Krieger Nancy, Moallef Soroush, Cowger Tori L, Chen Jarvis T, Balasubramanian Ruchita, McGregor Alecia J, Tabb Loni Philip, Hanage William P, Bassett Mary T
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
FXB Center for Health and Human Rights, Harvard University, Boston, MA, United States.
JNCI Cancer Spectr. 2025 Sep 1;9(5). doi: 10.1093/jncics/pkaf073.
Political determinants of cancer risk are largely unexplored, conceptually and empirically.
Observational analysis of associations present in 2017-2021 between 5 state-level political metrics and 4 age-standardized cancer outcomes (regional and distant stage at diagnosis for breast, cervical, and colorectal cancer among screening-age adults and premature cancer mortality), overall and in standardized linear regression models adjusting for state-level poverty and medical uninsurance.
In fully adjusted models (adjusted for state-level poverty and state-level medical uninsurance variables: % working age adults [age 35-64] without medical insurance; number of years of state Medicaid expansion), each 1 SD shift toward a more liberal political ideology (measured by voting record) among elected officials in the US House of Representatives was associated with decreased risk of diagnosis with regional and distant breast and colorectal cancer (respectively: -0.76, 95% confidence interval [CI] = -1.26 to -0.25; -0.75; 95% CI = -1.5 to 0). Risk of premature cancer mortality likewise was lower, in the fully adjusted models, with each 1 SD shift toward more liberal scores for the state electoral college vote (-2.01, 95% CI = -3.68 to -0.33), the state liberalism policy index (-2.51, 95% CI = -4.48 to -0.54), and political ideology of elected officials in the US Senate (-1.93, 95% CI = -3.71 to -0.14).
Our state-level analyses suggest that political metrics are associated with preventable cancer outcomes. Efforts to reduce population burdens of cancer and inequities in these burdens could benefit from analyses of sociopolitical drivers of cancer risk across the cancer continuum.
癌症风险的政治决定因素在概念和实证方面大多未被探索。
对2017年至2021年间5个州级政治指标与4个年龄标准化癌症结局（筛查年龄成人中乳腺癌、宫颈癌和结直肠癌诊断时的区域和远处分期以及过早癌症死亡率）之间的关联进行观察性分析，总体分析以及在调整了州级贫困和医疗未保险情况的标准化线性回归模型中进行分析。
在完全调整模型中（调整了州级贫困和州级医疗未保险变量：无医疗保险的工作年龄成年人百分比[35至64岁]；州医疗补助扩大的年限），美国众议院当选官员中，每向更自由的政治意识形态方向移动1个标准差（以投票记录衡量），与区域和远处乳腺癌及结直肠癌诊断风险降低相关（分别为：-0.76，95%置信区间[CI]=-1.26至-0.25；-0.75；95%CI=-1.5至0）。在完全调整模型中，随着州选举人团投票、州自由主义政策指数以及美国参议院当选官员的政治意识形态每向更自由分数方向移动1个标准差，过早癌症死亡率风险同样较低（分别为：-2.01，95%CI=-3.68至-0.33；-2.51，95%CI=-4.48至-0.54；-1.93，95%CI=-3.71至-0.14）。
我们的州级分析表明，政治指标与可预防的癌症结局相关。减少癌症人群负担及其负担方面的不平等现象的努力，可能受益于对癌症连续过程中癌症风险社会政治驱动因素的分析。
