Adamson Adewole S, Patel Vishal R, Welch H Gilbert
Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
BMJ Open. 2025 Feb 7;15(2):e084955. doi: 10.1136/bmjopen-2024-084955.
Incidence and mortality are fundamental epidemiologic measures of cancer burden, yet few studies have examined individual cancers to determine how these measures correlate across place. We assessed the relationship between incidence and mortality for commonly diagnosed cancers in the USA.
Population-based observational study of US counties.
The Surveillance, Epidemiology and End Results (SEER) database was used to obtain incidence (2000-2016) and mortality (2002-2018) data for the 12 most commonly diagnosed non-haematologic cancers.
County-level correlation between cancer incidence and mortality. Cancers were grouped into terciles based on the population-weighted correlation coefficient (r). We also examined the 10 year risk of death, both from the diagnosed cancer and other causes.
County-level incidence and mortality were strongly correlated in some cancers, yet uncorrelated in others. Cancers in the high-correlation tercile (r range: 0.96 to 0.78) included lung, stomach, liver and pancreas. For patients with these cancers, the risk of death from the diagnosed cancer was >4-times the risk of death from other causes. The moderate-correlation tercile (r: 0.75 to 0.58) included cancers of the colon, bladder, kidney and uterus. There was little or no relationship between incidence and mortality for cancers in the low-correlation tercile (r: 0.33 to -0.10): melanoma, prostate, breast and thyroid. The risk of death from the diagnosed cancer for these patients was either lower or no different than their risk of death from other causes.
For some cancers in the USA, the fundamental epidemiologic measure of disease frequency-incidence-now has little relationship with cancer death (mortality). Low correlations are most likely explained by differences in diagnostic practice leading to variable amounts of cancer overdiagnosis between different US counties.
发病率和死亡率是衡量癌症负担的基本流行病学指标，但很少有研究针对个别癌症来确定这些指标在不同地区之间的相关性。我们评估了美国常见诊断癌症的发病率与死亡率之间的关系。
基于美国各县人口的观察性研究。
利用监测、流行病学和最终结果（SEER）数据库获取12种最常见诊断的非血液系统癌症的发病率（2000 - 2016年）和死亡率（2002 - 2018年）数据。
癌症发病率与死亡率在县级层面的相关性。根据人口加权相关系数（r）将癌症分为三分位数组。我们还研究了确诊癌症及其他原因导致的10年死亡风险。
县级发病率和死亡率在某些癌症中高度相关，而在其他癌症中则不相关。高相关性三分位数组（r范围：0.96至0.78）中的癌症包括肺癌、胃癌、肝癌和胰腺癌。对于患有这些癌症的患者，因确诊癌症死亡的风险是因其他原因死亡风险的4倍以上。中度相关性三分位数组（r：0.75至0.58）包括结肠癌、膀胱癌、肾癌和子宫癌。低相关性三分位数组（r：0.33至 - 0.10）中的癌症（黑色素瘤、前列腺癌、乳腺癌和甲状腺癌）发病率与死亡率之间几乎没有或没有关系。这些患者因确诊癌症死亡的风险要么低于要么与因其他原因死亡的风险没有差异。
对于美国的某些癌症，疾病频率的基本流行病学指标——发病率——现在与癌症死亡（死亡率）几乎没有关系。低相关性最有可能是由诊断实践的差异导致不同美国县之间癌症过度诊断的数量不同所解释的。
