RESUMO
Findings from previous studies suggest that differences in socioeconomic status may be responsible for some, if not all, of the elevated incidence of cancer among blacks as compared with whites. Using incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, we tested this hypothesis by correlating black and white cancer incidence rates in three US metropolitan areas between 1978 and 1982 with data from the 1980 census on socioeconomic status within individual census tracts. The study analyzed data on the incidence of cancer at all sites combined (greater than 100 cancer sites) and at seven major sites separately. As in other studies, income and educational levels served as surrogates for socioeconomic status. The present study also used census-tract data on population density as a surrogate factor. Each of these measures of socioeconomic status was analyzed independently. Before correlation with census-tract data, age-adjusted data on cancer incidence showed statistically significant elevated risks among blacks for cancer at all sites combined and at four of the seven separate sites; whites showed an elevated risk for cancer at two sites. Cancer at only one site, the colon, showed no significant association with race. When age-adjusted incidence data were correlated with socioeconomic status, the comparative black-white risks changed: Whites showed an elevated risk of cancer at all sites combined and at three of the seven separate sites; blacks maintained their elevated risk at three sites. These findings suggest that the disproportionate distribution of blacks at lower socioeconomic levels accounts for much of the excess cancer burden among blacks. They also suggest that for both blacks and whites unidentified racial factors, which may be either cultural or genetic and which are not closely linked to socioeconomic status, may play a role in the incidence of some cancers.
Assuntos
Negro ou Afro-Americano , Neoplasias/economia , Neoplasias/etnologia , População Branca , Escolaridade , Feminino , Humanos , Incidência , Renda , Masculino , Densidade Demográfica , Vigilância da População , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
The burden of cancer on the U.S. black population has been compounded by a high prevalence of smoking among blacks. Lung cancer among blacks is a serious public health problem, with a mortality rate of 119 per 100,000 among black males compared to 81 per 100,000 for white males. Blacks, both male and female, have lower quit rates for smoking than does the general U.S. population. Why more blacks than whites continue to smoke is not clear, but the National Cancer Institute has recently funded several research projects to facilitate smoking cessation among blacks. It appears from preliminary findings that smoking cessation efforts among blacks are most successful if they use broadcast media that reach black audiences, if they tailor their print materials to address the needs of black smokers, and if black community networks are utilized.
Assuntos
Negro ou Afro-Americano/psicologia , Abandono do Hábito de Fumar/métodos , Fumar/etnologia , Adolescente , Adulto , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Prevalência , Apoio à Pesquisa como Assunto , Fumar/epidemiologia , Abandono do Hábito de Fumar/psicologia , Prevenção do Hábito de Fumar , Estados Unidos/epidemiologiaRESUMO
Human papillomavirus (HPV) detection is an integral part of cervical cancer screening, and a range of specimen collection procedures are being tested. Preliminary studies have found that the majority of women prefer self-collection of vaginal specimens instead of clinician-collected specimens of the cervix. The purposes of the current study were to explore the social and behavioral predictors of acceptance of self-collection of vaginal specimens among patients and to assess concordance in detection of HPV between clinician-collected cervical specimens and self-collected vaginal specimens. The study was conducted at a university family medicine clinic using a cross-sectional study design, and enrollment of women presenting for routine gynecological examination consecutively in a period of 1 year, self-administered questionnaires, collection of paired vaginal and cervical specimens for HPV DNA using Hybrid Capture 2, and cytologic analysis. Most women (79.8% [398/499]) agreed to collect vaginal specimens. In our study, 76.6% (216/282) African American women (AA), 88.1% (156/176) white non-Hispanic (WNH) women, and 63.4% (26/41) women of other races (P < 0.0001) agreed to self-collect vaginal specimens. HPV was detected in 16.0% (80/499) of clinician-collected cervical specimens and 26.1% (104/398) of self-collected vaginal specimens (P < 0.001). HPV detection was concordant in 13.4% (53/398) women in both cervical and vaginal specimens. Self-collection of vaginal specimens for HPV DNA detection is acceptable to most women presenting for routine gynecological examination. WNH women were more likely to obtain self-collected specimens than AA women. Vaginal specimens were more likely to be positive for HPV than were cervical specimens.
