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Does Violence Against Women result in disparities in cancer care for women with b

针对女性的暴力行为是否会导致女性癌症护理方面的差异

基本信息

批准号：
8247668
负责人：
Ann L Coker
金额：
$ 27.98万
依托单位：
UNIVERSITY OF KENTUCKY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-25 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8247668
关键词：
Adult Affect Appalachian Region Breast Breast Cancer Treatment Cancer Burden Cancer Control Cancer Patient Caring Censuses Cervical Child Choices and Control Clinic Colonoscopy Colorectal Colorectal Cancer Consent Cox Proportional Hazards Models Data Data Analyses Data Set Diagnosis Diagnostic Neoplasm Staging Divorce Education Ensure Epidemiologic Studies Equation Ethnic Origin Event Exposure to Family member Fecal occult blood Frequencies Funding Gender Geographic state Grant Health Health Insurance Healthcare Human Papillomavirus Incidence Individual Insurance Coverage Intervention Interview Kentucky Life Life Cycle Stages Link Literature Logistic Regressions Low income Malignant Neoplasms Malignant neoplasm of cervix uteri Malignant neoplasm of lung Mammography Measures Mediating Medical Medical Surveillance Medicare Medicare claim Medicare/Medicaid Mental Health Methods Minority Modeling Neighborhoods Occult blood screen Outcome Outcomes Research Palliative Care Pap smear Parents Pathway interactions Patient Self-Report Patients Pattern Physicians Positioning Attribute Poverty Poverty Areas Prevalence Public Health Race Recruitment Activity Registries Research Research Personnel Risk Role Rural Schools Screening for cancer Screening procedure Services Severities Smoke Smoking Status Socioeconomic Factors Socioeconomic Status Solutions Source Stage at Diagnosis Staging Supportive care Surveys Survivors Telephone Telephone Interviews Texas Time Tumor stage Unemployment Uninsured United Nations United States Centers for Medicare and Medicaid Services Violence Woman Women&apos s Health Work base cancer care cancer diagnosis cancer health disparity cancer prevention cancer therapy care seeking cohort emotional abuse experience health disparity improved low socioeconomic status malignant breast neoplasm men mortality neoplasm registry physical conditioning population based programs prospective psychologic residence rural area social socioeconomics survivorship tool violence against women

项目摘要

Background: Violence against women (VAW) is defined by the United Nations as "any act of gender based violence that results in physical, sexual, or psychological harm or suffering to women." In Kentucky almost 40% of women had experienced some form of VAW in their lifetime. The frequency of VAW poses a serious public health challenge not only due to the prevalence but also the long term impact on women's health, documented in an impressive body of literature. However, very little research has explored the effect of lifetime VAW on cancer prevention and control. Kentucky has a high cancer burden with the highest cancer mortality rate of all US states. Incidence rates of cancer and the proportion of women diagnosed at a later stage are higher in the Appalachian region of Kentucky. VAW frequently co-occurs with social factors leading to health disparities including unemployment, less education and minority race. Overall objectives of this project are to determine the extent to which VAW may explain noted disparities in cancer care based on women's race/ethnicity, socioeconomic status, access to health insurance, or residence in high poverty and rural areas of Kentucky. Specific aims: To determine whether VAW is associated with disparities in breast cancer (aim 1), colorectal cancer (aim 2) and cervical cancer (aim 3) care outcomes to include not receiving cancer screening at recommended intervals, being diagnosed with cancer at a later stage, not receiving recommended cancer treatment including supportive/palliative care, and poorer cancer specific survival among women diagnosed with these cancers in Kentucky and adjusting for relevant confounders including race, socioeconomic status, having health insurance, rural residence, and specific regions of high poverty (e.g., living in the Appalachian region of eastern Kentucky or the Delta region of western Kentucky). Methods: We propose a prospective cohort using the Kentucky Cancer Registry (KCR) as the source of 3150 breast cancer cases, 1575 colorectal cancer cases and 525 cervical cancer cases. These 5250 women will be interviewed by phone to determine their lifetime exposure to VAW and comorbid conditions. These data will be linked with state level Medicare claims data for women completing phone surveys who are 65 or older. The Medicare claims data, administered by the Center for Medicare and Medicaid Services, include comprehensive coverage of medical services regardless of where the patients seek care in the nation, which would allow the detailed examination of the proposed cancer care continuum: cancer screening, stage at diagnosis, treatment, supportive or palliative care and survivorship. Both logistic regression and Cox proportional hazards modeling will be used to determine the role of VAW (by frequency, duration, severity, recency and type) and socioeconomic attributes influencing disparities in cancer care. These associations will be investigated for each of the hypothesized five cancer care outcomes and by specific cancer. The mediating or moderating role of socioeconomic factors will also be explored using structural equation modeling. Relevance: This will be the first population-based cohort of the influence of VAW on the life course of cancer care in a state with high cancer burden and regions of extreme poverty. Findings will have significant public health impact in reducing disparities and improving cancer prevention and control in women.

