Cancer Data Registry of Idaho, Idaho Hospital Association, 615 N 7th St, PO Box 1278, Boise, ID 83701-1278. Email:
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Prev Chronic Dis. 2017 Sep 14;14:E81. doi: 10.5888/pcd14.170201.
Population-based cancer survival data provide insight into the effectiveness of health care delivery. Comparing survival for all cancer sites combined is challenging, because the primary cancer site and age distribution of patients may differ among areas or change over time. Cancer survival indices (CSIs) are summary measures of survival for cancers of all sites combined and are used in England and Europe to monitor temporal trends and examine geographic differences in survival. We describe the construction of the North American Cancer Survival Index and demonstrate how it can be used to compare survival by geographic area and by race.
We used data from 36 US cancer registries to estimate relative survival ratios for people diagnosed with cancer from 2006 through 2012 to create the CSI: the weighted sum of age-standardized, site-specific, relative survival ratios, with weights derived from the distribution of incident cases by sex and primary site from 2006 through 2008. The CSI was calculated for 32 registries for all races, 31 registries for whites, and 12 registries for blacks.
The survival estimates standardized by age only versus age-, sex-, and site-standardized (CSI) were 64.1% (95% confidence interval [CI], 64.1%-64.2%) and 63.9% (95% CI, 63.8%-63.9%), respectively, for the United States for all races combined. The inter-registry ranges in unstandardized and CSI estimates decreased from 12.3% to 5.0% for whites, and from 5.4% to 3.9% for blacks. We found less inter-registry variation in CSI estimates than in unstandardized all-sites survival estimates, but disparities by race persisted.
CSIs calculated for different jurisdictions or periods are directly comparable, because they are standardized by age, sex, and primary site. A national CSI could be used to measure temporal progress in meeting public health objectives, such as Healthy People 2030.
基于人群的癌症生存数据提供了对医疗保健提供效果的深入了解。比较所有癌症部位的综合生存率具有挑战性，因为患者的主要癌症部位和年龄分布可能因地区而异或随时间而变化。癌症生存指数（CSI）是所有部位癌症综合生存率的综合衡量指标，在英国和欧洲用于监测时间趋势并检查生存率的地理差异。我们描述了北美癌症生存指数的构建方法，并展示了如何使用它来按地理区域和种族比较生存率。
我们使用来自 36 个美国癌症登记处的数据，估计了 2006 年至 2012 年期间诊断为癌症的人群的相对生存率，以创建 CSI：通过性别和 2006 年至 2008 年期间的主要部位从发病病例分布中得出的加权总和，对 site-specific、相对生存率进行加权求和。为所有种族计算了 32 个登记处的 CSI，为白人计算了 31 个登记处，为黑人计算了 12 个登记处。
仅按年龄标准化的生存估计值与按年龄、性别和部位标准化的（CSI）分别为 64.1%（95%置信区间[CI]，64.1%-64.2%）和 63.9%（95% CI，63.8%-63.9%），代表所有种族的美国。未标准化和 CSI 估计值的登记处间差异从白人的 12.3%缩小到 5.0%，从黑人的 5.4%缩小到 3.9%。我们发现 CSI 估计值的登记处间差异小于未标准化的所有部位生存估计值，但种族差异仍然存在。
为不同司法管辖区或时间段计算的 CSI 是直接可比的，因为它们是按年龄、性别和主要部位标准化的。国家 CSI 可用于衡量实现公共卫生目标（如 2030 年健康人）的时间进展。