Assuntos
Alphapapillomavirus/isolamento & purificação , Colo do Útero/virologia , Manejo de Espécimes/métodos , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/métodos , Adolescente , Adulto , Idoso , Alphapapillomavirus/genética , Colo do Útero/patologia , Sondas de DNA de HPV/análise , Feminino , Humanos , Análise por Pareamento , Pessoa de Meia-Idade , Modelos Biológicos , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/diagnóstico , Displasia do Colo do Útero/diagnósticoRESUMO
During the last two decades extraordinary progress in developing and using effective cancer prevention strategies, early detection interventions, and cancer treatments has been made. This progress has resulted in an overall decline in mortality rates for all cancers combined. Nonetheless, cancer is the second most common cause of death in the United States. Although cancer is a diagnosis that many survive, cancer experiences across populations may vary considerably. These differences in cancer experiences have created an unequal disease burden that presents distinct professional and moral challenges to our nation. Many cancer control plans suggest specific strategies that prioritize eliminating cancer-related disparities. This article describes certain cancer-related disparities in the United States and gives several examples of how communities and disenfranchised populations are using comprehensive cancer control (CCC) approaches to eliminate these disparities. One or two interventions are highlighted in each example.
Assuntos
Atenção à Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Neoplasias/prevenção & controle , Etnicidade , Humanos , Vigilância da População , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The National Cancer Institute developed population-specific programs to better understand cancer as it occurs within underserved populations such as American Indians, Alaska Natives, Native Hawaiians, and American Samoans. METHODS: The data for American Samoans are derived from regional studies and from data collected from the Hawaii Surveillance, Epidemiology, and End Results (SEER) Registry. Native Hawaiian data are from the Hawaii SEER program and are limited to Native Hawaiians who live in that state. Alaska Native data are from the Lanier and Knutson 15-year summary of Alaska Native cancer data. American Indian data are from the New Mexico SEER program, which is generalizable to natives living in Arizona and New Mexico only and is relatively free of racial misclassification errors. RESULTS: An overview of age-adjusted cancer incidence and mortality rates among American Indians, Alaska Natives, Native Hawaiians, African Americans, and whites for 1977-1983 is provided. Five-year relative survival rates from cancer are from 1975-1984. Relative survival rates are provided for American Indians, Native Hawaiians, African Americans, and whites. CONCLUSIONS: Based on the limited data available, divergent cancer patterns appear to be present in these Native American populations. Alaska Natives and Native Hawaiians consistently display elevated rates that are frequently camouflaged when data are collapsed into "other" racial categories.
Assuntos
Etnicidade/estatística & dados numéricos , Indígenas Norte-Americanos/estatística & dados numéricos , Inuíte/estatística & dados numéricos , Neoplasias/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Samoa Americana/etnologia , Feminino , Havaí/etnologia , Humanos , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Neoplasias/epidemiologia , Neoplasias/mortalidade , Taxa de Sobrevida , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
Greater attention has been given recently to information technology and telecommunication reforms and their use for the improvement of health care service delivery. Broadly defined, telemedicine is the use of advanced telecommunications technologies for the purposes of making diagnoses, conducting research, transferring patient data, and/or improving disease management and treatment in remote areas. The emphasis is on use of telecommunications technologies at remote sites. This article provides a brief overview of telemedicine, its potential clinical applications, and the various benefits and leading issues surrounding it. It also describes selected telemedicine projects conducted at the University of Maryland School of Medicine in Baltimore.
