Geospatial Factors and Impacts II

描述(由申请人提供)：这是1R01CA126858的续展申请，家长资助的标题为“地理空间因素和影响：测量和使用”。几十年来，乳腺癌(BC)和结直肠癌(CRC)的预防和预后存在着地域差异。它们的持续可能表明，由于地理区域之间的不同因素，在国家和地方关于癌症控制预防的努力中，卫生保健资源的使用效率低下。然而，在我们自己的工作之外，过去很少使用空间分析方法来对抗这些差异。在母公司的赠款中，我们增强了分析空间数据的软件，使其得到广泛使用(迄今已有62,500名研究人员使用)，将其应用于有限的数据集，并展示了在分析中忽略空间影响的影响。在这 在新的应用中，我们将扩展现有的软件，以纳入新的空间分析方法，解决超出母公司赠款范围的两个特殊问题。我们将广泛使用新的增强软件，并利用新获得的数据进行全面分析。研究结果将向卫生规划者提供可操作的信息，通过对特定地区确定的人群进行有针对性的干预，提高减少结直肠癌和结直肠癌预防和结果(即癌症诊断时的癌症阶段)差异的能力。使用增强的软件，我们将应用新的方法能力来估计新获得的国家全面癌症登记数据中的空间关系，这些数据涵盖了美国的所有地区。这些合并的国家癌症登记/监测流行病学和最终结果计划(NPCR/SEER)登记数据是受限的，可用于区域疾病控制中心内经批准的项目的个人级别数据(包括癌症阶段)。我们将对美国不列颠哥伦比亚省和CRC人口进行复杂的地理空间多层次分析，将癌症患者与其县、州和地区特征联系起来。新的方法将允许在对影响癌症预防和诊断阶段差异的复杂多水平因素进行建模时，适当地结合空间异质性和空间依赖性。 公共卫生相关性：在这个项目中，我们将开发、应用和传播最科学、最严格的方法来解决持续存在的不平等这一令人困扰的问题。尽管空间分析方法已经存在了一段时间，但由于缺乏关于人口健康结果和行为的空间明确、细粒度的数据，以及缺乏估计具有空间效应的大型人口科学问题的软件，这些方法在全面的癌症控制活动中的应用一直受到阻碍。新的全面癌症登记数据与我们在空间分析软件方面的拟议进展一起使用，将使人口科学分析能够有效利用有限的卫生保健资源。

DESCRIPTION (provided by applicant): This is a renewal application of 1R01CA126858, the parent grant titled "Geospatial Factors and Impacts: Measurement and Use." Geographic disparities in breast cancer (BC) and colorectal cancer (CRC) prevention and outcomes have existed for decades. Their persistence may indicate inefficient use of healthcare resources in national and local efforts concerning cancer control prevention due to factors that differ between geographic areas. However, outside of our own work, spatial analytic methods have rarely been used in the past to combat these disparities. In the parent grant we enhanced software to analyze spatial data, made it widely available (to date used by 62,500 researchers), applied it to limited data sets, and demonstrated the impact of ignoring spatial effects in the analyses. In this new application, we will extend the existing software to incorporate new spatial analytic methods addressing two particular problems that were beyond the scope of the parent grant. We will make the new enhanced software widely available, and use newly available data to conduct comprehensive analyses. The results will provide actionable information to health planners that will improve the ability to reduce disparities in BC and CRC prevention and outcomes (i.e., cancer stage at time of cancer diagnosis), by using targeted interventions to identified populations in specific places. Using the enhanced software, we will apply the new methodological capabilities to estimate spatial relationships in the newly available national comprehensive cancer registry data, which cover all areas of the United States. These combined National Program of Cancer Registry/Surveillance Epidemiology and End Results (NPCR/SEER) registry data are restricted, person-level data (including cancer stage) available for approved projects inside the RDCs. We will conduct complex geospatial-multilevel analysis of U.S. BC and CRC populations, linking persons with cancer to their county, state, and regional characteristics. The new methods will allow for the proper incorporation of both spatial heterogeneity and spatial dependence in modeling the complex multilevel factors influencing disparities in cancer prevention and stage at diagnosis. PUBLIC HEALTH RELEVANCE: In this project we will develop, apply, and disseminate the most scientifically rigorous approach to solving the nagging problem of persistent disparities. Although spatial analytic methodologies have existed for some time, application of these methods in comprehensive cancer control activities has been hindered by the lack of spatially explicit, fine-grained data regarding population health outcomes and behaviors and the lack of software to estimate large population science problems with spatial effects. New comprehensive cancer registry data used together with our proposed advances in spatial analytic software will enable population science analyses addressing the effective use of limited health care resources.