美国胰腺癌发病率和死亡率的种族差异和趋势。

Racial Disparities and Trends in Pancreatic Cancer Incidence and Mortality in the United States.

机构信息

Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas.

出版信息

Clin Gastroenterol Hepatol. 2020 Jan;18(1):171-178.e10. doi: 10.1016/j.cgh.2019.05.059. Epub 2019 Jun 13.

DOI:10.1016/j.cgh.2019.05.059

PMID:31202981

Abstract

BACKGROUND & AIMS: Pancreatic cancer is one of the few cancers in the United States that is increasing in incidence. Little is known about racial disparities in incidence and mortality. We characterized racial disparities in pancreatic cancer incidence and mortality in different locations, time periods, age groups, and disease stages.

METHODS

We obtained data on the incidence of pancreatic cancer from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results program of cancer registries from 2001 through 2015 on incidence, demographics, tumor characteristics, and population estimates for all 50 states and the District of Columbia. We obtained data on mortality from pancreatic cancer from the National Center for Health Statistics during the same time period. We plotted incidence rates by 10-year age group (30-39 years through 70-79 years and 80 years or older) separately for white and black patients. We calculated incidence and mortality rate ratios with 95% CIs for categories of age and race. To determine racial disparities, we calculated incidence rate ratios (IRR) for black vs white patients and mortality rate ratios by state.

RESULTS

Disparities in pancreatic cancer incidence and mortality in black vs white patients decreased over 5-year time periods from 2001 through 2015. However, among all age groups, from 2001 through 2015, pancreatic cancer incidence and mortality were higher among blacks than whites (incidence, 24.7 vs 19.4 per 100,000; IRR, 1.28; 95% CI, 1.26-1.29; mortality, 23.3 vs 18.4 per 100,000; IRR, 1.27; 95% CI, 1.26-1.28). Black patients had a higher incidence of distant pancreatic cancer (IRR, 1.32; 95% CI, 1.31-1.34) and a lower incidence of local cancer. Incidence increased in whites and blacks of younger age groups and was most prominent among persons 30-39 years old. Incidence increased by 57% among younger whites (IRR, 1.70; 95% CI, 1.43-2.02) and by 44% among blacks (IRR, 1.47; 95% CI, 1.01-2.15) from 2001 through 2015. Mortality remained stable among blacks and slightly increased among whites during this time period.

CONCLUSIONS

In the United States, there are racial disparities in pancreatic incidence and mortality that vary with location, patient age, and cancer stage. Further research is needed to identify factors associated with increasing incidence and persistence of racial disparities in pancreatic cancer.

摘要

背景与目的

在美国，胰腺癌是为数不多发病率呈上升趋势的癌症之一。关于发病率和死亡率方面的种族差异，人们知之甚少。本研究旨在描述不同地理位置、不同时间段、不同年龄组和不同疾病分期的胰腺癌发病率和死亡率方面的种族差异。

方法

我们从美国国家癌症登记计划和癌症登记处的监测、流行病学和最终结果计划获取了 2001 年至 2015 年间所有 50 个州和哥伦比亚特区的胰腺癌发病率、人口统计学、肿瘤特征和人口估计数据。同期，我们从国家卫生统计中心获取了胰腺癌死亡率数据。我们按每 10 年为一个年龄组（30-39 岁、40-49 岁、50-59 岁、60-69 岁、70-79 岁和 80 岁及以上）分别绘制白人患者和黑人患者的发病率。我们计算了不同年龄和种族类别的发病率和死亡率比值及 95%可信区间。为了确定种族差异，我们按州计算了黑人与白人患者的发病率比值比（IRR）和死亡率比值比。

结果

在 2001 年至 2015 年的 5 年时间里，黑人与白人患者的胰腺癌发病率和死亡率差异逐渐缩小。然而，在所有年龄组中，从 2001 年至 2015 年，黑人患者的胰腺癌发病率和死亡率均高于白人患者（发病率分别为每 10 万人 24.7 例和 19.4 例；IRR 为 1.28；95%可信区间为 1.26-1.29；死亡率分别为每 10 万人 23.3 例和 18.4 例；IRR 为 1.27；95%可信区间为 1.26-1.28）。黑人患者患有远处胰腺癌的比例较高（IRR 为 1.32；95%可信区间为 1.31-1.34），局部癌症比例较低。年轻年龄组的白人患者和黑人患者的发病率均有所上升，其中 30-39 岁年龄组最为明显。在这段时间里，年轻白人患者的发病率上升了 57%（IRR 为 1.70；95%可信区间为 1.43-2.02），黑人患者的发病率上升了 44%（IRR 为 1.47；95%可信区间为 1.01-2.15）。在此期间，黑人患者的死亡率保持稳定，白人患者的死亡率略有上升。