Gomez Scarlett Lin, Canchola Alison J, Nelson David O, Keegan Theresa H M, Clarke Christina A, Cheng Iona, Shariff-Marco Salma, DeRouen Mindy, Catalano Ralph, Satariano William A, Davidson-Allen Kathleen, Glaser Sally L
Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.
Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.
Cancer Causes Control. 2017 Feb;28(2):145-154. doi: 10.1007/s10552-016-0846-y. Epub 2017 Jan 27.
In recent years, cancer case counts in the U.S. underwent a large, rapid decline-an unexpected change given population growth for older persons at highest cancer risk. As these declines coincided with the Great Recession, we examined whether they were related to economic conditions.
Using California Cancer Registry data from California's 30 most populous counties, we analyzed trends in cancer incidence during pre-recession (1996-2007) and recession/recovery (2008-2012) periods for all cancers combined and the ten most common sites. We evaluated the recession's association with rates using a multifactorial index that measured recession impact, and modeled associations between case counts and county-level unemployment rates using Poisson regression.
Yearly cancer incidence rate declines were greater during the recession/recovery (3.3% among males, 1.4% among females) than before (0.7 and 0.5%, respectively), particularly for prostate, lung, and colorectal cancers. Lower case counts, especially for prostate and liver cancer among males and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates, irrespective of time period, but independent of secular effects. The associations for melanoma translated up to a 3.6% decrease in cases with each 1% increase in unemployment. Incidence declines were not greater in counties with higher recession impact index.
Although recent declines in incidence of certain cancers are not differentially impacted by economic conditions related to the Great Recession relative to pre-recession conditions, the large recent absolute declines in the case counts of some cancer may be attributable to the large declines in unemployment in the recessionary period. This may occur through decreased engagement in preventive health behaviors, particularly for clinically less urgent cancers. Continued monitoring of trends is important to detect any rises in incidence rates as deferred diagnoses come to clinical attention.
近年来，美国癌症病例数大幅、快速下降，鉴于癌症高危老年人群数量增长，这一变化出人意料。由于这些下降与大衰退同时发生，我们研究了它们是否与经济状况有关。
利用加利福尼亚州人口最多的30个县的加利福尼亚癌症登记处数据，我们分析了衰退前（1996 - 2007年）和衰退/复苏期（2008 - 2012年）所有癌症合并以及十个最常见部位的癌症发病率趋势。我们使用一个衡量衰退影响的多因素指数评估衰退与发病率的关联，并使用泊松回归对病例数与县级失业率之间的关联进行建模。
衰退/复苏期（男性为3.3%，女性为1.4%）的年度癌症发病率下降幅度大于之前（分别为0.7%和0.5%），尤其是前列腺癌、肺癌和结直肠癌。病例数较低，特别是男性中的前列腺癌和肝癌以及女性中的乳腺癌、黑色素瘤和卵巢癌，与较高的失业率相关，与时间段无关，但不受长期影响。黑色素瘤的关联表明，失业率每增加1%，病例数最多减少3.6%。衰退影响指数较高的县发病率下降幅度并不更大。
尽管近期某些癌症发病率的下降相对于衰退前状况，并未受到与大衰退相关的经济状况的不同影响，但近期一些癌症病例数的大幅绝对下降可能归因于衰退期失业率的大幅下降。这可能是由于预防性健康行为的参与减少导致的，尤其是对于临床紧迫性较低的癌症。持续监测趋势对于在延迟诊断引起临床关注时检测发病率的任何上升非常重要。