背景：联合国将暴力侵害妇女行为定义为“任何基于性别的暴力行为，对妇女造成身体、性或心理伤害或痛苦。“在肯塔基州，都曾遭受过某种形式的暴力侵害暴力侵害妇女行为的频繁发生不仅对公共卫生构成严重挑战，这不仅是因为艾滋病的流行，也是因为它对妇女健康的长期影响，大量文献都有记载。然而，很少有研究探讨终身暴力侵害妇女对癌症预防和控制的影响。肯塔基州癌症负担高，癌症死亡率是美国各州最高的。癌症的发病率和在肯塔基州的阿巴拉契亚地区，晚期确诊的妇女比例更高。暴力侵害妇女行为经常与下列行为同时发生：导致健康差距的社会因素，包括失业、教育程度低和少数民族。总体目标该项目的主要目的是确定暴力侵害妇女行为在多大程度上可以解释基于妇女的性别的癌症护理方面的显著差异。种族/民族，社会经济地位，获得医疗保险，或居住在高度贫困和肯塔基州的农村地区。具体目标：确定对妇女的暴力行为是否与乳腺癌（目标1）、结肠直肠癌（目标2）和乳腺癌（目标3）的差异有关。 2)和子宫颈癌（目标3）的护理结果，包括不按建议的间隔接受癌症筛查，在晚期被诊断患有癌症，未接受推荐的癌症治疗，包括支持性/姑息治疗，在肯塔基州诊断为这些癌症的妇女中，混杂因素包括种族、社会经济地位、有健康保险、农村居住和特定地区的高风险。贫穷（例如，居住在肯塔基州东部的阿巴拉契亚地区或肯塔基州西部的三角洲地区）。研究方法：我们提出了一个前瞻性队列，使用肯塔基州癌症登记处（KCR）作为3150例乳腺癌病例的来源，结直肠癌1575例，宫颈癌525例。这5250名女性将接受电话采访，他们一生中暴露于暴力侵害妇女和共病状况。这些数据将与州一级的医疗保险索赔数据相关联为65岁或以上的女性完成电话调查。医疗保险索赔数据，由中心管理，医疗保险和医疗补助服务，包括全面覆盖的医疗服务，无论病人在哪里，在全国寻求护理，这将允许详细检查拟议的癌症护理连续体：癌症筛查、诊断阶段、治疗、支持性或姑息治疗和生存率。Logistic回归和考克斯比例风险模型将用于确定暴力侵害妇女的作用（按频率、持续时间、严重程度、新近程度和类型）和影响癌症护理差异的社会经济属性。这些协会将被调查的每一个假设的五种癌症治疗结果和特定癌症。社会经济的中介或调节作用还将使用结构方程模型来探讨这些因素。相关性：这将是第一个基于人群的队列在癌症负担高的州和极端贫困地区，暴力侵害妇女对癌症护理生命过程的影响贫困研究结果将对减少差距和改善癌症预防产生重大的公共卫生影响，控制女人。