Gauri Aliyah, Messiah Sarah E, Bouzoubaa Layla A, Moore Kevin J, Koru-Sengul Tulay
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Pediatrics, University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, FL, USA.
Ethn Health. 2020 Oct;25(7):995-1003. doi: 10.1080/13557858.2018.1471669. Epub 2018 May 5.
Florida has one of the highest cervical cancer mortality rates and socioeconomically diverse populations in the United States. We used statewide population-based cancer registry data to assess disparities in cervical cancer stage at diagnosis. Primary invasive adult female cervical cancer patients in the Florida Cancer Data Registry (1981-2013) were linked with 2000 United States Census data. Early (localized) and advanced (regional and distant) stage at diagnosis was assessed by age, race, ethnicity, neighborhood socioeconomic-, marital-, and smoking- status. Univariate and multivariable logistic regression models were fit to identify factors associated with the risk of advanced cervical cancer stage at diagnosis. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI) were calculated. Of 18,279 women (mean 51.3 years old), most were non-Hispanic (83.5%), white (79.1%), middle-low neighborhood socioeconomic status (NSES) (34.7%), married (46.0%), and never smoked (56.0%). Higher odds of advanced stage was observed for blacks (aOR: 1.42, 95%CI: 1.30-1.55, < 0.001) compared to whites, Hispanics (1.15, 1.06-1.25, = 0.001) compared to non-Hispanics, and middle-low (1.13, 1.02-1.25, = 0.02) and low NSES (1.42, 1.28-1.57, < 0.001) compared to high NSES. Previously (1.30, 1.21-1.39, < 0.001) and never married (1.37, 1.27-1.48, < 0.001) had higher odds of presenting with advanced stage versus married women. Never smokers had decreased odds of presenting with advanced stage compared to women with history of (1.41, 1.32-1.52, < 0.001) or current (1.29, 1.18-1.42, 0.001)smoking status. There are cancer disparities in women of black race, Hispanic ethnicity and of middle-low and lowest NSES in Florida. Evidence-based interventions targeting these vulnerable groups are needed. HPV: Human Papilloma Virus; CDC: Center for Disease Control and Prevention; SES: socioeconomic status; FCDS: Florida Cancer Data System; NSES: Neighborhood Socioeconomic Status; NPCR: National Program of Cancer Registries; IRB: Institutional Review Board; ACS: American Community Survey; SEER: Surveillance, Epidemiology and End Results; OR: Odds Ratio; CI: Confidence Interval.
佛罗里达州是美国宫颈癌死亡率最高且社会经济群体多样化的地区之一。我们利用全州基于人群的癌症登记数据来评估宫颈癌诊断时分期的差异。将佛罗里达癌症数据登记处（1981 - 2013年）的原发性侵袭性成年女性宫颈癌患者与2000年美国人口普查数据相链接。通过年龄、种族、族裔、社区社会经济状况、婚姻状况和吸烟状况来评估诊断时的早期（局限性）和晚期（区域性和远处性）分期。采用单变量和多变量逻辑回归模型来确定与诊断时晚期宫颈癌风险相关的因素。计算调整后的优势比（aOR）和相应的95%置信区间（95%CI）。在18279名女性（平均年龄51.3岁）中，大多数是非西班牙裔（83.5%）、白人（79.1%）、社区社会经济地位中低（NSES）（34.7%）、已婚（46.0%）且从不吸烟（56.0%）。与白人相比，黑人诊断为晚期阶段的几率更高（aOR：1.42，95%CI：1.30 - 1.55，P < 0.001）；与非西班牙裔相比，西班牙裔（1.15，1.06 - 1.25，P = 0.001）；与高NSES相比，中低（1.13，1.02 - 1.25，P = 0.02）和低NSES（1.42，1.28 - 1.57，P < 0.001）。与已婚女性相比，既往未婚（1.30，1.21 - 1.39，P < 0.001）和从未结婚（1.37，1.27 - 1.48，P < 0.001）的女性出现晚期阶段的几率更高。与有吸烟史（1.41，1.32 - 1.52，P < 0.001）或当前吸烟（1.29，1.18 - 1.42，P = 0.得克萨斯州01）的女性相比，从不吸烟的女性出现晚期阶段的几率降低。佛罗里达州黑人种族、西班牙裔族裔以及中低和最低NSES的女性存在癌症差异。需要针对这些弱势群体采取基于证据的干预措施。HPV：人乳头瘤病毒；CDC：疾病控制与预防中心；SES：社会经济地位；FCDS：佛罗里达癌症数据系统；NSES：社区社会经济地位；NPCR：国家癌症登记计划；IRB：机构审查委员会；ACS：美国社区调查；SEER：监测、流行病学和最终结果；OR：优势比；CI：置信区间
