Racial Disparity in Diagnostic Evaluation of Uterine Cancer

子宫癌诊断评估中的种族差异

• 批准号: 10276384
• 负责人: Jason Wright
• 金额: $ 65.5万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-27 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10276384
• 关键词: Accounting; Address; Affect; African American; Area; Awareness; Behavior; Behavioral; Belief; Cancer Death Rates; Cancer Patient; Cancerous; Caring; Characteristics; Clinical; Clinical Data; Clinical Pathology; Data; Data Mart; Databases; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic tests; Early Diagnosis; Effectiveness; Ethnic Origin; Evaluation; Exhibits; Future; Guidelines; Health Care Seeking Behavior; Health Services Accessibility; Healthcare; Healthcare Systems; Histologic; Incidence; Infrastructure; Intervention; Knowledge; Lead; Link; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Medicaid; Medicare; Newly Diagnosed; Obesity; Outcome; Pathway interactions; Patients; Prevalence; Process; Prognosis; Prognostic Factor; Provider; Race; Reporting; Research; Risk Factors; Role; SEER Program; Sampling; Secondary Prevention; Socioeconomic Factors; Socioeconomic Status; Stage at Diagnosis; Surveys; Symptoms; Technology; Testing; Time; Uterine Cancer; Uterine hemorrhage; Woman; behavioral health; beneficiary; black women; black/white disparity; cancer diagnosis; cancer type; caucasian American; data registry; design; disparity reduction; evidence base; experience; follow-up; health inequalities; high risk; improved; mortality disparity; mortality risk; neglect; neoplasm registry; novel; patient population; population based; racial disparity; social culture; socioeconomics; tumor

Uterine cancer is the most common gynecologic malignancy in the U.S., with a two-fold higher risk of mortality for black women than white women. Early diagnosis is vital for patients’ prognosis as it greatly improves the effectiveness of subsequent treatment. Evidence has shown a significant black-white difference in uterine cancer stage at diagnosis (53% of black women versus 69% of white women are diagnosed at early stage), which explains more of the racial gap in mortality risk than any other factor. However, there has been little research elucidating barriers in the diagnostic pathway that lead to this disparity in early diagnosis, and reasons for the more advanced-stage uterine cancer in black women remain largely unclear, hindering our ability to address this important health inequity. Since many factors in the diagnostic pathway may be modifiable and amenable to interventions, this reflects a lost opportunity of secondary prevention (i.e., early detection and control of the cancerous process). The overarching objective of this project is to reduce racial disparity in the early diagnosis of uterine cancer by systematically examining patients’ diagnostic pathway and identifying barriers to early diagnosis in black women. We will achieve this objective via the following specific aims: 1) to examine racial disparity between black and white women with uterine cancer in the quality of diagnostic evaluation they receive; 2) to compare symptoms and diagnostic evaluation of women who have early versus advanced stage uterine cancer and examine their role in influencing racial disparity in stage at diagnosis; and 3) to conduct a population-based patient experience survey and link to cancer registry data to examine how sociocultural, behavioral and access barriers affect disparity in uterine cancer diagnosis. Aims 1- 2 will draw on three unique large healthcare databases that have patient-level indicators of race/ethnicity and socioeconomic status, contain a complete record of patients’ diagnostic pathway starting from the time when symptoms are reported to a provider, and cover a diverse patient population encompassing the commercially insured, Medicaid enrollees, and Medicare beneficiaries. These databases include the Optum Clinformatics Data Mart, the MarketScan Multi-State Medicaid Database, and the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Aim 3 will exploit the infrastructure of statewide cancer registries and the latest technology of rapid case ascertainment to survey a population-based sample of women newly diagnosed with uterine cancer about their experience. By further linking patient reported survey data to pathology/clinical data in cancer registry, we can uniquely examine how sociocultural, behavior, and patient-perceived barriers affect uterine cancer stage at diagnosis and the potential interplay between tumor characteristics (e.g., histologic type) and patient experience. Findings from this study will provide an essential evidence base about causes of racial disparity in uterine cancer diagnosis. Such information can guide meaningful design of targeted interventions to promote early diagnosis in black women and reduce disparity.

子宫癌是美国最常见的妇科恶性肿瘤，死亡率是美国的两倍 黑人女性胜过白人女性。早期诊断对患者的预后至关重要，因为它可以极大地改善患者的预后 后续治疗的有效性。有证据表明，在子宫中存在显著的黑白差异 癌症诊断阶段(53%的黑人女性比69%的白人女性在早期诊断出癌症)， 这比其他任何因素都更能解释死亡风险的种族差异。然而，几乎没有 研究阐明了导致早期诊断差异的诊断途径中的障碍，以及 黑人女性患晚期子宫癌的原因在很大程度上仍不清楚，这阻碍了我们的 有能力解决这一重要的健康不平等问题。由于诊断途径中的许多因素可能是 这是可修改的，也是受干预的，这反映了二级预防(即早期预防)机会的丧失 癌症过程的检测和控制)。这个项目的首要目标是减少种族歧视 系统检查患者的诊断途径和方法在子宫癌早期诊断中的差异 找出黑人女性早期诊断的障碍。我们将通过以下具体措施实现这一目标 目的：1)检查患有子宫癌的黑人和白人妇女之间的种族差异 他们接受的诊断评估；2)比较症状和诊断评估 早期和晚期子宫癌的比较，并研究它们在影响早期和晚期子宫癌种族差异中的作用。 诊断；以及3)进行以人群为基础的患者体验调查，并与癌症登记数据建立联系，以 研究社会文化、行为和获取障碍如何影响子宫癌诊断的差异。AIMS 1- 2将利用三个独特的大型医疗保健数据库，这些数据库具有患者级别的种族/民族指标和 社会经济状况，包含从以下时间开始的患者诊断路径的完整记录 症状被报告给提供者，并涵盖商业上的不同患者群体 参保人、联邦医疗补助登记人和联邦医疗保险受益人。这些数据库包括Optom Clinformatics 数据集市，MarketScan多州医疗补助数据库，以及监测、流行病学和完 结果(SEER)-医疗保险数据库。AIM 3将利用全州癌症登记和 最新快速病例确证技术对新确诊妇女的人群抽样调查 关于他们患子宫癌的经历。通过进一步将患者报告的调查数据与病理/临床联系起来 在癌症登记处的数据中，我们可以独特地检查社会文化、行为和患者感知的障碍 影响诊断时的子宫癌分期和肿瘤特征之间的潜在相互作用(例如， 组织学类型)和患者经验。这项研究的发现将为以下方面提供重要的证据基础 子宫癌诊断中种族差异的原因。这些信息可以指导有意义的设计 有针对性的干预措施，促进黑人妇女的早期诊断，减少差异。