{"title":"癌症死亡率与地域不平等:2018-2021 年美国各县社会决定因素的详细描述和空间分析","authors":"","doi":"10.1016/j.puhe.2024.08.021","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>In the United States, cancer mortality rates continue to decline, yet geographic and racial disparities persist and are particularly evident in the Delta region, characterized by high economic distress and disease burden. We examined cancer mortality patterns by demographic groups across geographic region (Delta vs non-Delta) and investigated the influence of macro-level social determinants of health (SDoH) in cancer death.</div></div><div><h3>Study design and methods</h3><div>This observational study included cancer death records of individuals aged ≥20 years from 2018 to 2021 in the United States. County-level characteristics were ascertained through the linkage of multiple national administrative and community surveys. We estimated age-standardized mortality rates (ASR) and rate ratios. We calculated the adjusted relative risks by county-level SDoH (geographic region, rurality, household income, income inequality, health insurance, and education) and other factors using age-adjusted multivariate quasi-Poisson regression.</div></div><div><h3>Results</h3><div>In 2018–2021, approximately 2.4 million cancer deaths occurred in the United States. We observed important declines in the Black-White disparities, from 16.6% in 2018 (ASR = 289.9 vs 248.6 per 100,000) to 12.1% in 2021 (281.1 vs 250.8) in the Delta region and from 15.9% (254.9 vs 219.9) to 10.7% (240.6 vs 217.3) in the non-Delta region, though Black men in the Delta region remained the highest rate (ASR<sub>2021</sub> = 346.9 per 100,000). County-level analyses provided strong evidence of geographic inequality and the role of SDoH, particularly education and income inequality.</div></div><div><h3>Conclusions</h3><div>Unfavorable SDoH are associated with increased cancer death risk. Region-specific health policies and interventions in the Delta region are essential to advance cancer health equity.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003676/pdfft?md5=a31319cedf176c7f1cadd48de1c1d627&pid=1-s2.0-S0033350624003676-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Cancer mortality and geographic inequalities: a detailed descriptive and spatial analysis of social determinants across US counties, 2018–2021\",\"authors\":\"\",\"doi\":\"10.1016/j.puhe.2024.08.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>In the United States, cancer mortality rates continue to decline, yet geographic and racial disparities persist and are particularly evident in the Delta region, characterized by high economic distress and disease burden. We examined cancer mortality patterns by demographic groups across geographic region (Delta vs non-Delta) and investigated the influence of macro-level social determinants of health (SDoH) in cancer death.</div></div><div><h3>Study design and methods</h3><div>This observational study included cancer death records of individuals aged ≥20 years from 2018 to 2021 in the United States. County-level characteristics were ascertained through the linkage of multiple national administrative and community surveys. We estimated age-standardized mortality rates (ASR) and rate ratios. We calculated the adjusted relative risks by county-level SDoH (geographic region, rurality, household income, income inequality, health insurance, and education) and other factors using age-adjusted multivariate quasi-Poisson regression.</div></div><div><h3>Results</h3><div>In 2018–2021, approximately 2.4 million cancer deaths occurred in the United States. We observed important declines in the Black-White disparities, from 16.6% in 2018 (ASR = 289.9 vs 248.6 per 100,000) to 12.1% in 2021 (281.1 vs 250.8) in the Delta region and from 15.9% (254.9 vs 219.9) to 10.7% (240.6 vs 217.3) in the non-Delta region, though Black men in the Delta region remained the highest rate (ASR<sub>2021</sub> = 346.9 per 100,000). County-level analyses provided strong evidence of geographic inequality and the role of SDoH, particularly education and income inequality.</div></div><div><h3>Conclusions</h3><div>Unfavorable SDoH are associated with increased cancer death risk. Region-specific health policies and interventions in the Delta region are essential to advance cancer health equity.</div></div>\",\"PeriodicalId\":49651,\"journal\":{\"name\":\"Public Health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0033350624003676/pdfft?md5=a31319cedf176c7f1cadd48de1c1d627&pid=1-s2.0-S0033350624003676-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Public Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0033350624003676\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Public Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0033350624003676","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
摘要
目标在美国,癌症死亡率持续下降,但地域和种族差异依然存在,在三角洲地区尤为明显,该地区的特点是经济窘迫和疾病负担沉重。我们研究了不同地理区域(三角洲与非三角洲)人口群体的癌症死亡率模式,并调查了宏观层面的健康社会决定因素(SDoH)对癌症死亡的影响。研究设计与方法这项观察性研究纳入了美国 2018 年至 2021 年年龄≥20 岁的癌症死亡记录。县级特征通过多个全国性行政和社区调查的链接来确定。我们估算了年龄标准化死亡率(ASR)和比率比。我们使用年龄调整多变量准泊松回归法计算了县级 SDoH(地理区域、乡村、家庭收入、收入不平等、医疗保险和教育)和其他因素调整后的相对风险。结果2018-2021 年,美国约有 240 万人死于癌症。我们观察到黑人与白人之间的差距显著缩小,三角洲地区从2018年的16.6%(ASR = 289.9 vs 248.6 per 100,000)下降到2021年的12.1%(281.1 vs 250.8),非三角洲地区从15.9%(254.9 vs 219.9)下降到10.7%(240.6 vs 217.3),但三角洲地区的黑人男性发病率仍然最高(ASR2021 = 346.9 per 100,000)。县级分析有力地证明了地域不平等和 SDoH 的作用,尤其是教育和收入不平等。三角洲地区针对具体地区的卫生政策和干预措施对于促进癌症健康公平至关重要。
Cancer mortality and geographic inequalities: a detailed descriptive and spatial analysis of social determinants across US counties, 2018–2021
Objective
In the United States, cancer mortality rates continue to decline, yet geographic and racial disparities persist and are particularly evident in the Delta region, characterized by high economic distress and disease burden. We examined cancer mortality patterns by demographic groups across geographic region (Delta vs non-Delta) and investigated the influence of macro-level social determinants of health (SDoH) in cancer death.
Study design and methods
This observational study included cancer death records of individuals aged ≥20 years from 2018 to 2021 in the United States. County-level characteristics were ascertained through the linkage of multiple national administrative and community surveys. We estimated age-standardized mortality rates (ASR) and rate ratios. We calculated the adjusted relative risks by county-level SDoH (geographic region, rurality, household income, income inequality, health insurance, and education) and other factors using age-adjusted multivariate quasi-Poisson regression.
Results
In 2018–2021, approximately 2.4 million cancer deaths occurred in the United States. We observed important declines in the Black-White disparities, from 16.6% in 2018 (ASR = 289.9 vs 248.6 per 100,000) to 12.1% in 2021 (281.1 vs 250.8) in the Delta region and from 15.9% (254.9 vs 219.9) to 10.7% (240.6 vs 217.3) in the non-Delta region, though Black men in the Delta region remained the highest rate (ASR2021 = 346.9 per 100,000). County-level analyses provided strong evidence of geographic inequality and the role of SDoH, particularly education and income inequality.
Conclusions
Unfavorable SDoH are associated with increased cancer death risk. Region-specific health policies and interventions in the Delta region are essential to advance cancer health equity.
期刊介绍:
Public Health is an international, multidisciplinary peer-reviewed journal. It publishes original papers, reviews and short reports on all aspects of the science, philosophy, and practice of public health.