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

项目摘要/摘要 项目3(Loehrer)：了解社区一级的剥夺和农村居住的影响 癌症护理服务的提供 缺乏保险覆盖范围和个人收入与以下方面的巨大差距有关 对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， 减少接受癌症指导手术的可能性，并降低存活率。然而，更少的是 了解影响获得和接受癌症的上游地理空间健康决定因素 照顾住在农村社区的20%的美国人。患者级别的特征、 例如保险覆盖范围，与这些跨越不同农村社区的地理空间因素相互作用 不清楚。最后，在理解如何使用这些数据以最好地满足 地方和州政策的挑战，旨在改善不同人群癌症护理的公平性。至 为了解决这些差距，勒勒博士计划进行一项基于人群的观察性队列研究，以评估 农村居住地、社区层面的社会经济剥夺的影响及其与 为实体器官恶性肿瘤的表现和治疗提供保险。此外，混合- 方法方法将使社区成员以及地方和州政策制定者了解 如何应用、展示和传播这些数据，以改善癌症护理服务的公平性。这个 这项研究利用了选择的州癌症登记的新用途，以及地理上相关的衡量标准 社区层面的社会经济剥夺。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 可视化保险覆盖范围、农村住宅和当地社区级别之间的复杂关系 社会经济因素。这项研究将提供有关癌症上游地理空间驱动因素的重要信息 关注差异，同时评估将量化数据和地理空间数据、社区 经验和优先事项以及政策制定和执行的现实情况，以最好地解决公平问题 为农村人口提供癌症护理服务。

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.