Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda 20892, MD, USA; Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda 20892, MD, USA.
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 19104, PA, USA.
Prev Med. 2020 Mar;132:106005. doi: 10.1016/j.ypmed.2020.106005. Epub 2020 Jan 28.
Symptom awareness may improve cancer outcomes by prompting timely help-seeking and diagnosis. Research in the UK has shown lower symptom awareness among sociodemographic groups at higher risk of poor cancer outcomes; however, no population-based surveys in the US have assessed whether cancer symptom awareness varies across sociodemographic groups. We therefore examined associations between sociodemographic factors and recognition of 11 cancer symptoms using a novel population-based survey of US adults. We conducted telephone interviews in 2014 with a population-representative sample of English-speaking adults (aged 50 and older) in the US (N = 1425) using an adapted Awareness and Beliefs about Cancer (ABC) survey. Socioeconomic status (SES) was indexed by education. Additional sociodemographic factors included gender, age, marital status, and race. We used multivariable logistic regression models to examine the association between sociodemographic factors and recognition of each symptom, adjusting for cancer experience. Participants recognized an average of 8.43 symptoms as potential signs of cancer. In multivariable analyses, less education consistently predicted lower recognition across the symptoms. As socioeconomic inequalities in cancer mortality widen, it is increasingly important to understand factors that may contribute to these disparities. Our results suggest that US adults of lower SES have lower cancer symptom awareness across symptoms, findings that echo results from other developed countries. With low rates of cancer screening, another approach to reducing cancer burden and disparities may be through greater symptom awareness for symptoms with lower awareness, though additional work is needed to identify mechanisms through which awareness may have its effects on cancer outcomes.
症状意识提高可能通过促使及时寻求帮助和诊断来改善癌症结局。英国的研究表明，在癌症结局较差风险较高的社会人口群体中，症状意识较低；然而，美国没有基于人群的调查评估癌症症状意识是否因社会人口群体而异。因此，我们使用美国成年人的新型基于人群的调查研究了社会人口因素与 11 种癌症症状识别之间的关联。我们于 2014 年使用改编的癌症意识和信念（ABC）调查，对美国讲英语的成年人（年龄 50 岁及以上）进行了电话访谈，调查采用了具有代表性的人群样本（N=1425）。社会经济地位（SES）由教育程度来表示。其他社会人口因素包括性别、年龄、婚姻状况和种族。我们使用多变量逻辑回归模型，在调整癌症经历的情况下，检验社会人口因素与每种症状识别之间的关联。参与者平均识别出 8.43 种症状为癌症的潜在迹象。在多变量分析中，受教育程度较低的人始终预测对所有症状的识别率较低。随着癌症死亡率的社会经济不平等加剧，了解可能导致这些差异的因素变得越来越重要。我们的结果表明，美国 SES 较低的成年人对所有症状的癌症症状意识较低，这一发现与其他发达国家的结果一致。由于癌症筛查率较低，另一种降低癌症负担和差异的方法可能是提高对低意识症状的症状意识，尽管需要做更多的工作来确定意识可能通过哪些机制对癌症结局产生影响。
