The role of Federal legislation on breast cancer disparities

联邦立法对乳腺癌差异的作用

• 批准号: 8374988
• 负责人: ROBERT A LEVINE
• 金额: $ 16.53万
• 依托单位: MEHARRY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-12-14 至 2013-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8374988
• 关键词: Accounting; Address; Adverse effects; African American; Age; Area; Behavioral; Biological; Caring; Centers of Research Excellence; Cessation of life; Characteristics; Comorbidity; Data; Developed Countries; Diagnosis; Disease; Drug Prescriptions; Elderly; Elderly woman; Epidemiology; Ethnic Origin; HIV; Health; Health Insurance; Healthcare; Highly Active Antiretroviral Therapy; Individual; Intervention; Laws; Licensing; Life; Life Expectancy; Link; Logistic Regressions; Mammography; Measures; Medical; Medical Assistance; Medicare; Medicare claim; Modeling; Modification; National Cancer Institute; National Center on Minority Health and Health Disparities; Nature; Patients; Persons; Policies; Policy Maker; Positioning Attribute; Provider; Race; Relative (related person); Research Personnel; Resources; Respiratory distress; Role; Safety; Sampling; Screening procedure; Services; Socioeconomic Status; Solutions; Source; Statutes and Laws; Testing; Time; Translating; United States Centers for Medicare and Medicaid Services; United States Food and Drug Administration; Woman; abstracting; base; cancer health disparity; cancer information system; drug market; falls; hazard; health disparity; human very old age (85+); innovation; low socioeconomic status; malignant breast neoplasm; mortality; older women; premature; programs; psychologic; social; socioeconomics; success; surfactant

4.2.12. Levine Abstract. The role of federal legislation on breast cancer disparities After the Medicare program began to reimburse providers for screening mammography, mortality from breast cancer among US elderly began to fall. However, rates fell more rapidly among whites, and racial disparities widened. Interestingly, disparities did not widen uniformly across the US. We hypothesize that Medicare law inadvertently favors acquisition of screening mammography services by whites since it defines medical assistance as a cash benefit to pay providers regardless of the extent to which cash is the primary barrier to service acquisition. We propose to use the observed geographic variability in mortality disparities to address this hypothesis. We shall obtain large national samples of Medicare data and SEER-linked Medicare claims data to test the following sub-hypotheses: H-l: Regional and state level characteristics will have a significant effect on mammography utilization after adjusting for individual factors. H-2: The effect of regional and state level characteristics on mammography utilization will be different for African American and White women. H-3: The region having the greatest equitability for screening mammography utilization will be more likely to have programs in place aiming to increase mammography utilization and reduce disparities. H-4: Relative to places with moderate to high levels of success, failing places will be more likely to have low survival from breast cancer, and greater percentage increase in racial disparity in survival over time. H-5: Relative to places that are failing or have moderate to high screening mammography utilization, exceptionally successful places will be more likely to have high survival from breast cancer, and to have greater percentage reduction in racial disparity in survival over time. We believe there are compelling reasons to address the proposed hypotheses using alternative means as soon as possible: (a) thousands of deaths from breast cancer among the elderly may have already occurred or will occur because of unintended, adverse effects traceable to Medicare's definition of medical assistance as cash to pay providers; (b) breast cancer may be the tip of the iceberg, particularly with the advent of new programs to provide cash for prescription drugs as part of Medicare; and (c) there may be wider implications as regards the observed declines[2] in US position relative to other industrialized nations for life expectancy and other key measures. The project also proposes reasonable means for obtaining preliminary answers that will be useful for policy makers.

4.2.12.摘要：联邦立法对乳腺癌差异的作用在医疗保险计划开始报销提供者的乳房X光检查后，美国老年人乳腺癌的死亡率开始下降。然而，白人的比率下降得更快，种族差距扩大。有趣的是，美国各地的差距并没有均匀扩大。我们假设，医疗保险法无意中有利于白人获得筛查乳房X光检查服务，因为它将医疗援助定义为向提供者支付的现金福利，而不管现金在多大程度上是获得服务的主要障碍。我们建议使用观察到的死亡率差异的地理变异性来解决这一假设。 我们将获得医疗保险数据和与SEER相关的医疗保险索赔数据的大的国家样本，以测试以下子假设：H-1：在针对个体因素进行调整后，区域和州水平的特征将对乳房X射线摄影术的利用具有显著影响。 H-2：对于非裔美国人和白色女性，区域和州一级特征对乳腺X射线摄影利用率的影响不同。H-3：在乳房X线检查使用方面最公平的地区更有可能制定旨在提高乳房X线检查使用率和减少差异的方案。H-4：相对于那些成功率从中等到高的地方，失败的地方更有可能患乳腺癌的生存率很低，随着时间的推移，生存率的种族差异会增加更大的百分比。H-5：相对于失败或有中度到高度筛查乳腺X线摄影的地方 利用率，特别成功的地方将更有可能从乳腺癌中获得高生存率，并且随着时间的推移，生存率的种族差异将有更大的减少。我们相信有令人信服的理由尽快使用替代方法来解决所提出的假设：（a）数千名老年人死于乳腺癌可能是由于 已经发生或将要发生，因为意外的，不良影响可追溯到医疗保险的医疗援助的定义为现金支付提供者;（B）乳腺癌可能是冰山一角，特别是随着新的计划的出现，为处方药提供现金作为医疗保险的一部分;（c）美国在预期寿命和其他关键指标方面相对于其他工业化国家的地位下降可能会产生更广泛的影响。 该项目还提出了获得对决策者有用的初步答案的合理手段。