Facultad de Odontología, Universidad de Costa Rica, San José, Costa Rica.
Centro Centroamericano de Población, Universidad de Costa Rica, San José, Costa Rica.
Community Dent Oral Epidemiol. 2022 Aug;50(4):243-250. doi: 10.1111/cdoe.12658. Epub 2021 Jun 2.
Low socioeconomic position (SEP) has been associated with higher incidences and mortality of lip, oral cavity and pharynx (LOP) cancers in the vast majority of countries with available data. The origins of health inequalities in cancer are socioeconomic, although they vary by time and country. Evidence from Low-and Middle-income Countries (LMICs) remains scarce. This study aims to identify and describe socioeconomic inequalities in LOP cancers incidence and mortality in Costa Rica. The hypothesis tested is that people leaving in low-SEP districts in Costa Rica have greater incidence and mortality rates of lip, oral cavity and pharynx cancers.
The 10th revision of the International Classification of Diseases (ICD-10) was used to define cancer sites. Data come from a national population-based Cancer Registry with 100% completeness to study incidence. Incidence rate included all new cases of LOP cancer diagnosed from January 1, 2011, and December 31, 2015, for a total of 2 798 517 individuals, 13 832 524 years of follow-up and 601 LOP cases. Mortality rate was extracted from the National Death Index, including 2 739 733 individuals, 23 950 240 person-years of follow-up and 586 LOP cancer deaths, from January 1, 2010, to December 31, 2018. The 2011 Census (with 94% of Costa Rican inhabitants) was used to characterize the urbanicity and wealth of 477 districts. Survival models were performed for both incidence and mortality, allowing to consider existing competitive risks. Cox models were used for incidence, and parametric survival models based on a Gompertz distribution for mortality.
The study found that people who lived in the most socioeconomically disadvantaged areas had lower probabilities of developing LOP cancers than people in the richest districts. The same pattern for mortality, however, was not significant.
The hypothesis that incidence and mortality of LOP cancers will show a positive social gradient was not confirmed in this study, contradicting the existing literature. This could be explained by the social distribution of risky health behaviours, more frequent in socially advantaged populations.
在绝大多数有可用数据的国家中，社会经济地位（SEP）较低与唇、口腔和咽（LOP）癌症的更高发病率和死亡率有关。癌症健康不平等的根源是社会经济因素，但因时间和国家而异。来自中低收入国家（LMICs）的证据仍然很少。本研究旨在确定并描述哥斯达黎加 LOP 癌症发病率和死亡率的社会经济不平等。检验的假设是，生活在哥斯达黎加低社会经济地位地区的人唇、口腔和咽癌的发病率和死亡率更高。
采用国际疾病分类第 10 版（ICD-10）定义癌症部位。数据来自一个全国性的基于人群的癌症登记处，其完整性为 100%，用于研究发病率。发病率包括 2011 年 1 月 1 日至 2015 年 12 月 31 日期间诊断出的所有 LOP 癌症的新病例，共有 2798517 人，随访 13832524 年，601 例 LOP 病例。死亡率从国家死亡指数中提取，包括 2010 年 1 月 1 日至 2018 年 12 月 31 日期间的 2739733 人，23950240 人年随访和 586 例 LOP 癌症死亡。2011 年人口普查（94%的哥斯达黎加居民）用于描述 477 个区的城市化和富裕程度。对发病率和死亡率进行生存模型分析，以考虑现有的竞争风险。Cox 模型用于发病率，基于 Gompertz 分布的参数生存模型用于死亡率。
研究发现，生活在社会经济最不利地区的人患 LOP 癌症的概率低于最富裕地区的人。然而，死亡率的模式并不显著。
本研究没有证实 LOP 癌症的发病率和死亡率将呈现正的社会梯度的假设，与现有文献相矛盾。这可能是由于社会优势人群中更频繁的危险健康行为的社会分布造成的。