Assuntos
Telemedicina , Redes de Comunicação de Computadores , Serviços de Assistência Domiciliar , Humanos , Medicina Militar , Saúde Pública , Consulta Remota/organização & administração , Serviços de Saúde Rural , Telemedicina/organização & administração , Terminologia como AssuntoRESUMO
Emergence of cervical cancer as a public health problem is largely a twentieth-century phenomenon; although primary prevention remains elusive, secondary prevention--through use of Pap smears--has markedly reduced mortality. Yet, major differences persist in both incidence and mortality between black and white women. The "routine" policies of identifying age groups, timing, and sites for Pap testing will have to yield to more targeted approaches. Both providers and individuals at risk have challenges and responsibilities.
Assuntos
Política de Saúde , Teste de Papanicolaou , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal , Adulto , Negro ou Afro-Americano , Idoso , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/estatística & dados numéricos , Estados Unidos , Neoplasias do Colo do Útero/mortalidade , População BrancaRESUMO
Breast carcinoma is the most common cancer in women in the U.S. and the second leading cause of cancer death in women. Furthermore, there are racial differences in breast carcinoma incidence, mortality, and survival rates. Social and economic factors within racial/ethnic groups are being examined as risk factors not only for breast carcinoma mortality and survival but also as determinants of the rate of incidence. Social and economic factors have been associated in the literature predominantly with cancer mortality and survival. When socioeconomic status (SES) is considered, certain studies suggest that racial disparities in breast carcinoma are smaller than when social and economic factors are examined alone, but these disparities still persist. Sources of data for this discussion include the National Cancer Institute (NCI) (the Surveillance, Epidemiology, and End Results [SEER] program, a group of population-based cancer registries that cover up to 14% of the U.S. population. SEER reports cancer incidence, mortality, and survival rates), the U.S. Bureau of the Census, the National Center for Health Statistics (NCHS), and numerous articles from the scientific literature. Socioeconomic factors or SES can be considered "cross-cutting risk factors" (i.e., they can be related to the risk of developing breast carcinoma [rate of incidence] as well as to the risk of dying [mortality] from this disease). They also are the risk factors that "cut across" racial and ethnic populations. Socioeconomic factors are related to breast carcinoma mortality and survival rates in multicultural women. Racial disparities in breast carcinoma mortality and survival rates can be explained partially by stage distribution at the time of diagnosis, which may be related to SES. For example, African-American women present with more advanced stage distributions for breast carcinoma than white women. Similarly, women of lower SES present with higher stage disease than women of upper SES who present with more localized breast carcinoma. The lack of data regarding the SES of cancer patients limits our understanding of the contributions of SES to cancer incidence and mortality rates. SES appears to be related to breast carcinoma incidence, mortality, and survival rates. Breast carcinoma mortality is higher in women of lower SES. Additional research on SES, race, culture, and the relation of these factors to cancer incidence rate is needed.
Assuntos
Neoplasias da Mama/epidemiologia , Diversidade Cultural , Etnicidade , Grupos Raciais , Adolescente , Adulto , Idoso , Neoplasias da Mama/etnologia , Neoplasias da Mama/mortalidade , Carcinoma/epidemiologia , Carcinoma/etnologia , Carcinoma/mortalidade , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fatores de Risco , Programa de SEER , Classe Social , Fatores Socioeconômicos , Taxa de Sobrevida , Estados Unidos/epidemiologiaRESUMO
Colorectal cancer is the second leading cause of cancer death in the United States. In 1997, more than 131,000 new cases and more than 54,000 deaths were estimated. Racial and ethnic disparities in incidence, mortality and survival rates, and trends exist for this disease. Differences in colorectal cancer screening, early detection, and treatment in minority communities are related to therapeutic outcomes. Age-adjusted incidence rates for men with colorectal cancer are highest for Alaskan native men, followed by Japanese, then African-American men. For women, the incidence is highest for Alaskan native women, followed by African-American, then Japanese women. Mortality rates in men are highest for African Americans, followed by Alaskan natives and then Hawaiians. In women, mortality rates are highest for Alaskan natives, then African Americans and whites. Colorectal cancer screening rates vary by race, income, and education. It is interesting that, when compared with whites, African-American men demonstrate the higher reported rate of screening for this disease. In addition, site specificity is different for African Americans compared with whites. Findings also reveal that stage at diagnosis is an influential factor with regard to mortality and survival. This may be related in part to socioeconomic factors, differences in anatomic site, and treatment differences in African Americans. Risk factor data for this disease are scarce for minority populations. Documented differences in colorectal cancer incidence, mortality, and survival rates exist between minorities and whites. Additional research is needed on risk factors specific to African Americans and other minorities, differences in treatment, and the role of socioeconomic status.
