Nancy Krieger, Soroush Moallef, Tori L Cowger, Jarvis T Chen, Ruchita Balasubramanian, Alecia J McGregor, Loni Philip Tabb, William P Hanage, Mary T Bassett
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引用次数: 0
Abstract
Background: Political determinants of cancer risk are largely unexplored, conceptually and empirically.
Methods: 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.
Results: 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).
Conclusion: 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.
背景:癌症风险的政治决定因素在很大程度上未被探索,概念和经验。方法:观察分析2017-2021年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的区域和远端阶段以及过早癌症死亡率)之间的关联,总体和标准化线性回归模型调整了州级贫困和医疗保险。结果:在完全调整的模型中(根据州一级贫困和州一级医疗无保险变量进行调整):没有医疗保险的工作年龄成年人(35-64岁)的百分比;州医疗补助扩张的年限),在美国众议院当选官员中,每向更自由的政治意识形态(以投票记录衡量)转变1个标准差,就与区域和远处乳腺癌和结直肠癌的诊断风险降低相关(分别为:-0.76,95%置信区间[CI] = -1.26至-0.25;-0.75;95% CI = -1.5至0)。在完全调整后的模型中,每1个标准差向州选举团投票(-2.01,95% CI = -3.68至-0.33)、州自由主义政策指数(-2.51,95% CI = -4.48至-0.54)和美国参议院当选官员的政治意识形态(-1.93,95% CI = -3.71至-0.14)的自由派得分偏移,癌症过早死亡的风险也同样较低。结论:我们的州级分析表明,政治指标与可预防的癌症结果有关。减少癌症人口负担和这些负担中的不公平现象的努力可以受益于对整个癌症连续体中癌症风险的社会政治驱动因素的分析。