Johns Hopkins School of Medicine, Baltimore, MD, USA.
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA.
Oncologist. 2023 Sep 7;28(9):e835-e838. doi: 10.1093/oncolo/oyad176.
Substantial gaps in national healthcare spending and disparities in cancer mortality rates are noted across counties in the US. In this cross-sectional analysis, we investigated whether differences in local county-level social vulnerability impacts cancer-related mortality. We linked county-level age-adjusted mortality rates (AAMR) from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research database, to county-level Social Vulnerability Index (SVI) from the CDC Agency for Toxic Substances and Disease Registry. SVI is a metric comprising 15 social factors including socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. AAMRs were compared between least and most vulnerable counties using robust linear regression models. There were 4 107 273 deaths with an overall AAMR of 173 per 100 000 individuals. Highest AAMRs were noted in older adults, men, non-Hispanic Black individuals, and rural and Southern counties. Highest mortality risk increases between least and most vulnerable counties were noted in Southern and rural counties, individuals aged 45-65, and lung and colorectal cancers, suggesting that these groups may face highest risk for health inequity. These findings inform ongoing deliberations in public health policy at the state and federal level and encourage increased investment into socially disadvantaged counties.
美国各县之间的医疗保健支出存在显著差距，癌症死亡率也存在差异。在这项横断面分析中，我们研究了当地县级社会脆弱性差异是否会影响癌症相关死亡率。我们将疾病预防控制中心 (CDC) 广泛在线流行病学研究数据库中的县级年龄调整死亡率 (AAMR) 与疾病控制与预防中心毒物和疾病登记处的县级社会脆弱性指数 (SVI) 相关联。SVI 是一个由 15 个社会因素组成的指标，包括社会经济地位、家庭构成和残疾、少数民族地位和语言、住房类型和交通。使用稳健的线性回归模型比较了最脆弱和最不脆弱县之间的 AAMR。共有 4107273 人死亡，总 AAMR 为每 10 万人 173 人。在老年人、男性、非西班牙裔黑人以及农村和南部县，AAMR 最高。在最脆弱和最不脆弱县之间，风险最高的死亡率增加在南部和农村县、45-65 岁的人群以及肺癌和结直肠癌中最为显著，这表明这些人群可能面临最大的健康不平等风险。这些发现为州和联邦一级的公共卫生政策提供了信息，并鼓励向社会劣势县增加投资。
