德国农村地区与城市地区的头颈部癌症治疗的人口统计学和可及性比较。
Demographics and access to head and neck cancer care in rural areas compared to urban areas in Germany.
机构信息
Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany.
Department of Epidemiology and Medical Biometry, University Medical Center Ulm, Ulm, Germany.
出版信息
Cancer Med. 2023 Sep;12(18):18826-18836. doi: 10.1002/cam4.6505. Epub 2023 Sep 14.
BACKGROUND
Demographic development in rural and urban areas differs substantially. Demographics and access to specialized head and neck cancer centers may affect head and neck cancer patients' (HNCP) outcomes. Here, we compare epidemiological indicators and outcomes of HNCP in rural and urban Germany.
PATIENTS AND METHODS
In a retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) between 2002 and 2017, 212,920 HNCP were included. Incidence, demographics, travel distance to specialized centers, and ground values were compared between rural and urban areas with a focus on their association with patient outcomes.
RESULTS
The mean age of HNCP was significantly higher in urban areas (mean difference = 1.4 years; p < 0.0001), but increased at a comparable rate (p = 0.26) in rural and urban areas during the observation period. Gender imbalance was higher in rural areas (mean ratio of men/women: 4.1 vs. 3.1; p < 0.0001), but showed a comparable trend toward equilibration in both, rural and urban districts (p = 0.46). The portion of HNCP of the entire HNCP population living in urban areas increased from 55.9% in the year 2002 to 76.4% in the year 2017. There was no significant difference or change in the ratio of advanced to low UICC stage during the observation period (p = 0.26). However, travel distances to medical centers were higher in rural areas, especially (p < 0.0001) in East Germany. Median survival of HNCP in rural areas was significantly lower than in urban areas (42 months [SEM = 0.7; CI: 40.5-43.5] vs. 54 months [SEM = 1.2; CI: 51.7-56.3]; p < 0.0001) in East Germany, whereas in West Germany no significant difference was observed (59 months [SEM = 0.8; CI: 57.4-60.6] vs. 60 months [SEM = 0.5; CI: 59.0-61.0]; p = 0.15).
CONCLUSIONS
Place of residence contributes to survival outcome of HNCP. Access to specialized care and socioeconomic factors could be improved in East Germany.
背景
农村和城市地区的人口结构发展存在显著差异。人口统计学特征和获得专门的头颈部癌症中心的机会可能会影响头颈部癌症患者（HNCP）的预后。在这里，我们比较了德国农村和城市地区 HNCP 的流行病学指标和结局。
患者和方法
在对 2002 年至 2017 年间癌症登记数据中心（ZfKD）数据的回顾性分析中，纳入了 212920 名 HNCP。比较了农村和城市地区的发病率、人口统计学特征、到专门中心的旅行距离和地面值，并重点关注它们与患者结局的关系。
结果
城市地区 HNCP 的平均年龄明显较高（平均差异=1.4 岁；p<0.0001），但在观察期间，农村和城市地区的增长率相当（p=0.26）。农村地区的性别失衡更为严重（男性/女性平均比例：4.1 比 3.1；p<0.0001），但在农村和城市地区，这种平衡趋势相当（p=0.46）。居住在城市地区的 HNCP 占整个 HNCP 人群的比例从 2002 年的 55.9%增加到 2017 年的 76.4%。在观察期间，晚期与低 UICC 分期的比例没有显著差异或变化（p=0.26）。然而，农村地区到医疗中心的旅行距离较高，尤其是东德（p<0.0001）。农村地区 HNCP 的中位生存时间明显低于城市地区（42 个月[SEM=0.7；CI：40.5-43.5]比 54 个月[SEM=1.2；CI：51.7-56.3]；p<0.0001），而在西德则没有观察到显著差异（59 个月[SEM=0.8；CI：57.4-60.6]比 60 个月[SEM=0.5；CI：59.0-61.0]；p=0.15）。
结论
居住地影响 HNCP 的生存结局。东德在获得专门治疗和社会经济因素方面还有待改善。
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