Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, DHHS, NIH, Bethesda, MD.
Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, DHHS, NIH, Bethesda, MD.
Int J Cancer. 2019 Apr 15;144(8):1786-1795. doi: 10.1002/ijc.31776. Epub 2019 Jan 14.
Recent analyses have suggested decreases over time in colorectal cancer incidence at older ages (≥55 years) but increases at younger ages (20-54 years). Understanding the geographic heterogeneity of incidence facilitates resource allocation for potential interventions and advances our knowledge of differential etiologies for these cancers. We performed age-period-cohort analysis using 2000-2014 county-level incidence from the Surveillance, Epidemiology, and End Results (SEER) database, estimating relative risk (RR) and age-adjusted annual percent change (Net Drifts) simultaneously for 612 counties via a hierarchical model, separately for colon and rectum cancer, stratified by age group (20-54 vs. 55-84). We also studied correlates of RR and Net Drift with various county-level characteristics. In all SEER counties, colon and rectum cancer incidence rates increased at ages 20-54, whereas rates decreased at ages 55-84. There was marked heterogeneity in both RR and Net Drift among states and counties for both cancer types. Maps of county RR and Net Drift revealed localized clusters in several states. For both cancer types, counties with high RR and unfavorable Net Drift tended to have higher prevalence of obesity and diabetes and to be of a lower socioeconomic status. Counties with higher overall screening rates tended to have lower Net Drifts for both cancer types. Increasing colorectal cancer incidence in the younger age group is geographically widespread, although there is significant heterogeneity in temporal trends and risk both within and between states. These geographic patterns correlate with different county-level characteristics depending on cancer type and age group.
最近的分析表明,年龄较大(≥55 岁)的结直肠癌发病率随时间呈下降趋势,但年龄较小(20-54 岁)的发病率呈上升趋势。了解发病率的地理异质性有助于为潜在干预措施分配资源,并增进我们对这些癌症不同病因的认识。我们使用 2000-2014 年监测、流行病学和最终结果(SEER)数据库中的县级发病率进行了年龄-时期-队列分析,通过分层模型同时对 612 个县进行相对风险(RR)和年龄调整的年百分变化(净漂移)估计,分别针对结肠癌和直肠癌,按年龄组(20-54 岁与 55-84 岁)进行分层。我们还研究了 RR 和净漂移与各种县级特征之间的相关性。在所有 SEER 县,结肠癌和直肠癌的发病率在 20-54 岁年龄组上升,而在 55-84 岁年龄组下降。两种癌症类型的州和县之间的 RR 和净漂移均存在明显的异质性。县 RR 和净漂移图显示了几个州的局部集群。对于两种癌症类型,RR 较高且净漂移不利的县肥胖症和糖尿病的患病率较高,社会经济地位较低。总体筛查率较高的县,两种癌症类型的净漂移率均较低。尽管在州内和州际之间的时间趋势和风险存在显著差异,但年轻年龄组中结直肠癌发病率的增加在地理上是广泛的。这些地理模式与不同的县级特征相关,具体取决于癌症类型和年龄组。
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