Patel Manali I, McKinley Meg, Cheng Iona, Haile Robert, Wakelee Heather, Gomez Scarlett Lin
Division of Oncology, Department of Medicine, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA; Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Cancer Prevention Institute of California, 2201 Walnut Avenue, Fremont, CA, 94538, USA.
Lung Cancer. 2017 Jun;108:140-149. doi: 10.1016/j.lungcan.2017.03.014. Epub 2017 Mar 30.
Lung cancer incidence trends by histology, sex, race/ethnicity, and neighborhood socioeconomic status (nSES) have not been previously reported. We conducted a population-based study of lung cancer incidence over three peri-censal periods: 1988-1992, 1998-2002, and 2008-2012.
We abstracted lung cancer cases from the California Cancer Registry and used US Census and American Community Survey data to develop multidimensional nSES indices for each census period. We calculated nSES tertile-specific incidence rates and rate ratios for each peri-censal period and used incidence rate ratios (IRR) to assess changes in rates from 1988 to 1992 to 1998-2002 and 2008-2012.
There were a total of 231,205 lung cancer cases. Males: Among males, incidence rates of lung cancer decreased over time, all race/ethnicities, and all nSES tertiles, with larger declines among males in higher nSES areas. Rates either declined or were stable for adenocarcinoma, with larger declines for other histologic subtypes. Females: Among females, declines in incidence rates of lung cancer were more pronounced for females in higher nSES areas, but diverged more so than for males, with variations by histology and race/ethnicity. Incidence rates of adenocarcinoma increased over time among all females, with greater increase among females in low nSES areas.
Our findings demonstrate differences in incidence trends over three decades by histology, gender, race/ethnicity, and nSES. While incidence rates consistently declined over time for males, there were greater declines in incidence for high nSES populations. In contrast, among females, there was evidence of increases in lung cancer incidence among low SES API females, and for adenocarcinoma.
以往尚未报告按组织学类型、性别、种族/族裔及邻里社会经济地位（nSES）划分的肺癌发病率趋势。我们开展了一项基于人群的研究，调查了三个临近普查时期（1988 - 1992年、1998 - 2002年和2008 - 2012年）的肺癌发病率。
我们从加利福尼亚癌症登记处提取肺癌病例，并使用美国人口普查和美国社区调查数据为每个普查时期制定多维nSES指数。我们计算了每个临近普查时期nSES三分位数特定发病率和率比，并使用发病率比（IRR）评估1988年至1992年、1998 - 2002年和2008 - 2012年发病率的变化。
共有231,205例肺癌病例。男性：在男性中，肺癌发病率随时间下降，涵盖所有种族/族裔及所有nSES三分位数，nSES较高地区的男性下降幅度更大。腺癌发病率要么下降要么稳定，其他组织学亚型下降幅度更大。女性：在女性中，nSES较高地区的女性肺癌发病率下降更为明显，但与男性相比差异更大，存在组织学类型和种族/族裔差异。所有女性中腺癌发病率随时间增加，nSES较低地区的女性增加幅度更大。
我们的研究结果表明，在三十年时间里，肺癌发病率在组织学类型、性别、种族/族裔及nSES方面存在差异。虽然男性发病率随时间持续下降，但nSES较高人群的发病率下降幅度更大。相比之下，在女性中，有证据表明nSES较低的亚裔/太平洋岛民女性以及腺癌的肺癌发病率有所增加。
