McWhorter W P, Schatzkin A G, Horm J W, Brown C C
Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, Maryland.
Cancer. 1989 Mar 1;63(5):982-7. doi: 10.1002/1097-0142(19890301)63:5<982::aid-cncr2820630533>3.0.co;2-i.
Blacks and Whites have very different cancer incidence rates for many sites, but this may largely be due to the racial differences in socioeconomic status (SES). The authors tested this hypothesis by determining the effect of adjustment for SES on the black/white incidence ratios for 12 cancer sites. Race-specific census tract-level SES variables (median family income, percent below poverty level, and years of education) were obtained from the 1980 US census and applied to approximately 20,000 black and 88,000 white cancer cases from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the years 1978 to 1982. For each cancer site (with each sex considered separately), Poisson regression was used to produce age-adjusted black/white incidence ratios, with and without adjustment for SES. The SES variable with the strongest adjusting power was percent below poverty level. For many sites (breast, in situ and invasive cervix, esophagus, male lung, pancreas, stomach) poverty accounted for much or all of the racial differences. For several sites (bladder, multiple myeloma, prostate, uterine corpus), large racial differences persisted after adjustment for poverty, and these findings suggest directions for investigating the etiology of these cancers.
黑人和白人在许多部位的癌症发病率差异很大，但这很大程度上可能归因于社会经济地位（SES）的种族差异。作者通过确定调整SES对12个癌症部位的黑人/白人发病率比值的影响来检验这一假设。特定种族的普查区层面的SES变量（家庭收入中位数、贫困线以下人口百分比和受教育年限）取自1980年美国人口普查，并应用于1978年至1982年期间美国国家癌症研究所监测、流行病学和最终结果（SEER）项目中的约20000例黑人癌症病例和88000例白人癌症病例。对于每个癌症部位（男女分别考虑），使用泊松回归得出年龄调整后的黑人/白人发病率比值，包括调整和未调整SES的情况。调整能力最强的SES变量是贫困线以下人口百分比。对于许多部位（乳腺癌、原位和浸润性宫颈癌、食管癌、男性肺癌、胰腺癌、胃癌），贫困解释了大部分或全部种族差异。对于几个部位（膀胱癌、多发性骨髓瘤、前列腺癌、子宫体癌），在调整贫困因素后，仍然存在很大的种族差异，这些发现为研究这些癌症的病因指明了方向。
