Lewis Denise Riedel, Pickle Linda W, Zhu Li
Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
StatNet Consulting, Gaithersburg, MD, USA.
Front Public Health. 2017 May 19;5:82. doi: 10.3389/fpubh.2017.00082. eCollection 2017.
After a period of increasing rates, lung cancer incidence is declining in the US for men and women. We investigated lung cancer rate patterns by gender, geographic location, and histologic subtype, and for total lung cancer (TLC), for the entire study period, and for 2000-2011 from 17 surveillance, epidemiology, and end results areas.
For each gender-histologic type combination, time trend plots and maps of age-adjusted rates are presented. Time trend significance was tested by joinpoint regression analysis. Spatial random effects models were applied to examine effects of sociodemographic factors, health insurance coverage, smoking, and physician density at the county level. Linked micromap plots illustrate patterns for important model predictors.
Declining incidence trends occurred for TLC ( < 0.05, entire period). Squamous cell carcinoma trends increased for females only ( < 0.05). Small cell carcinoma trends declined overall, < 0.05, but recently increased faster for females than males. Adenocarcinoma rates initially declined, but were significantly increasing by 2004, < 0.05. Counties with higher current smoking and family poverty were strongly associated with higher risk for all gender-histologic types ( < 0.0001, for both variables). County socioeconomic status was associated with higher risk for all lung cancer subtypes for females, < 0.02. Counties with more diagnostic radiologists were associated with higher TLC rates ( < 0.03); counties with greater primary care physician access were associated with lower TLC rates ( < 0.03). TLC incidence rates were higher in eastern and southern states than western areas. Male rates were higher than female rates along the West Coast. Males and females had similar small cell rate patterns, with higher rates in the Midwest and southeast. Squamous cell carcinoma and adenocarcinoma rate patterns were similar to TLC patterns, except for relatively higher female adenocarcinoma rates in the northeast and northwest.
Geographic patterns and declining time trends for incident lung cancer are consistent with previous mortality patterns. Male-female time trend and geographic pattern differences occur by histologic type. Time trends remain significant, even after adjustment for significant covariates. Knowledge of the variation of lung cancer incidence by region and histologic type is useful for surveillance and for implementing lung cancer control efforts.
经过一段时间的发病率上升后，美国男性和女性的肺癌发病率正在下降。我们调查了整个研究期间以及2000 - 2011年来自17个监测、流行病学和最终结果地区的肺癌发病率模式，按性别、地理位置和组织学亚型以及总肺癌（TLC）进行分析。
针对每种性别 - 组织学类型组合，呈现年龄调整发病率的时间趋势图和地图。通过连接点回归分析检验时间趋势的显著性。应用空间随机效应模型来研究县级社会人口学因素、医疗保险覆盖范围、吸烟和医生密度的影响。关联微地图展示重要模型预测因子的模式。
TLC的发病率呈下降趋势（整个时期，<0.05）。仅女性的鳞状细胞癌趋势上升（<0.05）。小细胞癌趋势总体下降，<0.05，但最近女性的上升速度快于男性。腺癌发病率最初下降，但到2004年显著上升，<0.05。当前吸烟率较高和家庭贫困的县与所有性别 - 组织学类型的较高风险密切相关（两个变量均<0.0001）。县社会经济状况与女性所有肺癌亚型的较高风险相关，<0.02。诊断放射科医生较多的县与较高的TLC发病率相关（<0.03）；初级保健医生可及性较高的县与较低的TLC发病率相关（<0.03）。东部和南部各州的TLC发病率高于西部地区。西海岸男性发病率高于女性。男性和女性的小细胞癌发病率模式相似，中西部和东南部发病率较高。鳞状细胞癌和腺癌发病率模式与TLC模式相似，除了东北部和西北部女性腺癌发病率相对较高。
肺癌发病的地理模式和下降的时间趋势与先前的死亡率模式一致。按组织学类型存在男女时间趋势和地理模式差异。即使在对显著协变量进行调整后，时间趋势仍然显著。了解肺癌发病率按地区和组织学类型的变化对于监测和实施肺癌控制工作很有用。
