MODELING SPATIAL ACCESSIBILITY TO LOWER ENDOSCOPY SERVICES IN THE UNITED STATES

对美国下层内窥镜服务的空间可达性进行建模

• 批准号: 8504297
• 负责人: Min Lian
• 金额: $ 19.84万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-10 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8504297
• 关键词: Accounting; Address; Adult; Area; Belief; Cancer Etiology; Cancer Survivor; Cessation of life; Characteristics; Cohort Studies; Colonoscopy; Colorectal Cancer; Comb animal structure; Communities; County; Coupled; Data; Detection; Development; Diet; District of Columbia; Early Diagnosis; Endoscopy; Event; Excision; Flexible fiberoptic sigmoidoscopy; Foundations; Geographic Information Systems; Health; Health Policy; Health Services; Health Services Accessibility; Incidence; Individual; Intervention; Knowledge; Lesion; Life; Link; Location; Mammography; Maps; Measures; Medicare; Modeling; Neighborhoods; Outcome; Patients; Persons; Physicians; Policy Maker; Premalignant; Prevalence; Public Health; Quality of Care; Research; Risk; Second Primary Cancers; Services; Sigmoidoscopy; Stage at Diagnosis; Staging; Statistical Models; System; United States; United States National Institutes of Health; aged; base; colorectal cancer prevention; colorectal cancer screening; community setting; deprivation; evidence base; geographic difference; high risk; improved; malignant breast neoplasm; mortality; population health; prevent; public health relevance; screening; socioeconomics

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer deaths in the United States. Lower endoscopic examinations including flexible sigmoidoscopy and colonoscopy have been demonstrated to reduce the risks of incident CRC and CRC-specific mortality through detection and removal of precancerous lesions and early detection of CRC. However, lower endoscopy utilization is still less than 60% among persons aged 50 years or older. Previous research identified significant geographic variations in CRC screening, incidence, and survival. Small-area socioeconomic deprivation has been associated with CRC-related outcomes, but was unable to explain the observed geographic disparity in CRC-related outcomes, suggesting that other community-level characteristics contribute to geographic disparities in CRC-related outcomes. Access to healthcare is an important prerequisite to obtaining quality care and thus a determinant of health outcomes. Low spatial accessibility to mammography service has been associated with an increased risk of late-stage breast cancer. Little is known whether spatial accessibility to lower endoscopy services contributes to the geographic variation in CRC-related outcomes. Therefore, we will explore the hypothesis that geographic disparities in CRC screening, incidence and survival are attributable to spatial accessibility to lower endoscopy services. Two specific aims will be addressed: (1) Compute and map small-area spatial accessibility to lower endoscopy services across the United States including 50 states and Washington DC, using a GIS, Medicare data, and spatial statistical modeling, and (2) Examine the effects of small-area spatial accessibility to lower endoscopy services on CRC-related outcomes, including the risks of incident CRC, advanced stage at diagnosis, and CRC-specific mortality. We will use three different spatial approaches to quantify and map small-area spatial accessibility to lower endoscopy services based on the locations of physicians who performed a sigmoidoscopy or colonoscopy using Medicare data. Then, we will link the small-area spatial accessibility measures with data from the high- quality NIH-AARP Diet and Health Study including 566,407 persons to prospectively assess the effects of spatial accessibility to lower endoscopy services on CRC incidence, advanced stage at diagnosis and CRC- specific mortality. This is the first study to examine the geographic disparity in spatial accessibility to lower endoscopy services and prospectively evaluate its effect on CRC outcomes. The results of the proposed study will provide evidence for the development and implementation of evidence-based multilevel interventions to increase lower endoscopy use and thus improve CRC-related outcomes. In addition, the proposed study will develop a spatial accessibility map which will help local and state policy makers improve the allocation of lower endoscopy services.

描述（由申请人提供）：结直肠癌 (CRC) 是美国第四大常见癌症，也是癌症死亡的第二大原因。包括可屈性乙状结肠镜检查和结肠镜检查在内的下内镜检查已被证明可以通过检测和去除癌前病变以及早期发现结直肠癌来降低结直肠癌发生风险和结直肠癌特异性死亡率。然而，50 岁或以上人群的内窥镜使用率仍低于 60%。 先前的研究发现结直肠癌筛查、发病率和生存率存在显着的地理差异。小区域的社会经济剥夺与结直肠癌相关结果有关，但无法解释观察到的结直肠癌相关结果的地理差异，这表明其他社区层面的特征导致了结直肠癌相关结果的地理差异。获得医疗保健是获得优质护理的重要先决条件，也是健康结果的决定因素。乳房X光检查服务的空间可达性较低与晚期乳腺癌的风险增加有关。目前尚不清楚较低内窥镜检查服务的空间可及性是否会导致结直肠癌相关结果的地理差异。因此，我们将探讨这样一个假设：结直肠癌筛查、发病率和生存率的地理差异归因于内窥镜检查服务的空间可达性较低。将解决两个具体目标：(1) 使用 GIS、医疗保险数据和空间统计模型，计算并绘制美国各地（包括 50 个州和华盛顿特区）低位内窥镜检查服务的小区域空间可达性，以及 (2) 检查低位内窥镜检查服务的小区域空间可达性对 CRC 相关结果的影响，包括 CRC 事件风险、诊断晚期和特定于 CRC 的风险 死亡率。 我们将根据使用医疗保险数据进行乙状结肠镜检查或结肠镜检查的医生的位置，使用三种不同的空间方法来量化和绘制小区域空间可达性以降低内窥镜检查服务。然后，我们将小区域空间可达性测量与来自高质量 NIH-AARP 饮食与健康研究（包括 566,407 人）的数据联系起来，前瞻性评估较低内窥镜检查服务的空间可达性对 CRC 发病率、诊断晚期和 CRC 特异性死亡率的影响。这是第一项研究较低内窥镜检查服务的空间可及性的地理差异，并前瞻性评估其对结直肠癌结果的影响。拟议研究的结果将为开发和实施循证多层次干预措施提供证据，以减少内窥镜检查的使用，从而改善结直肠癌相关的结果。此外，拟议的研究将开发一个空间可达性地图，这将帮助地方和州政策制定者改善下消化道内窥镜检查服务的分配。