美国癌症协会关于 2023 年美国癌症差异现状的报告。

American Cancer Society's report on the status of cancer disparities in the United States, 2023.

机构信息

American Cancer Society, Atlanta, Georgia, USA.

Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

出版信息

CA Cancer J Clin. 2024 Mar-Apr;74(2):136-166. doi: 10.3322/caac.21812. Epub 2023 Nov 14.

Abstract

In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.

摘要

2021 年,美国癌症协会发布了第一份关于美国癌症差异状况的两年一度报告。在第二份报告中,作者提供了关于癌症发生和结果以及导致这些差异的因素在种族、民族、社会经济(以教育程度为标志)和地理(大都市地位)方面的最新数据。作者还审查了减少癌症差异的计划,并提供了进一步减轻这些不平等的政策建议。在风险因素、诊断时的阶段、接受治疗、生存和死亡率方面,许多癌症的种族/民族、教育程度和大都市地位存在很大差异。在 2016 年至 2020 年期间,黑人和美国印第安人/阿拉斯加原住民继续承担不成比例的更高的癌症死亡负担,无论是总体上还是主要癌症。按教育程度计算,黑人和白人男性和女性中,受教育程度≤12 年的人,总体癌症死亡率约为受教育程度≥16 年的人的 1.6-2.8 倍。在每个种族内,这种教育程度差异比每个教育程度内的黑人和白人之间的总体癌症死亡率差异大得多,黑人群体中的差异范围为 1.03 至 1.5 倍,这表明社会经济地位差异在癌症死亡率方面的种族差异中起着重要作用,因为黑人群体在社会经济地位较低的群体中比例不成比例地大。值得注意的是,总体癌症死亡率方面的最大黑人和白人差异出现在接受教育程度≥16 年的人群中。按居住区域,所有癌症和主要癌症死亡原因的死亡率在非大都市地区都大大高于大都市地区。例如,非大都市地区的结直肠癌死亡率比大都市地区男性高 23%,女性高 21%。按年龄组,65 岁以下人群的癌症死亡率的种族和地理差异大于 65 岁及以上人群。在癌症死亡率方面,许多观察到的种族、社会经济和地理差异与风险因素的暴露和癌症预防、早期发现和治疗的机会一致,这些差异主要源于健康决定因素方面的根本不平等。各级政府需要采取公平政策、广泛的跨学科参与以解决这些不平等问题,以及公平实施循证干预措施,如增加健康保险覆盖范围,以减少癌症差异。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索