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瑞士基于人群的研究显示,结直肠癌患者在诊断时的分期和生存方面存在社会经济和人口统计学方面的不平等。

Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population-based study.

机构信息

Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH-3012, Bern, Switzerland.

National Institute for Cancer Epidemiology and Registration (NICER), Hirschengraben 82, 8001, Zürich, Switzerland.

出版信息

Cancer Med. 2018 Apr;7(4):1498-1510. doi: 10.1002/cam4.1385. Epub 2018 Feb 26.

Abstract

Socioeconomic inequalities in cancer stage at diagnosis and survival are important public health issues. This study investigates the association between socioeconomic position (SEP) and colorectal cancer (CRC) stage at diagnosis and survival in Switzerland, a European country with highest level of medical facilities and life expectancy. We used population-based CRC data from seven Swiss cantonal cancer registries 2001-2008 (N = 10,088) linked to the Swiss National Cohort (SNC). Follow-up information was available until the end of 2013. SEP was estimated based on education. The association between cancer stage and SEP was assessed using logistic regression models including cancer localization (colon/rectum), sex, age, civil status, urbanity of residence, language region, and nationality (Swiss/non-Swiss). Survival was analyzed using competing risk regressions reporting subhazard ratios (SHRs) for the risk of dying due to CRC. We observed a social gradient for later stage CRC with adjusted odds ratios (ORs) of 1.11 (95% CI: 0.97-1.19) and 1.28 (95% CI: 1.08-1.50) for middle and low SEP compared to high SEP. Further, single compared to married people had elevated odds of being diagnosed at later stages. Survival was lower in patients with CRC with low SEP in the unadjusted model (SHR: 1.18, 95% CI: 1.07-1.30). After adjustment for stage at diagnosis and further sociodemographic characteristics, significant survival inequalities by SEP disappeared but remained for non-Swiss compared to Swiss citizens and for patients living in nonurban areas compared to their urban counterparts. Swiss public health strategies should facilitate equal access to CRC screening and optimal CRC care for all social groups and in all regions of Switzerland.

摘要

社会经济地位(SEP)与诊断时的结直肠癌(CRC)分期和生存之间的关联在欧洲医疗设施和预期寿命最高的瑞士国家进行了研究。我们使用了来自瑞士七个州癌症登记处 2001-2008 年的基于人群的 CRC 数据(N=10088),并与瑞士国家队列(SNC)进行了链接。随访信息可获得至 2013 年底。SEP 是根据教育程度来估计的。使用包括癌症定位(结肠/直肠)、性别、年龄、婚姻状况、居住的城市/农村、语言区和国籍(瑞士/非瑞士)在内的逻辑回归模型评估癌症分期与 SEP 之间的关联。使用竞争风险回归分析报告由于 CRC 而死亡的风险的亚危险比(SHR)来分析生存情况。我们观察到晚期 CRC 存在社会梯度,中低 SEP 组与高 SEP 组相比,调整后的优势比(OR)分别为 1.11(95%CI:0.97-1.19)和 1.28(95%CI:1.08-1.50)。此外,与已婚人群相比,单身人群被诊断为晚期的可能性更高。在未调整模型中,低 SEP 组的 CRC 患者的生存率较低(SHR:1.18,95%CI:1.07-1.30)。在调整诊断时的分期和其他社会人口特征后,SEP 导致的生存不平等现象消失了,但非瑞士公民与瑞士公民相比,以及居住在非城市地区的患者与城市地区的患者相比,仍然存在差异。瑞士公共卫生策略应促进所有社会群体和瑞士所有地区公平获得 CRC 筛查和最佳 CRC 护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4cef/5911574/5e089829be28/CAM4-7-1498-g001.jpg

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