Improving our understanding of breast cancer mortality disparities through recurrence: a multi-level approach among women in Georgia

通过复发提高我们对乳腺癌死亡率差异的理解：格鲁吉亚妇女的多层次方法

• 批准号: 10364766
• 负责人: Lauren E McCullough
• 金额: $ 54.52万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-04 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10364766
• 关键词: Accounting; Adopted; Affect; Area; Black Populations; Black race; Breast Cancer Patient; Breast Cancer survivor; Cancer Prognosis; Caring; Cells; Censuses; Characteristics; Clinical; Clinical Data; Clinical Research; Communities; Data; Diagnosis; Disease; Distal; Distant; Early Diagnosis; Economics; Epidemiologic Methods; Event; Funding Opportunities; Guidelines; Hospitals; Individual; Intervention; Investigation; Low income; Mediating; Mediator of activation protein; Minority; Nonmetastatic; Not Hispanic or Latino; Outcome; Outcomes Research; Pathway interactions; Pattern; Policies; Population; Population Heterogeneity; Population-Based Registry; Positioning Attribute; Prevalence; Prognosis; Public Health; Race; Recurrence; Research; Risk Estimate; Role; Rural; Social Environment; Societies; Source; Statistical Methods; Survivors; Time; Tumor Biology; United States; Woman; Work; breast cancer diagnosis; cancer health disparity; cancer recurrence; cancer survival; data registry; data streams; demographic disparity; demographics; disparity reduction; ethnic disparity; evidence base; experience; high risk; improved; innovation; intersectionality; lifetime risk; low socioeconomic status; malignant breast neoplasm; mortality; mortality disparity; multidisciplinary; multilevel analysis; neoplasm registry; population based; racial and ethnic disparities; racial disparity; rural disparities; rural residence; social epidemiology; survival disparity

PROJECT SUMMARY/ABSTRACT Significance. Although national and philanthropic efforts have sought to reduce and eliminate breast cancer (BC) mortality disparities over the past few decades, they have not only persisted—but widened. Additionally, due to incomplete capture of recurrence data, no previous investigation has identified drivers of disparities in BC recurrence following a diagnosis of early-stage (I–IIIA) disease. In Georgia, where economic and racial/ethnic disparities are among the greatest in the United States, the sources of BC outcome disparities are unresolved, and likely arise from the interplay of causal and contributing factors at multiple levels—from cell to society. Approximately 40% of all BC survivors will suffer a recurrence during their lifetime, and clinical data suggest a higher risk of recurrence in minority and low-income women. Given the high lifetime risk of recurrence, posited race/ethnic disparities in recurrent BC, and documented mortality disparities across demographic domains, now is the pivotal time to characterize underlying pathways contributing to inequities in BC prognosis. Innovation. Our proposal is innovative in that it will be the first to estimate risks and rates of BC recurrence by demographic characteristics, consider intersectionality in BC outcome disparities, and use a multilevel decomposition approach to identify potential targets for intervention. Approach. Integrating multiple data streams (e.g., discharge, administrative claims, hospital, and census data) with cancer registry data from a large, diverse population, we will identify proximal, intermediate, and distal determinants of race/ethnic, SES, and urban/rural disparities in both recurrence and BC-specific mortality, as well as examine recurrence and its treatments as mediators of disparities in mortality rates by race, SES, and urban/rural characteristics. Data will be from approximately 30,000 women diagnosed with a first primary stage I–IIIA BC in Georgia (2013–2017) and followed for up to 12 years. Impact. Previous research in this area has had consistent shortcomings including (1) insufficient ascertainment of recurrence at the population level; (2) examining one or few factors without accounting for shared contributions across multiple levels; and (3) inadequate power to explore intersections of identity. Our study, for the first time, will examine multi-level contributors to race/ethnic, SES, and urban/rural disparities in both BC recurrence and mortality among women with early-stage disease. Our innovative multi- level decomposition approach will move us beyond merely documenting disparities, to identifying modifiable targets within the social contexts of affected communities, facilitating prioritization of interventions.

项目概要/摘要 意义。尽管国家和慈善事业一直致力于减少和消除乳腺癌 (BC) 过去几十年来，死亡率差异不仅持续存在，而且还在扩大。此外， 由于复发数据捕获不完整，之前的调查尚未确定 BC 地区差异的驱动因素 诊断为早期 (I–IIIA) 疾病后复发。在乔治亚州，经济和种族/民族 差异是美国最大的，BC结果差异的根源尚未解决， 并且很可能是由从细胞到社会等多个层面的因果因素和影响因素的相互作用产生的。 大约 40% 的 BC 幸存者在其一生中会经历复发，临床数据表明 少数族裔和低收入妇女复发的风险较高。鉴于终生复发风险很高，假设 现在，不列颠哥伦比亚省经常出现的种族/民族差异，以及记录的跨人口领域的死亡率差异 现在是描述导致 BC 预后不公平的潜在途径的关键时刻。创新。 我们的提案具有创新性，因为它将是第一个按人口统计估计 BC 复发风险和率的提案 特征，考虑 BC 结果差异的交叉性，并使用多级分解 确定潜在干预目标的方法。方法。集成多个数据流（例如， 出院、行政索赔、医院和人口普查数据）以及来自大型、多样化的癌症登记数据 人口，我们将确定种族/民族、社会经济地位和城市/农村的近端、中间和远端决定因素 复发率和 BC 特异性死亡率的差异，并检查复发率及其治疗方法 种族、社会经济地位和城乡特征死亡率差异的中介因素。数据将来自 乔治亚州约 30,000 名女性被诊断患有首次初级 I-IIIA BC 期（2013-2017 年）并进行随访 长达 12 年。影响。该领域的先前研究一直存在缺陷，包括（1） 没有充分确定人口层面的复发情况； (2) 不考虑一个或几个因素 考虑多个级别的共同贡献； (3) 探索交叉点的能力不足 身份。我们的研究将首次考察种族/民族、社会经济地位和城市/农村的多层次贡献者 早期乳腺癌女性的复发率和死亡率存在差异。我们的创新多 层次分解方法将使我们超越仅仅记录差异，识别可修改的 受影响社区的社会背景内的目标，促进干预措施的优先顺序。