PO.PS01.02 · 人群科学
拉丁美洲乳腺癌发病率和死亡率的地理及社会文化差异：以哥伦比亚区域内部差异为重点的Joinpoint趋势分析
Geographic and sociocultural disparities in breast cancer incidence and mortality in Latin America: Joinpoint trend analysis with a focus on regional variations within Colombia
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摘要 Abstract
中文摘要
背景：乳腺癌（BC）仍是全球女性癌症相关死亡的主要原因。BC是拉丁美洲和加勒比地区（LAC）女性中最常见的恶性肿瘤和癌症相关死亡原因，且在该地区内存在显著异质性。虽然整体BC负担持续上升，但地理、人口统计学和社会文化差异塑造着结局。在哥伦比亚等国家内部开展的次国家级分析对于识别特定背景的挑战和有针对性干预的机会至关重要。
方法：我们分析了拉丁美洲一些负担最重国家的数据，并将其与美国进行比较，以量化乳腺癌（BC）发病率和死亡率的时间趋势。特别关注哥伦比亚的次国家级区域。使用国家和区域癌症登记来源以及Joinpoint回归分析来估计发病率和死亡率的年度变化百分比（APC）和平均年度变化百分比（AAPC），并进行年龄分组分析以按国家和年龄组（早期成人、成人、后期成人）比较发病率。描述性和生态学多变量分析探讨了与地理、人口统计学和社会文化变量的关联。我们试图将这些流行病学趋势与地理、人口统计学（人口结构）、文化和生活方式决定因素联系起来，旨在识别可能解释国家之间和国家内部所观察到BC负担变异性的关键相关性。
结果：所有国家的发病率和死亡率均随年龄增长而上升。美国和阿根廷在老年人中发病率最高，而哥伦比亚的发病率最低。在成人和后期成人年龄段中，各国BC发病率存在统计学显著差异（Kruskal-Wallis检验p<0.001），但在早期成人中则无。Joinpoint回归识别出各国之间以及哥伦比亚各城市内部趋势变化（joinpoints）的时机和幅度的差异，不同模式往往对应于城市化、社会经济地位和筛查可及性。多变量分析显示，发病率和死亡率的区域差异与地理、人口统计学和生活方式因素的相关性强于与遗传血统的相关性。
结论：BC发病率和死亡率在国际和次国家级的显著差异凸显了地理、人口结构和社会文化背景在拉丁美洲的影响。研究结果支持制定量身定制的公共卫生策略的必要性，强调有针对性的筛查和公平的医疗可及性。
查看英文原文 English abstract
Background : Breast cancer (BC) remains the leading cause of cancer-related mortality among females worldwide. BC is the most common malignancy and cancer-related death among women in Latin America and the Caribbean (LAC), with substantial heterogeneity across the region. While overall BC burden continues to rise, geographic, demographic, and sociocultural disparities shape outcomes. Subnational analysis within countries such as Colombia is essential to identify context-specific challenges and opportunities for targeted interventions.
Methodology : We analyzed data from some of the most burdened countries in Latin America and compared them to the United States to quantify temporal trends in breast cancer (BC) incidence and mortality. Particular attention was given to subnational regions within Colombia. Using national and regional cancer registry sources and Joinpoint regression analysis to estimate annual (APC) and average annual percent change (AAPC) in incidence and mortality, Age-block analyses were performed to compare incidence by country and age group (Early adult, Adult, Later adult). Descriptive and ecological multivariable analyses explored associations with geographic, demographic, and sociocultural variables. We sought to relate these epidemiological trends to geographic, demographic (population structure), cultural, and lifestyle determinants, aiming to identify key correlations that may explain the variability in BC burden observed both between and within countries.
Results: Incidence and mortality rates increased with age across all countries. USA and Argentina exhibited the highest incidence among older adults, while Colombia had the lowest rates. Statistically significant differences in BC incidence were observed among countries in the adult and later adult age blocks (Kruskal-Wallis p < 0.001), but not among early adults. Joinpoint regression identified variation in the timing and magnitude of trend changes (joinpoints) between countries and within Colombian cities, with divergent patterns often corresponding to urbanization, socioeconomic status, and access to screening. Multivariable analyses revealed that regional disparities in incidence and mortality correlated more strongly with geographic, demographic, and lifestyle factors than with genetic ancestry.
Conclusions: Marked international and subnational disparities in BC incidence and mortality underscore the influence of geography, population structure, and sociocultural context in Latin America. Findings support the need for tailored public health strategies, emphasizing targeted screening and equitable access to care.
利益披露 Disclosure
O. M. Vidal, None.