澳大利亚肝癌患者的人口统计学、健康和预后特征：新南威尔士州关联数据队列研究对癌症控制的启示
Demographic, health, and prognostic characteristics of Australians with liver cancer: a cohort study of linked data in New South Wales for informing cancer control.
机构信息
Cancer Institute NSW, NSW Government, Sydney, NSW, Australia.
Storr Liver Centre, The Westmead Institute of Medical research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia.
出版信息
BMC Public Health. 2023 Oct 9;23(1):1957. doi: 10.1186/s12889-023-16809-y.
BACKGROUND
Australian age-standardized incidence and death rates for liver cancer are lower than world averages, but increasing as in other economically advanced western countries. World Health Organization emphasizes the need to address sociodemographic disparities in cancer risk. A more detailed sociodemographic risk profiling was undertaken for liver cancer in New South Wales (NSW) by diagnostic stage, than possible with NSW Cancer Registry (NSWCR) alone, by incorporating linked data from the Australian Bureau of Statistics (ABS). The purpose was to inform targeting and monitoring of cancer services.
METHODS
The ABS manages the Multi-Agency Data Integration Project (MADIP) which includes a wide range of health, educational, welfare, census, and employment data. These data were linked at person level to NSWCR liver cancer registrations for the period post 2016 census to December 2018. De-identified data were analyzed. Sex-specific age-adjusted odds ratios (95%CIs) of liver cancer were derived using logistic regression by age, country of birth, residential remoteness, proficiency in spoken English, household income, employment status, occupation type, educational attainment, sole person household, joblessness, socioeconomic status, disability status, multimorbidity, and other health-related factors, including GP consultations. These data complement the less detailed sociodemographic data available from the NSWCR, with alignment of numerators and population denominators for accurate risk assessment.
RESULTS
Results indicate liver cancer disproportionately affects population members already experiencing excess social and health disadvantage. Examples where 95% confidence intervals of odds ratios of liver cancer were elevated included having poor English-speaking proficiency, limited education, housing authority tenancy, living in sole-person households, having disabilities, multiple medicated conditions, and being carers of people with a disability. Also, odds of liver cancer were higher in more remote regions outside major cities, and in males, with higher odds of more advanced cancer stages (degrees of spread) at diagnosis in more remote regions.
CONCLUSIONS
Linked data enabled more detailed risk profiling than previously possible. This will support the targeting of cancer services and benchmarking.
背景
澳大利亚的肝癌年龄标准化发病率和死亡率低于世界平均水平，但与其他经济发达的西方国家一样呈上升趋势。世界卫生组织强调需要解决癌症风险方面的社会人口差异。新南威尔士州（新州）通过与澳大利亚统计局（ABS）的数据链接，对肝癌进行了比新州癌症登记处（NSWCR）更详细的社会人口风险分析，按诊断阶段进行了分析。其目的是为癌症服务的定位和监测提供信息。
方法
ABS 管理着多机构数据集成项目（MADIP），其中包括广泛的健康、教育、福利、人口普查和就业数据。这些数据在个人层面上与新州癌症登记处的肝癌登记数据进行了链接，时间范围是 2016 年人口普查后至 2018 年 12 月。分析了去识别数据。通过逻辑回归，按年龄、出生国家、居住偏远程度、英语口语熟练程度、家庭收入、就业状况、职业类型、教育程度、独居家庭、失业、社会经济地位、残疾状况、多重疾病以及包括全科医生咨询在内的其他与健康相关的因素，得出了肝癌的性别特异性年龄调整比值比（95%置信区间）。这些数据补充了新州癌症登记处提供的较为详细的社会人口数据，使分子和人口分母相匹配，以进行准确的风险评估。
结果
结果表明，肝癌不成比例地影响已经面临过度社会和健康劣势的人群。比值比的 95%置信区间升高的肝癌病例包括英语水平差、受教育程度低、住房管理局租赁、独居家庭、残疾、多种药物治疗条件和残疾人士的照顾者。此外，在远离主要城市的偏远地区以及男性中，肝癌的几率更高，在更偏远地区，诊断时癌症分期（扩散程度）更高级别，肝癌的几率也更高。
结论
链接数据使风险分析比以前更加详细。这将支持癌症服务的定位和基准测试。
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