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.

项目总结/摘要 肺癌是美国癌症死亡的主要原因。肺癌治疗进展 大大提高了生存率。然而，该获益并未惠及所有种族/民族的患者 平等地与非西班牙裔欧洲裔美国人（EA）相比，非西班牙裔非洲裔美国人（AA） 不成比例地受到肺癌的影响，发病率更高，生存率更低。他们更糟糕的结果 在很大程度上是由诊断时的更晚期和适当阶段治疗的利用不足所驱动的。 重要的是，AA和EA肺癌患者在相似的治疗下可以获得相当的结果 方式。这有力地表明，癌症治疗的障碍是结果差异的核心， 消除具体障碍对于缩小长期存在的差距至关重要。然而，针对 肺癌治疗差异的潜在机制集中在不可改变的， 可变因素目前迫切需要阐明影响肺癌治疗的可变因素， 匿名戒酒会的病人。正如彭昌斯基所提出的，医疗保健的可及性包括五个不同的方面，包括 可负担性、适应性、可接受性、可获得性和可获得性。然而，大多数以前的研究 根据保险覆盖范围和提供者的可用性评估肺癌护理的可及性，以及其他 对获取方面的研究仍然严重不足。我们发现，保险覆盖面和可用性 癌症护理共同解释了<50%的指南一致性治疗利用不足的过度风险 在AA和EA肺癌患者中。因此，我们假设，过度的风险，利用不足的指南- AA与EA患者的一致性肺癌护理和死亡率归因于AA患者的访问障碍 不成比例的经验。为了验证这一新的假设，我们将开发一个集成数据库与AA 和EA患者诊断为非小细胞肺癌，主要包括数据从纵向 SEER-Medicare数据库，对Medicare登记者的基于人口的样本进行的国家年度调查， 全国性的供应商数据库和邻里环境措施。使用高级空间统计 为了解释供应商和社区内的集群，我们将同时评估五个 与肺癌护理和结局相关的获取维度（目标1），检查 （目标2），并进一步量化 获得层面对肺癌护理中种族差异的独立和集体贡献， 结果（目标3）。这将是第一个以人口为基础的研究，全面评估所有 肺癌治疗的五个可及性维度及其对肺癌差异的贡献。结果 将提供新的见解，了解哪些具体的访问组件是最重要的， 在解释肺癌差异方面是可以修改的，以及在肺癌护理连续体中， 最容易接受干预，以改善AA的肺癌护理并减少差异。