Analyzing National Complex Sample Surveys for Epidemiologic Studies of Cancer

描述（由申请人提供）：来自大型国家人口复杂调查的公共使用数据的现成可用性具有巨大的潜力，可用于评估：(1)人口癌症频率（发病率和流行率）；（二）住院时间和有关治疗费用；(3)癌症筛查率；(4)新发现的风险因素（例如筛检率、饮食）与不同癌症的关系。这个项目的目标是利用应用于至少七项美国复杂调查的新颖统计方法来证明这种潜力。具体来说，我们将使用行为风险因素监测系统和健康信息国家趋势调查来描述筛查率；全国健康与营养调查，探讨当前和未来癌症患者的行为（饮食、吸烟等）；全国住院病人样本和医疗支出小组调查，以描述治疗癌症的住院时间和相关费用；全国家庭和临终关怀调查，探讨癌症患者的临终关怀；以及全国健康访谈调查，以检查癌症幸存者的随访情况。复杂的抽样调查提出了一些相当独特的问题，我们将开发适当的模型和方法。我们的建议对医学研究人员有三个广泛的意义。(1)小亚群分析的新统计方法，标准的大样本复杂调查方法可能不合适；2)数据库的新统计程序太大，通常的复杂调查方法不可行；3)偏态数据调查方法复杂。另一个目标是使非统计人员广泛使用新开发的统计/流行病学方法。对于每个目标中描述的方法，我们计划创建可以与现有的，广泛使用的统计软件包（例如，SAS）一起使用的宏和过程。统计宏和程序将被记录下来并在互联网上提供，同时还将提供关于如何将这些宏应用于最终出版物中分析的示例的文档。

DESCRIPTION (provided by applicant): The ready availability of public-use data from large National population-based complex surveys have immense potential to lead to the assessment of (1) population frequency of cancer (incidence and prevalence); (2) hospital length of stay and related costs for treatment; (3) cancer screening rates; (4) newly discovered associations between risk factors (e.g. screening rates, diet) and different cancers. The goal of this project i to demonstrate this potential using novel statistical methods applied to at least seven United States complex surveys. Specifically, we will use the Behavioral Risk Factor Surveillance System and the Health Information National Trends Survey to describe screening rates; the National Health and Nutrition Examination Survey to explore behaviors (diet, smoking, etc.) in current and future cancer patients; the Nationwide Inpatient Sample and the Medical Expenditure Panel Survey to describe hospital length of stay and related costs for treating cancer; the National Home and Hospice Care Survey to explore end-of-life care for cancer patients; and the National Health Interview Survey to examine follow-up of cancer survivors. Complex sample surveys present some quite unique problems, and we will develop appropriate models and methods complex surveys. Our proposal has three broad aims of significance to medical researchers. (1) New statistical approaches for small subgroup analyses in which the standard large sample complex survey methods can be inappropriate; 2) New statistical procedures for databases that are too large for the usual complex survey approaches to be feasible; and 3) Complex survey methods for skewed data. An additional goal is to make the newly developed statistical/epidemiological methodology widely accessible to non-statisticians. For the methods described in each aim, we plan to create macros and procedures which can be used with existing, widely-used statistical packages (e.g., SAS). Statistical macros and procedures will be documented and made available on the Internet, together with documentation on how to apply these macros to the examples analyzed in the resulting publications. PUBLIC HEALTH RELEVANCE: National complex survey data are used often in cancer epidemiology. We propose new approaches for analyzing such data that are theoretically valid, technically simple and can be implemented within most standard sample survey packages.