Gorey K M, Holowaty E J, Fehringer G, Laukkanen E, Moskowitz A, Webster D J, Richter N L
School of Social Work, University of Windsor, Ontario, Canada.
Am J Public Health. 1997 Jul;87(7):1156-63. doi: 10.2105/ajph.87.7.1156.
This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States.
The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58,202 and 76,055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each person's residence at time of diagnosis were taken from population censuses.
In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; in the Canadian cohort, there was no such association for 12 of the 15 sites. Among residents of low-income areas, persons in Toronto experienced a survival advantage for 13 of 15 cancer sites at 1- and 5-year follow-up. No such between-country differentials were observed in the middle- or high-income groups.
The consistent pattern of a survival advantage in Canada observed across various cancer sites and follow-up periods suggests that Canada's more equitable access to preventive and therapeutic health care services is responsible for the difference.
本研究探讨社会经济地位对加拿大和美国被诊断患有癌症的成年人的生存是否有不同影响。
安大略癌症登记处和美国国立癌症研究所的监测、流行病学和最终结果（SEER）计划分别为安大略省多伦多市和密歇根州底特律市提供了总共58202例和76055例基于人群的原发性恶性癌症病例。每个人诊断时居住地的社会经济数据取自人口普查。
在美国队列中，15个最常见癌症部位中的12个，社会经济地位与生存率之间存在显著关联；在加拿大队列中，15个部位中的12个不存在这种关联。在低收入地区居民中，多伦多的居民在1年和5年随访时，15个癌症部位中的13个有生存优势。在中等或高收入群体中未观察到这种国家间差异。
在加拿大，不同癌症部位和随访期均观察到一致的生存优势模式，这表明加拿大在获得预防性和治疗性医疗保健服务方面更为公平，这是造成这种差异的原因。