Assuntos
Neoplasias Colorretais/epidemiologia , Grupos Minoritários , Negro ou Afro-Americano , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Incidência , Masculino , Fatores de Risco , Programa de SEER , Estados Unidos/epidemiologia , População BrancaRESUMO
About 35% (10-70%) of all cancers may be associated with nutritional causes (1). However, while natural or added substances in foods may be carcinogenic, nutritional deficiencies or excesses may promote carcinogenesis. We compared data from blacks and whites using dietary and nutritional status surveys in the United States to determine whether the poorer dietary patterns and nutritional status of American blacks may be associated with their higher incidence and mortality from certain cancers (compared with whites). Our review indicates that blacks eat more nitrate and animal foods and not enough fiber in relation to protein, fat, and carbohydrate. Blacks also have poorer nutritional status with respect to getting enough thiamine, riboflavin, vitamins A and C, and iron, to being obese (females), and to being underweight (males). This is in agreement with hypotheses regarding the interactions between diet and cancer (associations found in whites) and dose-response relationships reported for some cancers for which blacks have a higher incidence and mortality than whites. More large-scale prospective case-control and cohort studies are needed in both blacks and whites to elucidate the contribution of specific dietary and nutritional factors to the risk of specific cancers in these population groups. However, such studies must be preceded by methodological research to obtain more valid measures of dietary and nutritional status.
Assuntos
Negro ou Afro-Americano , Dieta , Neoplasias/etnologia , Estado Nutricional , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Fatores de Risco , Estados UnidosRESUMO
Although the United States spends more on health care than any country in the world, access to that care is becoming increasingly difficult. The National Cancer Institute and other federal agencies are sponsoring innovative research for delivering effective medical services, particularly to underserved populations. Models of successful collaboration between private and public sectors concerned with health care can be adapted and implemented at the national, state, and local levels. However, other measures are needed to ensure access to adequate health care for all Americans. Minimal but effective regulations are needed to ensure quality control, reduce duplication of services, and minimize cost increases. Public and private sectors also need to consider ways to extend adequate health insurance coverage to all Americans and to provide compensation for preventive services.
Assuntos
Acessibilidade aos Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Relações Interinstitucionais , Controle de Custos , Acessibilidade aos Serviços de Saúde/normas , Humanos , Área Carente de Assistência Médica , Modelos Organizacionais , Qualidade da Assistência à Saúde , Estados UnidosRESUMO
This study evaluated the association of race, comorbid illness, insurance status, and other prognostic factors on treatment and survival of patients with invasive carcinoma of the cervix, using as its methodology a retrospective study of patients with invasive carcinoma of the cervix treated from 1991 to 1998 at the University of Maryland. Of 161 such patients, 153 met the study criteria. Of these 153 women, 83 (54%) were African Americans and 70 (46%) were white. The mean (+/- SE) age of African American women was 52 +/- 1.8 years and that of white women was 50 +/- 1.8 years. African American women were more likely to present with stages II-IV disease (P = 0.01) and, as a consequence, underwent radiation therapy rather than surgery (P = 0.04). The survival of African American women with stage I-II disease was significantly lower than for white women. In the final regression model, stage III-IV disease (hazard ratio 3.2, 95% (CI 1.7, 6.1) African American race, (hazard ratio 1.9; 95% CI 1.0, 3.3) and comorbid illnesses (hazard ratio 2.3; 95% CI 1.3-4.0) were associated with poor survival. Adverse outcomes of African American women with cervical cancer persist after adjustment for stage of disease and other factors and are particularly apparent in stage I-II disease. The role of comorbid illness is deserving of further study.