摘要：Objectives. We examined the relationship of age at diagnosis and insurance status with stage among cervical cancer patients aged 21 to 85 years. Methods. We selected data on women (n = 69 739) diagnosed with invasive cervical cancer between 2000 and 2007 from the National Cancer Database. We evaluated the association between late stage (stage III/IV) and both insurance and age, with adjustment for race/ethnicity and other sociodemographic and clinical factors. We used multivariable log binomial models to estimate risk ratios (RRs) and 95% confidence intervals (CIs). Results. The proportion of late-stage disease increased with age: from 16.53% (21–34 years) to 42.44% (≥ 70 years). The adjusted relative risk of advanced-stage disease among women aged 50 years and older was 2.2 to 2.5 times that of patients aged 21 to 34 years. Uninsured (RR = 1.44; 95% CI = 1.40, 1.49), Medicaid (RR = 1.37, 95% CI = 1.34, 1.41), younger Medicare (RR = 1.12, 95% CI = 1.06, 1.19), and older Medicare (RR = 1.20, 95% CI = 1.15, 1.26) patients had a higher risk of late-stage disease than did privately insured patients. Conclusions. Screening should be encouraged for women at high risk for advanced-stage disease. The American Cancer Society estimates that 12 710 women will be diagnosed with cervical cancer and 4290 women will die from the disease in 2011. 1 Although incidence and mortality from cervical cancer have declined since the introduction of the Papanicolaou (Pap) test, approximately 35% of cervical cancer patients are diagnosed with regional disease and 11% with distant-stage disease. 2,3 Prognosis is strongly related to stage: the 5-year relative survival rate is 91.2% for patients with localized disease, but only 57.8% for patients with regional disease and 17.0% for those with distant disease. 3 Socioeconomic status, race, marital status, and geographic location have been identified as factors related to late stage at diagnosis among cervical cancer patients. 4–10 Previous studies also documented older age as a significant predictor of advanced stage, although the effects of insurance and age, which are 2 of the strongest predictors of cervical cancer screening, have not been studied together. 11,12 Women without health insurance are less likely to receive cervical cancer and other recommended cancer screening tests, yet few studies have examined the association between insurance status and cervical cancer stage at diagnosis, and the existing studies were limited to elderly (aged ≥ 65 years) Medicare recipients or patients from single-state tumor registries. 4,13 We examined the relationship of both age and insurance status with late-stage disease after adjustment for other known risk factors. Ours was the first study to our knowledge to examine this relationship in a large national sample of cancer patients.
