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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：对妇女的暴力行为（VAW）被联合国定义为“任何基于性别的暴力行为