Healthcare Access Dimensions and Racial Disparities in Lung Cancer

肺癌的医疗保健获取维度和种族差异

• 批准号: 10295400
• 负责人: Min Lian
• 金额: $ 39.38万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-02 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10295400
• 关键词: Address; Affect; African American; American; Cancer Burden; Cancer Etiology; Cancer Patient; Cessation of life; Characteristics; Chemotherapy and/or radiation; Continuity of Patient Care; Data; Databases; Diagnosis; Dimensions; Disease; Early Diagnosis; Education; Ethnic group; European; Geography; Guidelines; Health Insurance; Healthcare Systems; Hospitals; Incidence; Inferior; Insurance Coverage; Intervention; Malignant neoplasm of lung; Measures; Mediastinal; Medicare; Modality; Modeling; Neighborhoods; Non-Small-Cell Lung Carcinoma; Not Hispanic or Latino; Operative Surgical Procedures; Outcome; Palliative Care; Patients; Population Study; Provider; Radiation therapy; Risk; Role; SEER Program; Sampling; Services; Stage at Diagnosis; Staging; Statistical Models; Surveys; System; Testing; Treatment outcome; United States; Vulnerable Populations; base; beneficiary; cancer care; cancer health disparity; cancer therapy; care outcomes; cohort; density; differences in access; disadvantaged population; disparity reduction; effective intervention; experience; genetic testing; health care availability; improved; insight; longitudinal database; lung cancer screening; mortality; multimodality; novel; patient expectation; population based; population survey; racial and ethnic; racial difference; racial disparity; rural dwellers; screening; service organization; social disadvantage; sociodemographics; surveillance data; targeted treatment; treatment disparity

PROJECT SUMMARY/ABSTRACT Lung cancer is the leading cause of cancer death in the United States. Advances in lung cancer treatment have substantially improved survival. However, the benefit has not reached all racial/ethnic groups of patients equally. Compared with non-Hispanic European Americans (EA), non-Hispanic African Americans (AA) are disproportionately affected by lung cancer with higher incidence and inferior survival. Their poorer outcomes are largely driven by more advanced stages at diagnosis and underutilization of stage-appropriate treatment. Importantly, AA and EA patients with lung cancer can achieve comparable outcomes under similar treatment modalities. This strongly suggests that barriers to cancer care are central to outcome disparities, and strategies targeting specific barriers will be critical to reduce long-standing disparities. However, studies addressing the underlying mechanisms of lung cancer treatment disparities have focused on non-modifiable and much less modifiable factors. There is an urgent need to elucidate modifiable factors influencing lung cancer treatment in AA patients. As Penchansky proposed, healthcare access consists of five distinct dimensions, including affordability, accommodation, acceptability, availability, and accessibility. However, most of previous studies assessed access to lung cancer care based on insurance coverage and availability of providers, and other dimensions of access remain critically understudied. We found that insurance coverage and availability of cancer care collectively explained <50% of the excess risk of underutilization of guideline-concordant treatment in AA vs EA lung cancer patients. Thus, we hypothesize that excess risks of underutilization of guideline- concordant lung cancer care and mortality in AA vs EA patients are attributable to access barriers AA patients disproportionately experience. To test this novel hypothesis, we will develop an integrated database with AA and EA patients diagnosed with non-small cell lung cancer, primarily including data from the longitudinal SEER-Medicare database, national annual surveys of population-based samples of Medicare enrollees, a nationwide database of providers, and neighborhood contextual measures. Using advanced spatial statistical modeling to account for clustering within providers and neighborhoods, we will simultaneously assess five access dimensions in association with lung cancer care and outcomes (Aim 1), examine racial differences in access dimensions overall and by indicators of social disadvantage (Aim 2), and further quantify the independent and collective contributions of access dimensions to racial disparities in lung cancer care and outcomes (Aim 3). This will be the first population-based study to comprehensively assess the impacts of all five access dimensions on lung cancer treatment and their contributions to lung cancer disparities. The results will provide novel insights into which specific components of access are most important and potentially modifiable in explaining lung cancer disparities, as well as where in the lung cancer care continuum they may be most amenable to intervention to improve lung cancer care for AAs and reduce disparities.

项目摘要/摘要 肺癌是美国癌症死亡的主要原因。肺癌治疗的新进展 大大提高了存活率。然而，这种益处并没有惠及所有种族/民族的患者 同样如此。与非西班牙裔欧洲裔美国人(EA)相比，非西班牙裔非裔美国人(AA) 不成比例地受肺癌影响，发病率较高，生存率较低。他们更糟糕的结果 这在很大程度上是由较晚期的诊断阶段和未充分利用适合阶段的治疗所致。 重要的是，肺癌的AA和EA患者在类似的治疗下可以获得类似的结果。 医疗模式。这有力地表明，癌症治疗的障碍是结果差异和策略的核心 针对特定障碍将是减少长期存在的差距的关键。然而，解决这些问题的研究 肺癌治疗差异的潜在机制一直集中在不可改变的和少得多的地方 可修改的因素。迫切需要阐明影响肺癌治疗的可改变因素 再生障碍性贫血患者。正如Penchansky提出的那样，医疗保健服务由五个不同的维度组成，包括 可负担性、容纳性、可接受性、可获得性和可及性。然而，以前的大多数研究都是 根据保险覆盖范围和提供者的可用性评估获得肺癌护理的机会，以及其他 准入方面的研究仍然严重不足。我们发现，保险范围和可获得性 癌症护理共同解释了指南一致性治疗未得到充分利用的额外风险的50% 在AA和EA肺癌患者中。因此，我们假设指南未得到充分利用的额外风险- AA和EA患者的肺癌护理和死亡率的一致性可归因于AA患者的准入障碍 不成比例的体验。为了验证这一新的假设，我们将开发一个集成了AA的数据库 和被诊断为非小细胞肺癌的EA患者，主要包括来自纵向的数据 SEER-Medicare数据库，全国基于人口的联邦医疗保险参与者样本年度调查，a 全国范围内的供应商数据库，以及社区背景措施。使用高级空间统计 建模以考虑提供者和社区内的集群，我们将同时评估五个 与肺癌护理和结果相关的获取维度(目标1)，检查 全面和按社会劣势指标评估各方面(目标2)，并进一步量化 可获得性维度对肺癌护理和治疗中的种族差异的独立和集体贡献 成果(目标3)。这将是第一项以人口为基础的研究，全面评估所有 关于肺癌治疗及其对肺癌差异的贡献的五个准入维度。结果是 将提供有关Access的哪些特定组件最重要和最有潜力的新见解 在解释肺癌差异方面是可修改的，以及在肺癌护理连续统中它们可能在哪里 最愿意采取干预措施，以改善对AA的肺癌护理，减少差距。