In-Depth Examination of Disparities in Cancer Outcomes

描述（由申请人提供）：这项拟议的研究使用1996年至2000年的医疗保险和医疗补助资格和索赔文件与密歇根州癌症和死亡证明登记处链接的密歇根州居民，以创建一个新诊断的癌症患者的初始队列。该队列将通过医疗补助资格状态（双重资格与仅医疗保险）进行识别。我们建议检查乳腺癌、结直肠癌、肺癌和前列腺癌的发病率、诊断时这些疾病的分期、为患者提供的治疗和相关的护理费用以及诊断后的生存时间的差异。这项研究旨在扩大有关社会，个人，种族和健康系统变量之间的复杂相互作用的知识，这些变量会产生和影响沿着癌症轨迹的差异。我们测试了一组系统推导的假设，并试图确定在轨迹的早期发现的差异如何影响在轨迹的后期点的差异。例如，诊断的后期是否会导致不适当的护理，从而导致更高的成本和更短的生存期？检查癌症检测和/或治疗差异对生存率的影响是这项研究对科学状况的重要补充之一。我们有四个简单明了的目标，这些目标在分析上非常复杂。我们的目标是针对两个感兴趣的人群--有双重资格获得医疗保险和全部医疗补助福利的人，以及有资格获得医疗保险而没有医疗补助的人（在本申请中，称为“仅医疗保险”）。“）这些目标是：1）测量双重资格和仅医疗保险受益人的癌症发病率; 2）比较双重资格和仅医疗保险受益人的诊断阶段; 3）比较两组之间的治疗交付并估计护理成本;以及4）测量双重资格和仅医疗保险受益人的生存率。

DESCRIPTION (provided by applicant): This proposed research uses 1996 through 2000 Medicare and Medicaid eligibility and claim files for Michigan residents linked with the Michigan Cancer and Death Certificate Registries to create an inception cohort of newly diagnosed cancer patients. This cohort will be identified by Medicaid eligibility status (dually eligible versus Medicare only). We propose to examine disparities in the incidence of breast, colorectal, lung, and prostate cancer, the stage of these diseases at diagnosis, treatment afforded to patients and associated costs of care, and the survival time following diagnosis. This research seeks to expand knowledge regarding the complex interactions among the social, personal, racial, and health system variables that create and influence disparities along the cancer trajectory. We test a systematically derived set of hypotheses and seek to determine how disparities identified early in the trajectory influence disparities at later points in the trajectory. For example, does later stage at diagnosis lead to less appropriate care that leads to higher costs and shorter survival? An examination of the impact of disparities in cancer detection and/or treatment on survival is one of the significant additions of this research to the state of the science. We have four simply stated aims that are analytically highly complex. Our aims are targeted at two populations of interest--persons dually eligible for Medicare and full Medicaid benefits and persons eligible for Medicare without Medicaid (for the purposes of this application, referred to as "Medicare only.") These aims are: 1) Measure the cancer incidence rates in dually eligible and Medicare only beneficiaries; 2) Compare stage of diagnosis for dually eligible and Medicare only beneficiaries; 3) Compare treatment delivery between the two groups and estimate the cost of care; and 4) Measure survival rates for dually eligible and Medicare only beneficiaries.