Henley S Jane, Anderson Robert N, Thomas Cheryll C, Massetti Greta M, Peaker Brandy, Richardson Lisa C
National Center for Chronic Disease Prevention and Health Promotion, CDC.
National Center for Health Statistics, CDC.
MMWR Surveill Summ. 2017 Jul 7;66(14):1-13. doi: 10.15585/mmwr.ss6614a1.
PROBLEM/CONDITION: Previous reports have shown that persons living in nonmetropolitan (rural or urban) areas in the United States have higher death rates from all cancers combined than persons living in metropolitan areas. Disparities might vary by cancer type and between occurrence and death from the disease. This report provides a comprehensive assessment of cancer incidence and deaths by cancer type in nonmetropolitan and metropolitan counties.
2004-2015.
Cancer incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2009-2013 and trends in annual age-adjusted incidence rates for 2004-2013. Cancer mortality data from the National Vital Statistics System were used to calculate average annual age-adjusted death rates for 2011-2015 and trends in annual age-adjusted death rates for 2006-2015. For 5-year average annual rates, counties were classified into four categories (nonmetropolitan rural, nonmetropolitan urban, metropolitan with population <1 million, and metropolitan with population ≥1 million). For the trend analysis, which used annual rates, these categories were combined into two categories (nonmetropolitan and metropolitan). Rates by county classification were examined by sex, age, race/ethnicity, U.S. census region, and cancer site. Trends in rates were examined by county classification and cancer site.
During the most recent 5-year period for which data were available, nonmetropolitan rural areas had lower average annual age-adjusted cancer incidence rates for all anatomic cancer sites combined but higher death rates than metropolitan areas. During 2006-2015, the annual age-adjusted death rates for all cancer sites combined decreased at a slower pace in nonmetropolitan areas (-1.0% per year) than in metropolitan areas (-1.6% per year), increasing the differences in these rates. In contrast, annual age-adjusted incidence rates for all cancer sites combined decreased approximately 1% per year during 2004-2013 both in nonmetropolitan and metropolitan counties.
This report provides the first comprehensive description of cancer incidence and mortality in nonmetropolitan and metropolitan counties in the United States. Nonmetropolitan rural counties had higher incidence of and deaths from several cancers related to tobacco use and cancers that can be prevented by screening. Differences between nonmetropolitan and metropolitan counties in cancer incidence might reflect differences in risk factors such as cigarette smoking, obesity, and physical inactivity, whereas differences in cancer death rates might reflect disparities in access to health care and timely diagnosis and treatment.
Many cancer cases and deaths could be prevented, and public health programs can use evidence-based strategies from the U.S. Preventive Services Task Force and Advisory Committee for Immunization Practices (ACIP) to support cancer prevention and control. The U.S. Preventive Services Task Force recommends population-based screening for colorectal, female breast, and cervical cancers among adults at average risk for these cancers and for lung cancer among adults at high risk; screening adults for tobacco use and excessive alcohol use, offering counseling and interventions as needed; and using low-dose aspirin to prevent colorectal cancer among adults considered to be at high risk for cardiovascular disease based on specific criteria. ACIP recommends vaccination against cancer-related infectious diseases including human papillomavirus and hepatitis B virus. The Guide to Community Preventive Services describes program and policy interventions proven to increase cancer screening and vaccination rates and to prevent tobacco use, excessive alcohol use, obesity, and physical inactivity.
问题/状况：以往报告显示，美国非大都市（农村或城市）地区居民的所有癌症合并死亡率高于大都市地区居民。不同癌症类型以及疾病发生与死亡之间的差异可能有所不同。本报告全面评估了非大都市和大都市县按癌症类型划分的癌症发病率和死亡率。
2004 - 2015年。
利用美国疾病控制与预防中心国家癌症登记计划以及美国国立癌症研究所监测、流行病学和最终结果计划的癌症发病率数据，计算2009 - 2013年的年均年龄调整发病率以及2004 - 2013年年均年龄调整发病率的趋势。利用国家生命统计系统的癌症死亡率数据，计算2011 - 2015年的年均年龄调整死亡率以及2006 - 2015年年均年龄调整死亡率的趋势。对于5年平均年率，各县被分为四类（非大都市农村、非大都市城市、人口<100万的大都市以及人口≥100万的大都市）。对于使用年率的趋势分析，这些类别合并为两类（非大都市和大都市）。按县分类的发病率按性别、年龄、种族/族裔、美国人口普查区域和癌症部位进行了检查。发病率趋势按县分类和癌症部位进行了检查。
在可获取数据的最近5年期间，非大都市农村地区所有解剖学癌症部位合并的年均年龄调整癌症发病率低于大都市地区，但死亡率高于大都市地区。在2006 - 2015年期间，所有癌症部位合并的年均年龄调整死亡率在非大都市地区（每年-1.0%）下降速度比大都市地区（每年-1.6%）慢，这加大了这些比率的差异。相比之下，在2004 - 2013年期间，非大都市和大都市县所有癌症部位合并的年均年龄调整发病率每年均下降约1%。
本报告首次全面描述了美国非大都市和大都市县的癌症发病率和死亡率。非大都市农村县与烟草使用相关的几种癌症以及可通过筛查预防的癌症的发病率和死亡率较高。非大都市和大都市县在癌症发病率上的差异可能反映了诸如吸烟、肥胖和身体活动不足等风险因素的差异，而癌症死亡率的差异可能反映了在获得医疗保健以及及时诊断和治疗方面的差距。
许多癌症病例和死亡是可以预防的，公共卫生项目可采用美国预防服务工作组和免疫实践咨询委员会（ACIP）基于证据的策略来支持癌症预防和控制。美国预防服务工作组建议对患这些癌症平均风险的成年人进行基于人群的结直肠癌、女性乳腺癌和宫颈癌筛查，对高风险成年人进行肺癌筛查；对成年人进行烟草使用和过度饮酒筛查，根据需要提供咨询和干预；并根据特定标准使用低剂量阿司匹林预防被认为心血管疾病高风险成年人的结直肠癌。ACIP建议针对与癌症相关的传染病进行疫苗接种，包括人乳头瘤病毒和乙型肝炎病毒。《社区预防服务指南》描述了经证实可提高癌症筛查和疫苗接种率以及预防烟草使用、过度饮酒、肥胖和身体活动不足的项目和政策干预措施。
Zotero 插件