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Carcinoma/mortalidade , Neoplasias do Colo do Útero/mortalidade , Carcinoma/etnologia , Carcinoma/patologia , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Maryland/epidemiologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores Socioeconômicos , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/patologia , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: The objective was to study the association of race, comorbid illness, and lymph node dissection (LND) with complications in patients undergoing hysterectomy for endometrial carcinoma. METHODS: The Health Care Cost Utilization Project analysis studied women undergoing hysterectomy for endometrial carcinoma in 1996. Chi-square and Student t tests were used to determine differences in means or proportions. Linear, stepwise, and three-stage regression analyses were used to build predictive models for charges and lengths of stay (LOS). RESULTS: The mean age of the 5730 patients was 64.5 (standard deviation, 12.37); 72% of the patients were white, 5% were African American, and 23% were classified as "other." Ninety percent underwent total abdominal hysterectomy, 5% total vaginal hysterectomy (TVH), 4% radical abdominal hysterectomy, and 1% TVH/laparoscopy. Thirty-eight percent also underwent LND. Lymph node dissection was performed more frequently at teaching hospitals (P = 0.0000) and was associated with more complications. Comorbid illness (i.e., diabetes, heart disease) was documented in 51% of admissions, and > or = 1 comorbidity was documented in 21.5%. African Americans were more likely to have one or more comorbid illnesses, underwent more LNDs (P = 0.02), suffered more complications (P = 0.0001), and were more likely to die in the hospital compared with whites or others (P = 0.000). Although LND, complications, and longer LOS were more likely to occur in teaching hospitals (P = 0.0005), total charges and inpatient death were not higher in teaching hospitals. CONCLUSIONS: The higher frequency of comorbid illness, complications, LND, and inpatient death in African Americans reflects severity of medical illness and cancer in these patients. Teaching hospital admission was associated with more complications and longer LOS, but not a higher death rate.
Assuntos
Neoplasias do Endométrio/economia , Neoplasias do Endométrio/cirurgia , Custos Hospitalares/estatística & dados numéricos , Hospitais de Ensino/economia , Hospitais de Ensino/estatística & dados numéricos , Histerectomia/efeitos adversos , Histerectomia/economia , Complicações Pós-Operatórias/epidemiologia , Negro ou Afro-Americano/estatística & dados numéricos , Comorbidade , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Análise de Regressão , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: The aim of this study was to evaluate the association of age, race, and comorbid illness with procedures and complications in hospitalized patients with invasive carcinoma of the cervix in a statewide population-based database over a 3-year period. METHODS: Hospitalizations were classified into homogeneous subgroups based on a diagnosis of invasive cervical cancer. Cancer-related complications and comorbid diseases were evaluated. chi(2) and t tests determined differences in means or proportions. Linear regression techniques were applied to build models for hospitalization charges and lengths of stay (LOS). RESULTS: There were 1009 admissions. The mean age was 49.5, with a median age of 46 (21-100, SD 15.4). Of the total, 606/1009 (60%) were white, 354/1009 (35%) were African-American (AA), and 5% were "other" races. AAs were more likely to have Medicaid or be uninsured (44% vs 23%, P = 0. 001) and were more likely to be admitted for an emergency (unadjusted odds ratio (OR) = 1.6; 1.2-2.2), to have a comorbid illness (P = 0.001), to be admitted for a cancer-related complication (P = 0.036), to be admitted for a transfusion (P = 0. 01), and to be admitted for radiation therapy rather than surgery (P = 0.001). The following were associated with LOS and higher hospital costs: emergency admissions for complications of cancer, comorbid illness, and older age. CONCLUSIONS: Racial differences exist in patterns of admission, type of therapy, and severity of illness; however, there were no differences in charges or LOS for similar procedures. The large percentage of African-Americans uninsured or insured by government-supported programs indicates the potential impact of public policy on the care of these patients. Socioeconomic status rather than phenotypic appearance may be a more important determinant of outcome.