy has revealed that cervical cancer mortality rates are underestimated, particularly in black women. The highest rates are seen in the oldest black women, and public health efforts should focus on appropriate screening and adequate treatment in this population. Cancer 2017;123:1044-50. © 2016 American Cancer Society.
本研究的目的是确定在对子宫切除术患病率进行校正后美国宫颈癌的年龄标准化和特定年龄年度死亡率，并评估年龄和种族差异。
根据国家卫生统计中心的县死亡率数据（2000 - 2012年）得出按年龄、州、年份和种族分层的宫颈癌死亡估计数。使用行为危险因素监测系统调查中20岁及以上女性子宫切除术患病率的同等分层数据，从分母中去除无患病风险的女性。计算特定年龄和年龄标准化死亡率，并使用Joinpoint回归分析死亡率趋势。
校正后两个种族的年龄标准化率均较高。对于黑人女性，校正后的死亡率为每10万人10.1例（95%置信区间[CI]，9.6 - 10.6），而未校正的率为每10万人5.7例（95% CI，5.5 - 6.0）。白人女性校正后的率为每10万人4.7例（95% CI，4.6 - 4.8），而未校正的率为每10万人3.2例（95% CI，3.1 - 3.2）。未进行校正时，种族间死亡率差异被低估了44%。85岁及以上的黑人女性校正后的率最高：每10万人中有37.2例死亡。校正率的趋势分析表明，白人女性的率每年下降0.8%，而黑人女性每年下降3.6%（P <.05）。
对子宫切除术进行校正后发现，宫颈癌死亡率被低估，尤其是在黑人女性中。年龄最大的黑人女性的死亡率最高，公共卫生工作应专注于该人群的适当筛查和充分治疗。《癌症》2017年；123:1044 - 50。© 2016美国癌症协会。
