背景:虽然美国的宫颈癌发病率(IR)在过去20年中有所下降,非子宫颈人乳头瘤病毒(HPV)相关癌症增加。德克萨斯州(TX)的许多人生活在医疗服务不足的地区,患HPV相关癌症的风险更高。由于以前对这些地区的研究集中在宫颈癌上,与其他TX区域相比,我们在EastTX和TX-墨西哥边界的IR分析中纳入了其他HPV相关癌症.
方法:2006年至2019年的癌症数据来自TX癌症注册中心。HPV相关宫颈病例,阴道,外阴,阴茎,肛门,纳入了口咽癌和相应的患者级人口统计学数据.我们计算了每100,000的IR,并绘制了热图,以按县可视化癌症IR。为了控制潜在的混杂因素,我们增加了县级的危险因素:吸烟率,过度饮酒,肥胖,性传播感染,初级保健提供者的可用性和牙医的可用性,县健康排名和路线图计划。我们报告了按地区和时间划分的IRs,以及每种类型癌症和地区的关联的未调整和调整风险比(RR)。最后,我们为每种癌症创建了不同时期的校正模型,以观察地区差异的时间趋势.
结果:肛门风险,子宫颈,在调整后的模型中,Border部分地区的口鼻咽癌低于TX的其余部分。我们还观察到随着时间的推移,肛门和口咽部癌症的风险增加,宫颈和阴道癌症的风险降低。
结论:患者社会人口统计学,行为危险因素,和获得护理可能导致不同地区癌症IR的一些观察到的差异。这表明针对这些地区的有针对性的预防努力,特别是在低社会经济地位的社区,可以造福子孙后代。
BACKGROUND: While cervical cancer incidence rates (IR) in the United States have dropped in the last 20 years, non-cervical human papillomavirus (HPV) associated cancers increased. Many people in Texas (TX) live in medically underserved areas and have higher risk of developing HPV-associated cancers. Since previous studies of these regions focused on cervical cancer, we included other HPV-associated cancers in our analysis of IR in East TX and the TX-Mexico Border compared to other TX regions.
METHODS: Cancer data from 2006 to 2019 were obtained from the TX Cancer Registry. Cases of HPV-associated cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers and corresponding patient-level demographic data were included. We calculated IR per 100,000 and drew heat maps to visualize cancer IR by county. To control potential confounders, we added county-level risk factors: rates for smoking, excessive drinking, obesity, STIs, primary care provider availability and dentist availability, from the County Health Rankings and Roadmaps program. We reported IRs by region and time and estimated unadjusted and adjusted risk ratio (RR) for association of each type of cancer and region. Lastly, we created adjusted models for each cancer by period to see time trends of regional differences.
RESULTS: Risk of anal, cervical, and oropharyngeal cancer was lower at parts of the Border than in the rest of TX in the adjusted model. We also observed increasing anal and oropharyngeal cancer risk and decreasing cervical and vaginal cancer risk over time.
CONCLUSIONS: Patient sociodemographics, behavioral risk factors, and access to care may contribute to some observed differences in cancer IR across regions. This indicates that targeted prevention efforts towards these regions, especially in low socioeconomic status communities, may benefit future generations.