基于人群的加拿大和美国癌症生存状况按社会经济地位划分：CONCORD-2 研究结果。

Population-Based Cancer Survival in Canada and the United States by Socioeconomic Status: Findings from the CONCORD-2 Study.

机构信息

Centers for Disease Control and Prevention, Atlanta, Georgia.

University of Calgary, Alberta, Canada.

出版信息

J Registry Manag. 2022 Spring;49(1):23-33.

PMID:37260622

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10198415/

Abstract

BACKGROUND

Population-based cancer survival provides insight into the effectiveness of health systems to care for all residents with cancer, including those in marginalized groups.

METHODS

Using CONCORD-2 data, we estimated 5-year net survival among patients diagnosed 2004-2009 with one of 10 common cancers, and children diagnosed with acute lymphoblastic leukemia (ALL), by socioeconomic status (SES) quintile, age (0-14, 15-64, ≥65 years), and country (Canada or United States).

RESULTS

In the lowest SES quintile, survival was higher among younger Canadian adults diagnosed with liver (23% vs 15%) and cervical (78% vs 68%) cancers and with leukemia (62% vs 56%), including children diagnosed with ALL (92% vs 86%); and higher among older Americans diagnosed with colon (62% vs 56%), female breast (87% vs 80%), and prostate (97% vs 85%) cancers. In the highest SES quintile, survival was higher among younger Americans diagnosed with stomach cancer (33% vs 27%) and younger Canadians diagnosed with liver cancer (31% vs 23%); and higher among older Americans diagnosed with stomach (27% vs 22%) and prostate (99% vs 92%) cancers.

CONCLUSIONS

Among younger Canadian cancer patients in the lowest SES group, greater access to health care may have resulted in higher cancer survival, while higher screening prevalence and access to health insurance (Medicare) among older Americans during the period of this study may have resulted in higher survival for some screen-detected cancers. Higher survival in the highest SES group for stomach and liver may relate to treatment differences. Survival differences by age and SES between Canada and the United States may help inform cancer control strategies.

摘要

背景

基于人群的癌症生存状况可深入了解卫生系统为所有癌症患者（包括弱势群体患者）提供治疗的效果。

方法

利用 CONCORD-2 数据，我们按社会经济地位（SES）五分位数、年龄（0-14 岁、15-64 岁、≥65 岁）和国家（加拿大或美国），评估了 2004-2009 年间诊断出的 10 种常见癌症和儿童急性淋巴细胞白血病（ALL）患者的 5 年净生存率。

结果

在 SES 最低五分位数中，加拿大较年轻的成年人中，诊断为肝癌（23% vs. 15%）和宫颈癌（78% vs. 68%）和白血病（62% vs. 56%），包括诊断为 ALL 的儿童（92% vs. 86%）的生存率较高；而美国较年长的成年人中，诊断为结肠癌（62% vs. 56%）、女性乳腺癌（87% vs. 80%）和前列腺癌（97% vs. 85%）的生存率较高。在 SES 最高五分位数中，美国较年轻的成年人中，诊断为胃癌（33% vs. 27%）和加拿大较年轻的成年人中诊断为肝癌（31% vs. 23%）的生存率较高；而美国较年长的成年人中，诊断为胃癌（27% vs. 22%）和前列腺癌（99% vs. 92%）的生存率较高。

结论

在 SES 最低五分位数中，加拿大较年轻的癌症患者的生存率较高，可能是因为获得了更多的医疗保健机会；而美国在研究期间，较年长的成年人的筛查流行率更高，获得了医疗保险（医疗保险），可能导致某些筛查发现的癌症的生存率更高。SES 最高五分位数中，胃和肝癌的生存率较高可能与治疗差异有关。加拿大和美国之间按年龄和 SES 划分的生存率差异可能有助于制定癌症控制策略。