2015-2021年加州成年人过早癌症死亡率的种族和社区社会决定因素

IF 3.3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology Pub Date : 2025-07-11 DOI:10.1016/j.annepidem.2025.07.012

Neil A. Maizlish , Paul Simon , Adrienne Damicis , Tracy Delaney , Helen Dowling

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引用次数: 0

摘要

目的：调查加利福尼亚成年人癌症死亡率的社会决定因素，并根据种族/民族、年龄、性别和Covid-19大流行期对其影响的改变。方法：健康场所指数（HPI）衡量社区的社会经济和环境条件以及获得医疗保健的机会。我们从死亡证明和2015年至2021年美国人口普查的人口中汇总了2010年人口普查区的224,997例癌症死亡病例。在这项横断面研究中，我们调整了HPI十分位数的年龄死亡率，并采用分段回归检验了HPI剂量反应。结果：从2015年到2019年，所有癌症死亡率每HPI十分位数下降5.1%。所有癌症的第1和第10十分位数的比率为1.67 (CI95%: 1.58-1.77)，肺癌为2.07(1.81-2.37)，结直肠癌为1.79(1.49-2.16)，前列腺癌为1.75(1.28-2.37)，乳腺癌为1.22（1.01-1.48）。与2015-2019年相比，2020-2021年的hpi -所有癌症梯度变化不大，但平均降低了8%。种族/族裔群体之间的死亡率差异与种族/族裔群体内HPI十分位数之间的差异相当。特定部位的hpi归因死亡率百分比为：所有癌症（27%）、肺癌（39%）、前列腺癌（31%）、结肠直肠癌（29%）和乳腺癌（16%）。结论：在Covid-19大流行之前和期间，与健康社会决定因素相关的癌症死亡率差异相似且很大。

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Race and neighborhood social determinants of premature cancer mortality in California adults, 2015–2021

Purpose

To investigate social determinants of cancer mortality and effect modification by race/ethnicity, age, sex, and Covid-19 pandemic period in Californian adults.

Methods

The Healthy Places Index (HPI) measures neighborhood socioeconomic and environmental conditions, and access to healthcare. We aggregated 224,997 cancer deaths to 2010 census tracts from death certificates and populations from U.S. census, 2015–2021. In this cross-sectional study, we age-adjusted death rates of HPI deciles and examined HPI dose-response with segmental regression.

Results

From 2015 to 2019, all-cancer mortality rates declined 5.1 % per HPI decile. The rate ratio between the 1st and 10th decile was 1.67 (CI_95 %: 1.58–1.77) for all cancers, 2.07 (1.81–2.37) for lung, 1.79 (1.49–2.16) for colorectal, 1.75 (1.28–2.37) for prostate, and 1.22 (1.01–1.48) for breast cancer. The HPI-all-cancer gradient in 2020–2021 was little changed from 2015 to 2019, but rates averaged 8 % lower. Disparities in death rates between race/ethnicity groups were comparable to those between HPI deciles within race/ethnicity groups. The site-specific HPI-attributable percent of mortality was: all cancers (27 %), lung (39 %), prostate (31 %), colorectal (29 %), and breast ((16 %).

Conclusions

Disparities in cancer mortality associated with social determinants of health were similar and large before and during the Covid-19 pandemic.

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来源期刊

Annals of Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.40

自引率

1.80%

发文量

207

审稿时长

59 days

期刊介绍： The journal emphasizes the application of epidemiologic methods to issues that affect the distribution and determinants of human illness in diverse contexts. Its primary focus is on chronic and acute conditions of diverse etiologies and of major importance to clinical medicine, public health, and health care delivery.