Lo Chun-Han, Tun Kyaw Min, Pan Chun-Wei, Lee Jeffrey K, Singh Harminder, Samadder N Jewel
Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada.
Cook County Health, John H. Stroger Hospital, Chicago, Illinois.
Gastro Hep Adv. 2024 Jun 7;3(6):821-829. doi: 10.1016/j.gastha.2024.05.007. eCollection 2024.
Social determinants of health contribute to disparities in gastrointestinal (GI) cancer mortality between individuals in the US. Their effects on count-level mortality rates remain uncertain. We aimed to assess the association between county social vulnerability and GI cancer mortality.
In this ecological study (2016-2020), we obtained US county Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and age-adjusted mortality rates (AAMRs) for GI cancers from Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiological Research). SVI ranges from 0 to 1, with higher indices indicating greater vulnerability. We presented AAMRs by quintiles of SVIs. We used Poisson regression through generalized estimating equation to calculate rate ratios (RRs) and 95% confidence intervals (CIs) for GI cancer mortality by quintiles of SVI.
There were 799,968 deaths related to GI cancers from 2016 to 2020, resulting in an AAMR (95% CI) of 39.9 (41.4-51.2) deaths per 100,000 population. The largest concentration of counties with greater SVI and GI cancer mortality was clustered in the southern US. Counties with greater SVI had higher mortality related to all GI cancers (RR, 1.19 [95% CI, 1.14-1.24]), gastric cancer (1.58 [1.48-1.69]), liver cancer (1.54 [1.36-1.73]), and colorectal cancer (RR, 1.23 [95% CI, 1.15-1.31]). RRs for overall GI cancers were greater among individuals <45 years (1.24 [1.15-1.32]), men (1.22 [1.16-1.27]), Hispanic individuals (1.33 [1.18-1.50]), and rural counties (1.21 [1.14-1.27]) compared with their counterparts.
Socially disadvantaged counties face a disproportionately high burden of GI cancer mortality in the US. Targeted public health interventions should aim to address social inequities faced by underserved communities.
健康的社会决定因素导致美国个体间胃肠道（GI）癌死亡率存在差异。它们对计数水平死亡率的影响仍不确定。我们旨在评估县社会脆弱性与GI癌死亡率之间的关联。
在这项生态研究（2016 - 2020年）中，我们从疾病控制与预防中心/有毒物质与疾病登记机构获取了美国县社会脆弱性指数（SVI），并从疾病控制与预防中心的WONDER（广泛的流行病学研究在线数据）获取了GI癌的年龄调整死亡率（AAMR）。SVI范围为0至1，指数越高表明脆弱性越大。我们按SVI五分位数呈现AAMR。我们通过广义估计方程使用泊松回归来计算按SVI五分位数划分的GI癌死亡率的率比（RRs）和95%置信区间（CIs）。
2016年至2020年有799,968例与GI癌相关的死亡，导致每10万人口的AAMR（95% CI）为39.9（41.4 - 51.2）例死亡。SVI较高且GI癌死亡率较高的县主要集中在美国南部。SVI较高的县与所有GI癌（RR，1.19 [95% CI，1.14 - 1.24]）、胃癌（1.58 [1.48 - 1.69]）、肝癌（1.54 [1.36 - 1.73]）和结直肠癌（RR，1.23 [95% CI，1.15 - 1.31]）相关的死亡率更高。与同龄人相比，年龄<45岁的个体（1.24 [1.15 - 1.32]）、男性（1.22 [1.16 - 1.27]）、西班牙裔个体（1.33 [1.18 - 1.50]）和农村县（1.21 [1.14 - 1.27]）的总体GI癌RRs更高。
在美国，社会弱势县面临着不成比例的高GI癌死亡负担。有针对性的公共卫生干预措施应旨在解决服务不足社区所面临的社会不平等问题。
