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美国 1999 年至 2020 年期间西班牙裔人群的癌症死亡率趋势。

US Cancer Mortality Trends Among Hispanic Populations From 1999 to 2020.

机构信息

Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Yale School of Medicine, New Haven, Connecticut.

出版信息

JAMA Oncol. 2023 Aug 1;9(8):1090-1098. doi: 10.1001/jamaoncol.2023.1993.

Abstract

IMPORTANCE

Advances in cancer research and treatment access have led to decreasing cancer mortality in the US; however, cancer remains the leading cause of death among Hispanic individuals.

OBJECTIVE

To evaluate longitudinal cancer mortality trends from 1999 to 2020 among Hispanic individuals by demographic characteristics and to compare age-adjusted cancer death rates between the Hispanic population and other racial and ethnic populations during 2000, 2010, and 2020.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study obtained age-adjusted cancer death rates among Hispanic individuals of all ages between January 1999 and December 2020, using the Centers for Disease Control and Prevention WONDER database. Cancer death rates in other racial and ethnic populations were extracted for 2000, 2010, and 2020. Data were analyzed from October 2021 to December 2022.

EXPOSURES

Age, gender, race, ethnicity, cancer type, and US census region.

MAIN OUTCOMES AND MEASURES

Trends and average annual percent changes (AAPCs) in age-adjusted cancer-specific mortality (CSM) rates among Hispanic individuals were estimated by cancer type, age, gender, and region.

RESULTS

From 1999 to 2020, 12 644 869 patients died of cancer in the US, of whom 690 677 (5.5%) were Hispanic; 58 783 (0.5%) were non-Hispanic American Indian or Alaska Native; 305 386 (2.4%), non-Hispanic Asian or Pacific Islander; 1 439 259 (11.4%), non-Hispanic Black or African American; and 10 124 361 (80.1%), non-Hispanic White. For 26 403 patients (0.2%), no ethnicity was stated. The overall CSM rate among Hispanic individuals decreased by 1.3% (95% CI, 1.2%-1.3%) annually. Overall CSM rate decreased more for Hispanic men (AAPC, -1.6%; 95% CI, -1.7% to -1.5%) compared with women (AAPC, -1.0%; 95% CI, -1.0% to -0.9%). While death rates among Hispanic individuals decreased for most cancer types, mortality rates for liver cancer (AAPC, 1.0%; 95% CI, 0.6%-1.4%) increased among Hispanic men, and rates of liver (AAPC, 1.0%; 95% CI, 0.8%-1.3%), pancreas (AAPC, 0.2%; 95% CI, 0.1%-0.4%), and uterine (AAPC, 1.6%; 95% CI, 1.0%-2.3%) cancers increased among Hispanic women. Overall CSM rates increased for Hispanic men aged 25 to 34 years (AAPC, 0.7%; 95% CI, 0.3%-1.1%). By US region, liver cancer mortality rates increased significantly in the West for both Hispanic men (AAPC, 1.6%; 95% CI, 0.9%-2.2%) and Hispanic women (AAPC, 1.5%; 95% CI, 1.1%-1.9%). There were differential findings in mortality rates when comparing Hispanic individuals with individuals belonging to other racial and ethnic populations.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, despite overall CSM decreasing over 2 decades among Hispanic individuals, disaggregation of data demonstrated that rates of liver cancer deaths among Hispanic men and women and pancreas and uterine cancer deaths among Hispanic women increased from 1999 to 2020. There were also disparities in CSM rates among age groups and US regions. The findings suggest that sustainable solutions need to be implemented to reverse these trends among Hispanic populations.

摘要

重要性

癌症研究和治疗机会的进步导致美国的癌症死亡率下降;然而,癌症仍然是西班牙裔个体死亡的主要原因。

目的

评估 1999 年至 2020 年间西班牙裔个体的癌症死亡趋势,按人口统计学特征进行细分,并比较 2000 年、2010 年和 2020 年西班牙裔人群与其他种族和族裔人群的年龄调整后癌症死亡率。

设计、地点和参与者:本横断面研究使用疾病控制与预防中心 WONDER 数据库,获取了 1999 年 1 月至 2020 年 12 月期间所有年龄段西班牙裔个体的年龄调整后癌症死亡率数据。还提取了其他种族和族裔人群在 2000 年、2010 年和 2020 年的癌症死亡率数据。数据分析于 2021 年 10 月至 2022 年 12 月进行。

暴露因素

年龄、性别、种族、族裔、癌症类型和美国人口普查区域。

主要结果和测量指标

根据癌症类型、年龄、性别和区域,估计了西班牙裔个体特定癌症死亡率(CSM)的趋势和平均年百分比变化(AAPC)。

结果

从 1999 年至 2020 年,美国有 12644869 人死于癌症,其中 690677 人(5.5%)为西班牙裔;58783 人(0.5%)是非西班牙裔美洲印第安人或阿拉斯加原住民;305386 人(2.4%)是非西班牙裔亚裔或太平洋岛民;1439259 人(11.4%)是非西班牙裔黑人和非洲裔美国人;10124361 人(80.1%)是非西班牙裔白人。对于 26403 名患者(0.2%),未说明族裔。西班牙裔个体的总体 CSM 率每年下降 1.3%(95%CI,1.2%-1.3%)。与女性(AAPC,-1.0%;95%CI,-1.0%至-0.9%)相比,西班牙裔男性的总体 CSM 率下降幅度更大(AAPC,-1.6%;95%CI,-1.7%至-1.5%)。尽管西班牙裔个体的大多数癌症类型的死亡率都有所下降,但肝癌(AAPC,1.0%;95%CI,0.6%-1.4%)在西班牙裔男性中有所上升,肝癌(AAPC,1.0%;95%CI,0.8%-1.3%)、胰腺癌(AAPC,0.2%;95%CI,0.1%-0.4%)和子宫癌(AAPC,1.6%;95%CI,1.0%-2.3%)在西班牙裔女性中的死亡率也有所上升。25 岁至 34 岁的西班牙裔男性的总体 CSM 率上升(AAPC,0.7%;95%CI,0.3%-1.1%)。按美国地区划分,肝癌死亡率在西班牙裔男性(AAPC,1.6%;95%CI,0.9%-2.2%)和西班牙裔女性(AAPC,1.5%;95%CI,1.1%-1.9%)中均显著上升。在比较西班牙裔个体与其他种族和族裔个体的死亡率时,存在不同的发现。

结论和相关性

在这项横断面研究中,尽管西班牙裔个体的总体 CSM 在 20 多年来有所下降,但数据的细分表明,西班牙裔男性和女性的肝癌死亡率以及西班牙裔女性的胰腺癌和子宫癌死亡率从 1999 年到 2020 年有所上升。在年龄组和美国地区之间也存在 CSM 率的差异。研究结果表明,需要实施可持续的解决方案来扭转西班牙裔人群中的这些趋势。

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