南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (8): 1417-1424.doi: 10.12122/j.issn.1673-4254.2023.08.20

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社会经济学地位与盲肠腺癌死亡风险的关系：一项基于美国人群的分析

邵子安，吕 军   

  1. 南方医科大学第一临床医学院，广东 广州 510515；暨南大学附属第一医院临床研究部，广东 广州 510630；广东省中医药信息化重点实验室，广东 广州 510632
  • 出版日期:2023-08-20 发布日期:2023-09-13

Socioeconomic status and cecal adenocarcinoma mortality risk: an American population-based analysis

SHAO Zi'an, LYU Jun   

  1. First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Clinical Research, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou 510632, China
  • Online:2023-08-20 Published:2023-09-13

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摘要： 目的 通过监测、流行病学和最终结果（SEER）数据库了解美国复杂社区水平的社会经济学地位（SES）与盲肠腺癌患者死亡率之间的关系。方法 通过SEER数据库对2011~2015年确诊的美国盲肠腺癌患者的信息进行查询。采用因子分析、聚类分析、单变量和多变量COX比例风险模型，确立了5个社会保障因素：因素1：经济和教育劣势；因素2：与移民有关的特征（语言隔离高，国外出生率高，住宅拥挤率高）；因素3：县内搬迁率高；因素4：州内搬迁率高；因素5：国内搬迁率高。确定了5个SES定义的集群。结果 在17 185例患者中，全因死亡人数为5948例，存活人数为11 237例。在多变量COX回归分析中，以集群1（贫困率低、受教育程度高）为参考，集群 3（县内流动率高）的 HR 值为 1.13（95% CI=1.04-1.21，P<0.05），风险比集群1高13%。集群4（语言隔离率低、国外出生率低和住宅拥挤率低、国内流动率低）的HR值为1.15（95% CI=1.07-1.24，P<0.001），风险比集群1高15%。集群5（经济和教育劣势、与移民有关特征、国内流动率低）的HR值为1.11（95% CI=1.03-1.20，P<0.01），风险比集群1高11%。相关SES指标的因素基于盲肠腺癌患者的死亡率显示出显著的统计学意义，表明经济水平和受教育程度低的是盲肠腺癌患者死亡的危险因素。结论 较低的社会经济学地位与美国盲肠腺癌患者的死亡风险的增加相关，且人群分布存在差异，完善医保政策和加强心理治疗可为盲肠腺癌患者的预后改善提供指导。

关键词: SEER；社会经济学地位；盲肠腺癌；生存率

Abstract: Objective To explore the relationship between socioeconomic status (SES) and disease mortality in patients with cecal adenocarcinoma in America through the Surveillance, Epidemiology, and End Results (SEER) database. Methods The SEER database was queried for patients with cecal adenocarcinoma in America diagnosed from 2011 to 2015. Factor analysis, cluster analysis, and univariate and multivariate Cox proportional hazard models were used for data analysis. Five social security factors were identified: factor 1, economic and educational disadvantage; factor 2, characteristics related to immigration (language isolation and foreign birth); factor 3, high relocation rate in the county; factor 4, high intra-state relocation rate; and factor 5, high domestic relocation rate. Five clusters defined by SES were identified. Results The number of all-cause deaths among 17 185 patients was 5948, and the number of survivors was 11,237. In the multivariate Cox regression analysis, with cluster 1 (low poverty rate and high education level) as the reference, the hazard ratio (HR) of cluster 3 (high intra-county mobility rate) was 1.13 (95% CI: 1.04-1.21, P<0.05), and the risk was 13% higher than that of cluster 1. The HR of cluster 4 (low language isolation, foreign birth, housing overcrowding, and intra-country mobility rates) was 1.15 (95% CI: 1.07-1.24, P<0.001) with a 15% higher risk than cluster 1. The HR of cluster 5 (economic and educational disadvantages, immigration-related characteristics, and low intra-country mobility) was 1.11 (95% CI: 1.03-1.20, P<0.01) with a 11% higher risk. The factors related to SES indicators were based on the mortality of patients with cecal adenocarcinoma, indicating that low economic and education levels are risk factors for cecal adenocarcinoma. Conclusion Low socioeconomic status is associated with an increased risk of death in patients with cecal adenocarcinoma in the United States and show different distribution patterns based on population. Improving health insurance policies and strengthening psychotherapy can provide guidance for improving prognosis f cecal adenocarcinoma patients.

Key words: SEER; socioeconomic status; cecal adenocarcinoma; survival rate