Addressing Urban Rural Disparities in Cancer: The Case for Registry Expansion

美国各县之间的地理差异相当大。农村和农村地区之间的保健差距 尤其是美国城市居民的情况正在恶化。癌症也不例外。在改善 由于缺乏导致改善结果的可采取行动的项目的数据，造成了差距。我们 建议将科罗拉多中央癌症登记处（CCR）与全州所有付款人索赔数据库联系起来 （APCD）。我们补充这些数据与地区资源文件和其他公共使用的数据，以提高 现有基础设施。结果数据集将包含个人、治疗、县和 2009-2018年的政策和保健服务水平。我们专注于常见的成人癌症：乳腺癌， 宫颈、前列腺、结肠直肠、黑素瘤和肺。我们的目标是： 目标1：从农村/城市居住情况的角度，评价与社区合作报告和农村人口发展报告相联系的完整性， 种族/民族、年龄、性别和保险类型（医疗保险、医疗补助、私人保险、无保险）。这一目标对于以下方面至关重要： 在其他国家的传播和实施工作。它有两个目的：1）通知登记处 APCD在病例确定和治疗数据中的实用性，以及2）告知研究界 使用关联注册表-APCD数据的好处和缺陷。 目标二。测量农村居住与以下结果之间的关系：阶段、治疗 (time治疗、指南一致性护理、新批准药物的使用）、花费和死亡率。 H1：农村居住将与不良结局呈正相关。 H2：居住在农村地区的西班牙裔和美洲印第安人将不成比例地经历不良后果 相对于农村地区的白色人和城市地区的西班牙裔人。 目标3：评估医疗补助的责任护理合作（ACC）对癌症结局的影响。 H1：通过加强护理协调，ACCs的入组改善了农村居民的癌症结局， 预防 这项拟议的研究将产生新的数据，以告知中央癌症之间的联系是否 登记处和所有付款人索赔数据库为理解和解决差异提供了宝贵的数据， 特别是在农村人口中。我们测试了关于距离医疗保健资源的假设， 可用资源的类型（初级和专科护理）以及管理这些资源的政策。这些 评估将为缩小差距所需的卫生保健投资类型的政策辩论提供信息 癌症治疗和死亡率之间的差异。

Geographic disparities among U.S. counties are considerable. Health care disparities between rural and urban Americans, in particular, is worsening. Cancer outcomes are no exception. Progress toward ameliorating disparities has been hindered by a lack of data on the actionable items that lead to improved outcomes. We propose to link the Colorado Central Cancer Registry (CCR) with the statewide All Payer Claims Database (APCD). We supplement these data with the Area Resource File and other public use data to enhance the existing infrastructure. The resulting dataset will contain information at the person, treatment, county, and policy and health care delivery levels for the years 2009-2018. We focus on common adult cancers: breast, cervical, prostate, colorectal, melanoma, and lung. Our aims are: Aim 1: Evaluate the completeness of the linked CCR and APCD in terms of rural/urban residency, race/ethnicity, age, gender, and insurance type (Medicare, Medicaid, private, uninsured). This aim is critical for dissemination and implementation efforts in other states. It serves two purposes: 1) informs the registry about the utility of the APCD in case ascertainment and treatment data and 2) informs the research community about the benefits and pitfalls of using linked registry-APCD data. Aim 2. Measure the relationship between rural residence and the following outcomes: stage, treatment (time to treatment, guideline concordant care, use of newly approved agents), spending, and mortality. H1: Rural residence will be positively associated with adverse outcomes. H2: Hispanics and American Indians residing in rural areas will disproportionately experience poor outcomes relative to their white counterparts in rural areas and their Hispanic counterparts in urban areas. Aim 3: Evaluate the impact of Medicaid's Accountable Care Collaborative (ACC) on cancer outcomes. H1: Enrollment in ACCs improved cancer outcomes for rural residents through enhanced care coordination and prevention. The proposed study will generate new data to inform whether linkages between central cancer registries and All Payer Claims Databases yield valuable data for understanding and addressing disparities, particularly in rural populations. We test hypotheses regarding distance to health care resources and the type of resources available (primary and specialty care) and the policies that govern them. These assessments will inform policy debates about the type of health care investments needed to close the gap between cancer treatment and mortality in rural and urban areas.