美国县社会经济地位与癌症过早死亡率的关系。

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology Pub Date : 2025-01-18 DOI:10.1016/j.canep.2025.102747

Aleah L. Thomas , Rachel J. Kulchar , Erica S. Stephens , Lee Mason , Sarah S. Jackson , Alexandra R. Harris , Aldenise P. Ewing , Meredith S. Shiels , Catherine M. Pichardo , Jennifer K. McGee-Avila , Wayne R. Lawrence

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引用次数: 0

摘要

有一致的数据表明，社会经济地位（SES）与老年人的癌症存活率有关，但关于区域水平的社会经济地位与癌症过早死亡风险之间关系的研究仍未得到很好的理解。本研究调查了县级社会经济地位与癌症过早死亡之间的关系。方法：从2016-2020年全国死亡证明数据中确定人口统计学特征和死亡原因。癌症过早死亡被定义为25-64岁之间的癌症死亡率。县域SES采用Yost指数计算，并按分布划分五分位数（1 =最低SES， 5=最高SES）。为了计算县SES与癌症之间的死亡率调整率比（aRR）和相应的95 %置信区间（95 %CI），我们进行了多变量线性混合模型，调整了混杂因素。结果：共纳入3143个县。在5个社会经济地位五分位数中，所有癌症的年龄调整死亡率分别为每10万人107.6、98.4、88.6、81.1和66.7。与经济地位高的县相比，经济地位低的县的过早癌症死亡率高出58% %（1对5 =1.58,95 %CI: 1.55-1.60）。当按性别分层时，也观察到类似的关联，尽管男性的风险最大([女性=1.48,95 %CI: 1.45-1.52]；[aRRmen=1.66, 95 %CI: 1.62-1.70])。在主要癌症类型中，社会经济地位最低的县的肺癌死亡率的相关性最大(aRR=2.03；95 %置信区间:1.98—-2.08)。结论：我们的研究结果表明，社会经济地位较低的县因癌症过早死亡的风险更高。基于地点的干预措施应针对整个癌症控制连续体的社会经济环境。

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County socioeconomic status and premature mortality from cancer in the United States

Introduction

There are consistent data demonstrating socioeconomic status (SES) is associated with cancer survivorship among older adults, but research on the relationship between area-level SES and risk of premature mortality from cancer remains not well understood. This study investigated the association between county-level SES and premature mortality from cancer.

Methods

Demographic characteristics and causes of death were ascertained from the national death certificate data for years 2016–2020. Premature cancer death was defined as cancer mortality between ages 25–64. County SES was calculated using the Yost Index and categorized into distribution-based quintiles (1 =lowest SES, 5=highest SES). To calculate the mortality-adjusted rate ratios (aRR) and corresponding 95 % confidence intervals (95 %CI) for the associations between county SES and cancer, we performed multivariable linear mixed models, adjusting for confounders.

Results

A total of 3143 counties were included. The age-adjusted mortality rates of all cancers combined were 107.6, 98.4, 88.6, 81.1, and 66.7 per 100,000 population for the 5 SES quintiles, respectively. Compared with high SES counties, low SES counties had a 58 % greater premature cancer mortality rate (aRR_{quintile 1 vs.}5 =1.58, 95 %CI: 1.55–1.60). Similar associations were observed when stratified by sex, though risk was greatest among men ([aRR_women=1.48, 95 %CI: 1.45–1.52]; [aRR_men=1.66, 95 %CI: 1.62–1.70]). Among leading cancer types, the association was greatest for lung cancer mortality for the lowest SES counties (aRR=2.03; 95 %CI: 1.98–2.08).

Conclusion

Our findings demonstrate that lower SES counties are at greater risk of premature mortality from cancer. Place-based interventions should target the socioeconomic environment across the cancer control continuum.

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来源期刊

Cancer Epidemiology 医学-肿瘤学

CiteScore

4.50

自引率

3.80%

发文量

200

审稿时长

39 days

期刊介绍： Cancer Epidemiology is dedicated to increasing understanding about cancer causes, prevention and control. The scope of the journal embraces all aspects of cancer epidemiology including: • Descriptive epidemiology • Studies of risk factors for disease initiation, development and prognosis • Screening and early detection • Prevention and control • Methodological issues The journal publishes original research articles (full length and short reports), systematic reviews and meta-analyses, editorials, commentaries and letters to the editor commenting on previously published research.