Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America.
Nevada Central Cancer Registry, Nevada Division of Public and Behavioral Health, Carson City, Nevada, United States of America.
PLoS One. 2019 Aug 19;14(8):e0221337. doi: 10.1371/journal.pone.0221337. eCollection 2019.
Colorectal cancer (CRC) is the third greatest cancer burden in the United States. The remarkably diverse Mountain West state of Nevada has uncharacteristically high CRC mortality compared to other Western states. We aimed to study the determinants of the CRC excess burden by using data from the Nevada Central Cancer Registry from 2003-2013. Five-year cause-specific age-adjusted survival from colorectal cancer was calculated and stratified by sex, race/ethnicity and region of Nevada. Cox Proportional Hazards regression modelling was used to study the impact of demographic, social, and clinical factors on CRC survival in Nevada, assessing follow-up as accurately as possible. The extent to which differences in survival can be explained by receipt of stage-appropriate treatment was also assessed. 12,413 CRC cases from 2003-2013 in Nevada were analyzed. Five-year CRC survival was low: 56.0% (95% CI: 54.6-57.5) among males and 59.5% (95% CI: 58.0-61.1) among females; significantly lower than national 5-year survival of 65.1% and 66.5%, respectively. Low survival was driven by populous Southern Nevada; after adjustment for all covariates, Southern Nevadans were at 17% higher risk of death than their counterparts in Northwestern Nevada (HR:1.17; 95% CI:1.08-1.27). Many patients did not receive stage-appropriate treatment, although this only partly explained the poor survival, uniformly low for every race/ethnicity in Nevada. The observed disparity for this one state within a single nation merits public health attention; regardless of the state or region of residence, all Americans deserve equal opportunity for optimum health outcomes in the face of a cancer diagnosis. The current study provides baseline information critical to clinicians, public health professionals, and all relevant stakeholders as they attempt to discern why Nevada's outcomes are vastly divergent from its neighboring Western states and make plans for remediation.
结直肠癌（CRC）是美国第三大癌症负担。内华达州是一个山地多、西部风情浓厚的奇特州，与其他西部州相比，CRC 死亡率异常高。我们旨在利用 2003-2013 年内华达州中央癌症登记处的数据，研究 CRC 负担过重的决定因素。计算了 2003-2013 年内华达州结直肠癌患者的五年特定原因年龄调整生存率，并按性别、种族/族裔和内华达州地区进行分层。使用 Cox 比例风险回归模型研究人口统计学、社会和临床因素对内华达州 CRC 生存的影响，尽可能准确地评估随访情况。还评估了生存率差异在多大程度上可以用接受适当阶段治疗来解释。分析了 2003-2013 年内华达州的 12413 例 CRC 病例。CRC 的五年生存率较低：男性为 56.0%（95%CI：54.6-57.5），女性为 59.5%（95%CI：58.0-61.1）；明显低于全国 5 年生存率 65.1%和 66.5%。较低的生存率是由人口众多的南内华达州驱动的；在调整了所有协变量后，南内华达州人死亡的风险比西北内华达州的人高 17%（HR：1.17；95%CI：1.08-1.27）。许多患者没有接受适当的治疗，但这只是部分解释了较差的生存率，内华达州的每一种族/族裔都很低。在一个单一国家内，一个州的这种观察到的差异值得引起公共卫生部门的关注；无论居住在哪个州或地区，所有美国人在面对癌症诊断时都应该有平等的机会获得最佳的健康结果。目前的研究为临床医生、公共卫生专业人员和所有相关利益攸关方提供了重要的基线信息，因为他们试图了解为什么内华达州的结果与邻国西部各州有很大的差异，并计划补救。
