Multilevel factors for racial/ethnic and socioeconomic disparities in prognosis of hepatocellular carcinoma

肝细胞癌预后中种族/民族和社会经济差异的多层次因素

• 批准号: 10308039
• 负责人: Amit Singal
• 金额: $ 89.87万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-03 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308039
• 关键词: Affect; Age; Biological; Biological Factors; Black Populations; Cancer Etiology; Centers for Population Health; Cessation of life; Clinic; Clinical; Computerized Medical Record; Cuban; Data; Data Reporting; Databases; Diagnosis; Distal; Epidemiology; Ethnic Origin; Grant; Guidelines; Health; Health Disparities Research; Health Services; Hepatology; Hispanic; Hospitals; Income; Individual; Inequality; Intervention; Knowledge; Liver Dysfunction; Malignant Neoplasms; Measures; Mexican; Minority Groups; Modeling; Multicenter Studies; Neighborhoods; Newly Diagnosed; Not Hispanic or Latino; Outcome; Pathway interactions; Patients; Persons; Population; Population Heterogeneity; Primary carcinoma of the liver cells; Prognosis; Provider; Public Health; Race; Registries; Reporting; Serum; Site; Social Conditions; Social Policies; Social support; Socioeconomic Status; Stage at Diagnosis; Statistical Methods; Subgroup; System; Time; Translational Research; Tumor Biology; Tumor stage; Universities; base; biobank; black patient; clinical database; cohort; demographics; disadvantaged population; disparity reduction; ethnic minority; health care service utilization; health disparity; health disparity populations; health literacy; health outcome disparity; implicit bias; improved; interest; intersectionality; low socioeconomic status; mortality; multidisciplinary; multilevel analysis; prognostic; prospective; racial and ethnic; racial and ethnic disparities; racial determinant; response; segregation; social; social relationships; socioeconomic disadvantage; socioeconomic disparity; socioeconomics; survival disparity; tumor

Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer-related death in the U.S. HCC disproportionally affects racial/ethnic minority and socioeconomically disadvantaged populations, with higher age-adjusted mortality observed in non-Hispanic blacks and Hispanic whites than non-Hispanic whites. To evaluate these disparities, we will use an adapted Warnecke/Centers for Population Health and Health Disparities ecological multi-level model attributing disparate health outcomes to biological-environmental interactions between and across distal (population social conditions and policies), intermediate (social and physical contexts including social relationships), and proximal (individual demographics and biological responses) determinants. Applying this model to HCC disparities will facilitate identification of key drivers of disparities in prognosis, which is the first necessary step to develop intervention strategies aimed at improving survival and reducing disparities following HCC diagnosis. Specifically, our proposal will characterize the contribution of proximal, intermediate, and distal determinants to disparities in 3 known measures of HCC prognosis: a) tumor stage at diagnosis, b) receipt of timely and guideline-concordant HCC treatment, and c) overall survival. Leveraging existing clinical databases and a biorepository of stored serum, we will conduct a multi-center study using electronic medical record-derived, patient-reported, provider-reported, and serum- based biological factors in a cohort of ~5000 patients newly diagnosed with HCC over a 13-year period to: Aim 1: Characterize the contribution of proximal, intermediate, and distal determinants of racial/ethnic and socioeconomic disparities in HCC tumor stage at diagnosis Aim 2: Determine racial/ethnic and socioeconomic disparities in receipt of timely and guideline- concordant HCC treatment including proximal, intermediate, and distal determinants Aim 3: Identify proximal, intermediate, and distal determinants of racial/ethnic and socioeconomic disparities in overall survival following HCC diagnosis Overall, we will identify factors across and within multiple levels associated with disparities in HCC prognosis between non-Hispanic white, Hispanic white, and non-Hispanic black patients as well as low versus high SES class in a large, racial/ethnically and socioeconomically diverse diverse cohort of ~5000 HCC patients. Our study will provide an understanding of why HCC prognosis disparities exist and at what level interventions should be implemented to reduce disparities improving overall survival.

肝细胞癌 (HCC) 是美国癌症相关死亡增长最快的原因 种族/族裔少数群体和社会经济弱势群体受到不成比例的影响， 非西班牙裔黑人和西班牙裔白人的年龄调整死亡率高于非西班牙裔白人。到 评估这些差异，我们将使用经过改造的 Warnecke/人口健康中心 差异生态多层次模型将不同的健康结果归因于生物环境 远端（人口社会条件和政策）、中间（社会和政策）之间和之间的相互作用 物理环境，包括社会关系）和近端（个人人口统计和生物特征） 反应）决定因素。将此模型应用于 HCC 差异将有助于识别 HCC 的关键驱动因素 预后的差异，这是制定旨在改善预后的干预策略的第一个必要步骤 HCC 诊断后的生存率并减少差异。具体来说，我们的建议将描述 近端、中间和远端决定因素对 3 种已知 HCC 指标差异的影响 预后：a) 诊断时的肿瘤分期，b) 及时接受符合指南的 HCC 治疗，以及 c) 总体生存率。利用现有的临床数据库和储存血清的生物样本库，我们将进行 使用电子病历、患者报告、提供者报告和血清的多中心研究 在 13 年期间，对约 5000 名新诊断为 HCC 的患者进行了基于生物学因素的研究，以： 目标 1：表征近端、中间和远端决定因素的贡献 诊断时 HCC 肿瘤分期的种族/民族和社会经济差异 目标 2：在收到及时和指导方针的情况下确定种族/民族和社会经济差异 一致的 HCC 治疗，包括近端、中间和远端决定因素 目标 3：确定种族/民族和社会经济的近端、中间和远端决定因素 HCC 诊断后总生存率的差异 总体而言，我们将确定与 HCC 预后差异相关的跨多个水平和多个水平内的因素 非西班牙裔白人、西班牙裔白人和非西班牙裔黑人患者之间以及低 SES 与高 SES 之间的差异 在大约 5000 名 HCC 患者的大型、种族/族裔和社会经济多样化队列中进行分类。我们的 研究将有助于了解 HCC 预后差异存在的原因以及干预水平 应实施以减少差异，提高总体生存率。