Social and built environment and race/ethnic variations in cancer outcomes

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DESCRIPTION (provided by applicant): Cancer stage at diagnosis, treatment, and survival vary substantially across racial/ethnic groups, but the reasons for these disparities are incompletely understood and only partly characterized by Census-based socioeconomic measures. Cancer surveillance data can be a powerful and efficient resource for examining racial/ethnic disparities in cancer outcomes, and their utilization in this regard can be greatly improved by the addition of data that more fully characterize race/ethnicity and socioeconomic status. We propose to use these data to examine the effects on outcomes after colorectal, prostate, and breast cancers of previously unexplored factors (the neighborhood social and built environment and personal immigration experience), across several racial/ethnic groups. We will create measures of social and built environments using geodata from publicly-available Census, business, unemployment, and medical facility databases and incorporate these measures into a GIS with geocoded cancer incidence and mortality data from the population-based California Cancer Registry database. Using this data resource, we aim to: 1) identify patient subgroups delineated by individual-level and neighborhood sociodemographics who are more likely to be diagnosed with late or advanced disease; 2) determine the effect of proximity to and density of health care providers on selected treatment patterns; and 3) assess the effects of neighborhood socioeconomics and built environment on cancer survival. We are focusing on social and built environment constructs (neighborhood socioeconomic status and material deprivation, unemployment, medical care, walkability/sprawl and opportunities to access physical activity facilities, and neighborhood services) that have plausible associations with our outcomes of interest. The analyses will include 333,000 breast, 318,000 prostate, and 230,000 colorectal cancer cases who were diagnosed and resided in California during 1988-2003, and were non-Hispanic White, Black, Hispanic, Chinese, Japanese, Filipino, Korean, Vietnamese, Hawaiian/Pacific Islander, or South Asian. This study's objective is to understand the contributions of individual- and community-level factors to outcome measures across and within racial/ethnic groups. The long-term goal is to provide the necessary background information for more targeted studies that address the interactive roles of the neighborhood built and social environment on the survivorship experience. Discerning the contextual neighborhood effects from the individual effects is directly relevant to public health, as the results will help planners to focus interventions towards improving the survivorship experience on the individual or community level, or both. Addressing the survivorship experience via secondary data analysis is consistent with the Small Grants in Cancer Epidemiology Program Announcement, and the goal of determining the underlying causes of cancer health disparities is directly responsive to the mission of the NCI.