Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.
Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.
Am J Prev Med. 2018 May;54(5):688-698. doi: 10.1016/j.amepre.2018.01.021. Epub 2018 Mar 15.
Despite having lower overall incidence rates, rural populations tend to have higher cancer mortality rates. Rural populations often have higher rates of cancers with primary and secondary prevention modalities. However, there is limited research on rural-urban differences in incidence by stage. Therefore, the objective was to assess rural-urban differences in cancer rates by stage.
The North American Association of Central Cancer Registries public use data set (2009-2013) was used to calculate age-adjusted incidence rates and rate ratios (rural versus urban) for all stageable cancers, tobacco-associated cancers, human papillomavirus-associated cancers, and individual cancers with screening modalities. Analyses were performed in summer 2017 for all populations and stratified by race/ethnicity and region for localized and distant stages.
For all cancers, rural populations had lower rates of localized stage cancers (rate ratio=0.95, 95% CI=0.95, 0.95) and higher rates of distant stage cancer (rate ratio=1.05, 95% CI=1.05, 1.06). Higher rates of distant stage human papillomavirus-associated, tobacco-associated, colorectal, oropharyngeal, lung, cervical cancers, and melanoma were identified in rural populations. Racial/ethnic stratifications identified higher rates of distant stage cancers in rural non-Hispanic whites, but not non-Hispanic blacks and Hispanics. Distant stage lung cancer rates were higher in all rural groups, whereas rural whites had higher distant rates of tobacco-associated, colorectal, and cervical cancers, and rural blacks had higher distant rates for human papillomavirus-associated and oral cancers. Regional stratifications showed the greatest disparity in stage at diagnosis in the South.
These findings might help explain the higher rural cancer mortality rates and provide additional evidence to support targeted interventions.
尽管农村人口的总体发病率较低，但他们的癌症死亡率往往更高。农村人口往往有更高的癌症发病率，并有初级和二级预防措施。然而，关于城乡之间按阶段划分的发病率差异的研究有限。因此，本研究的目的是评估癌症发病率的城乡差异。
使用北美癌症登记协会公共使用数据集（2009-2013 年），计算所有可分期癌症、与烟草相关的癌症、人乳头瘤病毒相关的癌症以及具有筛查方式的个别癌症的年龄调整发病率和比率（农村与城市）。分析于 2017 年夏季在所有人群中进行，并按局部和远处阶段进行种族/族裔和地区分层。
对于所有癌症，农村人口的局部阶段癌症发病率较低（比率=0.95，95%CI=0.95，0.95），而远处阶段癌症发病率较高（比率=1.05，95%CI=1.05，1.06）。农村人口中发现了更高的远处阶段人乳头瘤病毒相关、与烟草相关、结直肠癌、口咽癌、肺癌、宫颈癌和黑色素瘤的发病率。种族/族裔分层显示，农村非西班牙裔白人的远处阶段癌症发病率更高，但非西班牙裔黑人和西班牙裔则不然。所有农村群体的远处阶段肺癌发病率均较高，而农村白人的远处阶段与烟草相关、结直肠癌和宫颈癌发病率较高，农村黑人的远处阶段人乳头瘤病毒相关和口腔癌发病率较高。区域分层显示，在南部地区，诊断时的分期差异最大。
这些发现可能有助于解释农村地区较高的癌症死亡率，并提供更多证据支持有针对性的干预措施。
