In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6–2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black–White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black–White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.

中文翻译：

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美国癌症协会关于 2023 年美国癌症差异状况的报告

2021 年，美国癌症协会发布了第一份关于美国癌症差异状况的两年期报告。在第二份报告中，作者提供了有关该国癌症发生和结果的种族、民族、社会经济（教育程度作为标志）和地理（大都市地位）差异以及造成这些差异的因素的最新数据。作者还回顾了减少癌症差异的计划，并提供了进一步减轻这些不平等的政策建议。许多癌症的危险因素、诊断分期、接受护理、生存率和死亡率因种族/民族、教育程度和大都市状况而存在很大差异。2016 年至 2020 年期间，黑人和美洲印第安人/阿拉斯加原住民继续承受着不成比例的较高癌症死亡负担，无论是总体死亡还是主要癌症死亡。按教育程度划分，黑人和白人男性和女性中，受教育年限≤12年的个体的总体癌症死亡率比受教育年限≥16年的个体高出约1.6-2.8倍。每个种族内受教育程度的差异远远大于每个受教育程度内癌症总体死亡率的黑人与白人差异，黑人高出 1.03 至 1.5 倍，这表明社会经济地位差异在癌症种族差异中发挥着重要作用鉴于黑人在社会经济地位较低的群体中所占比例过高，死亡率也随之上升。值得注意的是，黑人与白人总体癌症死亡率差异最大的是受教育年限≥16 年的人群。按居住地区划分，非大都市地区的所有癌症死亡率和癌症主要原因的死亡率均远高于大都市地区。例如，就结直肠癌而言，与大城市地区相比，非大城市地区男性死亡率高出 23%，女性死亡率高出 21%。按年龄组划分，65 岁以下人群癌症死亡率的种族和地理差异大于 65 岁及以上人群。许多观察到的癌症死亡率的种族、社会经济和地理差异与接触危险因素和获得癌症预防、早期发现和治疗的机会的差异相一致，这在很大程度上根源于健康社会决定因素的根本不平等。需要各级政府制定公平的政策、广泛的跨学科参与来解决这些不平等问题，以及公平实施循证干预措施（例如增加健康保险覆盖范围），以减少癌症差异。