Understanding the Influence of Community-level Deprivation and Rural Residence in Cancer Care

项目总结/摘要 项目3（Loehrer）：了解社区一级的流离失所者和农村居民的影响 癌症护理交付 缺乏保险覆盖面和个人收入与就业方面的巨大差距有关。 实体器官恶性肿瘤患者的癌症护理，包括出现时的晚期疾病， 降低了接受癌症导向手术的可能性，并降低了生存率。然而， 了解影响获得和接受癌症的健康的上游地理空间决定因素 照顾生活在农村社区的20%的美国人。患者水平特征， 例如保险覆盖面，与不同农村社区这些地理空间因素相互作用， 不清楚最后，在理解如何利用这些数据最好地满足 地方和国家政策的挑战，旨在提高不同人群的癌症护理的公平性。到 为了解决这些差距，Loehrer博士计划进行一项基于人群的观察性队列研究，以评估 农村居住的影响，社区一级的社会经济剥夺，以及它们之间的相互作用 实体器官恶性肿瘤的表现和管理的保险范围。此外，混合- 方法方法将使社区成员以及地方和州决策者了解， 如何应用、呈现和传播这些数据，以提高癌症护理提供的公平性。的 这项研究利用了选择州癌症登记处的新用途， 社区一级的社会经济剥夺。多层次定量方法，地理可视化， 地理计算方法、时空分析和混合方法都将用于描述和 将保险范围、农村居民和当地社区之间的复杂关系形象化 社会经济因素。该研究将提供有关癌症上游地理空间驱动因素的重要信息 在评估联合收割机结合定量和地理空间数据的最佳方式的同时， 经验和优先事项，以及政策制定和执行的现实情况，以最好地解决 为农村人口提供癌症护理。

PROJECT SUMMARY/ABSTRACT Project 3 (Loehrer): Understanding the Influence of Community-Level Deprivation and Rural Residence in Cancer Care Delivery Lack of insurance coverage and individual income have been associated with considerable disparities in cancer care for patients with solid organ malignancies, including later-stage disease at time of presentation, decreased probability of undergoing cancer-directed surgery, and decreased survival. However, much less is understood about upstream geospatial determinants of health that influence access to, and receipt of, cancer care for the 20% of Americans that live in rural communities. The manner in which patient-level characteristics, such as insurance coverage, interact with these geospatial factors across diverse rural communities remains unclear. Finally, significant gaps persist in understanding how these data can be used to best meet the challenges of local and state policy aimed at improving equity of cancer care across diverse populations. To address these gaps, Dr. Loehrer plans to conduct a population-based observational cohort study to evaluate the influence of rural residence, community-level socioeconomic deprivation, and their interaction with insurance coverage on presentation with, and management of, solid organ malignancies. Additionally, mixed- methods approaches will engage community members, as well as local and state policymakers, to understand how these data can be applied, presented, and disseminated to improve equity of cancer care delivery. The study capitalizes on the novel use of select state cancer registries with geographically-linked measures of community-level socioeconomic deprivation. Multilevel quantitative methods, geovisualization, geocomputational approaches, spatiotemporal analyses, and mixed methods will all be used to describe and visualize complex relationships between insurance coverage, rural residence, and local community-level socioeconomic factors. The study will provide important information on upstream geospatial drivers of cancer care disparities while also evaluating the best way to combine quantitative and geospatial data, community experience and priorities, and realities of policy development and implementation to best address equity of cancer care delivery for rural populations.