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

描述（由申请人提供）：不同种族/族裔群体的癌症诊断、治疗和生存期差异很大，但这些差异的原因尚不完全清楚，仅部分通过基于人口普查的社会经济指标表征。癌症监测数据可以成为检查癌症结果中种族/民族差异的强大而有效的资源，通过添加更充分表征种族/民族和社会经济地位的数据，可以大大提高其在这方面的利用率。我们建议使用这些数据来检查结直肠癌，前列腺癌和乳腺癌的影响，以前未探索的因素（社区的社会和建筑环境和个人移民经验），在几个种族/民族群体。我们将创建社会和建筑环境的措施，使用地理数据从公开的人口普查，商业，失业和医疗设施数据库，并将这些措施纳入地理信息系统与地理编码的癌症发病率和死亡率数据从人口为基础的加州癌症登记数据库。使用此数据资源，我们的目标是：1）识别由个人水平和社区社会人口统计学划分的患者亚组，这些患者更有可能被诊断为晚期或晚期疾病; 2）确定医疗保健提供者的接近程度和密度对选定治疗模式的影响; 3）评估社区社会经济学和建筑环境对癌症生存率的影响。我们关注的是社会和建筑环境结构（社区社会经济地位和物质匮乏，失业，医疗保健，步行/蔓延和获得体育活动设施的机会，以及社区服务），这些结构与我们感兴趣的结果有合理的关联。分析将包括1988-2003年期间确诊并居住在加州的333，000例乳腺癌、318，000例前列腺癌和230，000例结肠直肠癌病例，这些病例为非西班牙裔白色人、黑人、西班牙裔、中国人、日本人、菲律宾人、韩国人、越南人、夏威夷/太平洋岛民或南亚人。本研究的目的是了解个人和社区层面的因素，跨种族/族裔群体和内部的结果措施的贡献。长期目标是为更有针对性的研究提供必要的背景信息，这些研究涉及社区建筑和社会环境对生存体验的互动作用。从个体效应中辨别出环境邻里效应与公共卫生直接相关，因为其结果将有助于规划者将干预措施的重点放在改善个人或社区层面的生存体验上，或两者兼而有之。通过二次数据分析解决生存率经验与癌症流行病学计划公告中的小额赠款一致，并且确定癌症健康差异的根本原因的目标直接响应NCI的使命。

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.