Tai Eric, Hallisey Elaine, Peipins Lucy A, Flanagan Barry, Lunsford Natasha Buchanan, Wilt Grete, Graham Shannon
1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia .
2 Agency for Toxic Substances and Disease Registry, Geospatial Research , Analysis, and Services Program, Centers for Disease Control and Prevention, Atlanta, Georgia .
J Adolesc Young Adult Oncol. 2018 Feb;7(1):22-29. doi: 10.1089/jayao.2017.0066. Epub 2017 Sep 21.
Adolescents with cancer have had less improvement in survival than other populations in the United States. This may be due, in part, to adolescents not receiving treatment at Children's Oncology Group (COG) institutions, which have been shown to increase survival for some cancers. The objective of this ecologic study was to examine geographic distance to COG institutions and adolescent cancer mortality.
We calculated cancer mortality among adolescents and sociodemographic and healthcare access factors in four geographic zones at selected distances surrounding COG facilities: Zone A (area within 10 miles of any COG institution), Zones B and C (concentric rings with distances from a COG institution of >10-25 miles and >25-50 miles, respectively), and Zone D (area outside of 50 miles).
The adolescent cancer death rate was highest in Zone A at 3.21 deaths/100,000, followed by Zone B at 3.05 deaths/100,000, Zone C at 2.94 deaths/100,000, and Zone D at 2.88 deaths/100,000. The United States-wide death rate for whites without Hispanic ethnicity, blacks without Hispanic ethnicity, and persons with Hispanic ethnicity was 2.96 deaths/100,000, 3.10 deaths/100,000, and 3.26 deaths/100,000, respectively. Zone A had high levels of poverty (15%), no health insurance coverage (16%), and no vehicle access (16%).
Geographic access to COG institutions, as measured by distance alone, played no evident role in death rate differences across zones. Among adolescents, socioeconomic factors, such as poverty and health insurance coverage, may have a greater impact on cancer mortality than geographic distance to COG institution.
与美国其他人群相比，患癌青少年的生存率改善较少。这可能部分归因于青少年未在儿童肿瘤学组（COG）机构接受治疗，而这些机构已被证明可提高某些癌症的生存率。这项生态学研究的目的是考察到COG机构的地理距离与青少年癌症死亡率之间的关系。
我们计算了在COG机构周围选定距离的四个地理区域内青少年的癌症死亡率以及社会人口统计学和医疗保健可及性因素：A区（任何COG机构方圆10英里内的区域）、B区和C区（分别为距COG机构大于10至25英里和大于25至50英里的同心环）以及D区（50英里以外的区域）。
青少年癌症死亡率在A区最高，为每10万人中有3.21人死亡，其次是B区，为每10万人中有3.05人死亡，C区为每10万人中有2.94人死亡，D区为每10万人中有2.88人死亡。美国非西班牙裔白人、非西班牙裔黑人以及西班牙裔人群的全美国死亡率分别为每10万人中有2.96人死亡、3.10人死亡和3.26人死亡。A区贫困率高（15%）、无医疗保险覆盖率（16%）且无车辆可及率（16%）。
仅以距离衡量的到COG机构的地理可及性在各区域死亡率差异中未起明显作用。在青少年中，贫困和医疗保险覆盖率等社会经济因素对癌症死亡率的影响可能比到COG机构的地理距离更大。
