Ndubuisi S C, Kofie V Y, Andoh J Y, Schwartz E M
Bureau of Cancer Control, Preventive Health Services Administration, District of Columbia Commission of Public Health, Washington 20001, USA.
Urology. 1995 Jul;46(1):71-7. doi: 10.1016/S0090-4295(99)80162-9.
Prostate cancer (PC) is a major health problem for American black males. Blacks experience higher PC incidence and mortality compared to whites. Although the racial difference in PC incidence remains unexplained, the difference in PC mortality has been largely attributed to the late stage of disease at presentation. By using the incidence data on District of Columbia residents, this study compares the stage at diagnosis between black men and white men and attempts to determine if observed differences may be attributed to socioeconomic status (SES).
Reporting facilities staged PC using the Surveillance, Epidemiology, and End Results summary staging scheme. Averages of high school education, income, and home ownership at the census tract level were used as proxies for SES, and frequency distributions were reported. Data were stratified based on stage to examine the influence of race and SES on stage.
For 1987 to 1991, 980 men (median age, 71 years) were reportedly diagnosed with PC. Black patients are younger and prostate tumors appear more likely to be more aggressive among blacks than whites. SES is negatively associated with late stage PC, and currently married men, compared with previously married, are less likely to be diagnosed with metastatic PC. Black men are more likely to present with later stage disease, and this racial difference persists even when SES is controlled.
Late stage diagnosis is associated with favorable SES indicators. But substantial racial gradients in the distribution of diagnostic stage persisted even after adjustment for SES. This suggests the need for more intensive efforts to address issues related to access, quality, and utilization of cancer screening services as they pertain to all African-American men in the District of Columbia irrespective of their social status.
前列腺癌（PC）是美国黑人男性面临的一个主要健康问题。与白人相比，黑人的前列腺癌发病率和死亡率更高。尽管前列腺癌发病率的种族差异尚无法解释，但前列腺癌死亡率的差异在很大程度上归因于疾病确诊时的晚期阶段。通过使用哥伦比亚特区居民的发病率数据，本研究比较了黑人男性和白人男性的诊断阶段，并试图确定观察到的差异是否可归因于社会经济地位（SES）。
报告机构使用监测、流行病学和最终结果总结分期方案对前列腺癌进行分期。将普查区层面的高中教育程度、收入和房屋拥有率的平均值用作社会经济地位的代理指标，并报告频率分布。数据按阶段分层，以检验种族和社会经济地位对阶段的影响。
在1987年至1991年期间，据报告有980名男性（中位年龄71岁）被诊断患有前列腺癌。黑人患者更年轻，而且与白人相比，黑人的前列腺肿瘤似乎更具侵袭性。社会经济地位与晚期前列腺癌呈负相关，与已婚男性相比，未婚男性被诊断为转移性前列腺癌的可能性较小。黑人男性更有可能在疾病晚期就诊，即使在控制了社会经济地位之后，这种种族差异仍然存在。
晚期诊断与良好的社会经济地位指标相关。但即使在对社会经济地位进行调整之后，诊断阶段分布中的显著种族梯度仍然存在。这表明需要做出更大努力，解决与癌症筛查服务的可及性、质量和利用相关的问题，这些问题涉及哥伦比亚特区所有非裔美国男性，无论其社会地位如何。
