Wiggins C L, Becker T M, Key C R, Samet J M
New Mexico Tumor Registry, University of New Mexico School of Medicine, Albuquerque 87131.
J Natl Cancer Inst. 1993 Oct 20;85(20):1670-8. doi: 10.1093/jnci/85.20.1670.
Racial and ethnic differences in cancer incidence and mortality are well documented. New Mexico's ethnically and racially diverse population provides an opportunity to further examine ethnic and racial differences in cancer occurrence.
To address differences in cancer mortality among the state's Hispanics, American Indians, and non-Hispanic Whites, we examined mortality data collected from 1958 through 1987.
Sex and age-specific and age-adjusted cancer mortality rates were calculated for all sites and specific sites for American Indians, Hispanics, and non-Hispanic Whites. From 1958 through 1987, deaths due to malignant neoplasms were coded according to the International Classification of Diseases. The categories of malignant neoplasms investigated were chosen, in part, to minimize bias due to changes in disease classification. Ethnicity was assigned by the Bureau of Vital Statistics on the basis of information on death certificates. Denominators were derived from the censuses of 1960, 1970, 1980, and 1990. Age-standardized mortality rates were calculated for 5-year periods (1958-1962, 1963-1967, 1968-1972, 1973-1977, 1978-1982, and 1983-1987), with the 1970 U.S. population as the standard. We also examined age-specific rates by time period.
Within each of New Mexico's ethnic groups, overall cancer mortality increased over the 30-year time span, and the cancer mortality rates were greater for males than for females. For most major cancer sites, mortality rates for New Mexico's non-Hispanic Whites were comparable with data for U.S. Whites. American Indians had the lowest rates for most sites, whereas cancer mortality rates for most sites among Hispanics were intermediate between the two other groups. However, Hispanics and American Indians had higher mortality rates for cancers of the gallbladder, cervix, and stomach compared with non-Hispanic Whites throughout most of the study period. Several other cancer sites showed major mortality rate differences among these racial and ethnic groups, including cancers of the colon, rectum, breast, bladder, lung, ovary, and uterus. We also observed strong temporal trends of increasing or decreasing mortality rates for several cancer sites.
Race and ethnicity have been strong determinants of cancer mortality in New Mexico. Within the span of one generation, cancer mortality has changed substantially for some cancer sites in each of the population groups studied.
These mortality data underscore the need for appropriately designed etiologic studies of cancer in diverse racial and ethnic groups. Such etiologic studies could provide new insights concerning risk factors for cancer and useful data for developing race- and ethnic-specific cancer control strategies.
癌症发病率和死亡率方面的种族差异已有充分记录。新墨西哥州种族和民族多样化的人口为进一步研究癌症发生情况中的种族差异提供了契机。
为了研究该州西班牙裔、美国印第安人和非西班牙裔白人之间的癌症死亡率差异，我们分析了1958年至1987年收集的死亡率数据。
计算了美国印第安人、西班牙裔和非西班牙裔白人所有部位及特定部位的性别和年龄别以及年龄调整后的癌症死亡率。1958年至1987年期间，恶性肿瘤死亡病例按照国际疾病分类进行编码。部分所选恶性肿瘤类别旨在尽量减少因疾病分类变化导致的偏差。种族由生命统计局根据死亡证明上的信息确定。分母来自1960年、1970年、1980年和1990年的人口普查。以1970年美国人口为标准，计算了5年时间段（1958 - 1962年、1963 - 1967年、1968 - 1972年、1973 - 1977年、1978 - 1982年和1983 - 1987年）的年龄标准化死亡率。我们还按时间段检查了年龄别死亡率。
在新墨西哥州的每个种族群体中，总体癌症死亡率在30年期间有所上升，男性的癌症死亡率高于女性。对于大多数主要癌症部位，新墨西哥州非西班牙裔白人的死亡率与美国白人的数据相当。美国印第安人在大多数部位的死亡率最低，而西班牙裔大多数部位的癌症死亡率介于其他两个群体之间。然而，在研究的大部分时间里，与非西班牙裔白人相比，西班牙裔和美国印第安人胆囊癌、宫颈癌和胃癌的死亡率更高。其他几个癌症部位在这些种族和民族群体之间也显示出主要的死亡率差异，包括结肠癌、直肠癌、乳腺癌、膀胱癌、肺癌、卵巢癌和子宫癌。我们还观察到几个癌症部位死亡率上升或下降的明显时间趋势。
种族和民族一直是新墨西哥州癌症死亡率的重要决定因素。在一代人的时间内，所研究的每个群体中某些癌症部位的癌症死亡率都发生了显著变化。
这些死亡率数据强调了对不同种族和民族群体进行适当设计的癌症病因学研究的必要性。此类病因学研究可为癌症风险因素提供新的见解，并为制定针对种族和民族的癌症控制策略提供有用数据。
