Developing Neighborhood Archetypes for Understanding Disparities in Cancer

开发社区原型以了解癌症的差异

• 批准号: 8928061
• 负责人: Salma Shariff-Marco
• 金额: $ 19.44万
• 依托单位: CANCER PREVENTION INSTIT OF CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-16 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8928061
• 关键词: Accounting; Address; Affect; African American; Area; Asian Americans; Asians; California; Cancer Etiology; Cancer Patient; Censuses; Characteristics; Classification; Communities; Community Healthcare; Complex; Critical Pathways; Data; Data Set; Data Sources; Databases; Diagnosis; Dimensions; Disease; Environment; Ethnic Origin; Family; Food; Goals; Health; Health Policy; Hispanics; Home environment; Household; Individual; Intervention; Link; Literature; Malignant Neoplasms; Malignant neoplasm of prostate; Measures; Minority; Mission; Neighborhoods; Not Hispanic or Latino; Outcome; Pacific Island Americans; Pathway interactions; Policies; Population Heterogeneity; Population Research; Process; Public Health; Race; Research; Resources; Rural; Safety; Sampling; Shapes; Social Characteristics; Social Environment; Socioeconomic Status; Source; System; Testing; Time; United States National Institutes of Health; Vulnerable Populations; Work; base; built environment; food environment; health disparity; improved; innovation; insight; low socioeconomic status; malignant breast neoplasm; mortality; neoplasm registry; novel; novel strategies; patient population; population based; population health; social; suburb; success

DESCRIPTION (provided by applicant): Disparities in cancer survival continue to persist by race/ethnicity, socioeconomic status (SES) and nativity. Neighborhood factors are critical pathways through which disparities are shaped and perpetuated. However, the literature has shown mixed results and neighborhood-based interventions have had limited success. To advance research on neighborhoods and health, new approaches need to reflect the fact that neighborhood effects on health arise through complex and dynamic processes, underscoring the importance of studying not only the individual effects of neighborhood features on health outcomes, but also their synergistic effects. A promising approach is to encompass multiple dimensions within a single classification system, archetypes, that capture meaningful distinctions across neighborhoods (e.g., Low SES, rural; Poor, urban minority; Middle-class suburban/exurban families). The archetype approach is an efficient way to maximally integrate multiple sources of available information on neighborhood characteristics and has the potential to identify improved opportunities for intervening and reducing health disparities. Leveraging a comprehensive database of small- area level data on social and built neighborhood environments and applying novel statistical approaches, this application proposes to develop neighborhood archetypes around two time periods, 2000 and 2010, for the large, diverse state of California. The central hypotheses are that 1) multiple neighborhood factors can be combined together to form neighborhood archetypes; and 2) that cancer mortality among breast and prostate cancer patients will vary by these neighborhood archetypes, and these associations will vary by race/ethnicity and nativity. The specific aims of this study are to: 1) Investigate the utiity of the archetypes approach to characterize distinct neighborhoods across California. Specifically, we will extend to the census block group level previously developed census tract neighborhood archetypes using confirmatory latent class analysis (LCA). We will also expand, with additional built and social environment features, prior neighborhood archetypes using exploratory LCA. 2) Examine the associations between neighborhood archetypes and survival among a population-based, racially/ethnically diverse set of breast and prostate cancer patients. Specifically, we will test whether neighborhood archetypes are associated with all cause and cancer- specific mortality and whether this association is moderated by race/ethnicity. We will also test whether nativity moderates the neighborhood archetype associations among Hispanics and Asian Americans. The resulting neighborhood archetypes will provide an innovative resource for future research. Applying the archetypes to investigate breast and prostate cancer survival among California's diverse population, this research will yield insights into how neighborhood characteristics work synergistically with each other and interact with individual characteristics to influence health. This research has the potential to contribute to a broader, more fundamental understanding of place effects on health, with applications to both population health and health disparities research.

描述（由申请人提供）：由于种族/民族、社会经济地位 (SES) 和出生地的不同，癌症生存率仍然存在差异。邻里因素是差异形成和延续的关键途径。然而，文献显示的结果好坏参半，基于社区的干预措施取得的成功有限。为了推进邻里与健康的研究，新方法需要反映邻里对健康的影响是通过复杂和动态的过程产生的这一事实，强调不仅研究邻里特征对健康结果的个体影响的重要性，而且还要研究它们的协同效应。一种有前途的方法是在单一分类系统（原型）中包含多个维度，捕捉社区之间有意义的区别（例如，社会经济地位低的农村；贫困的城市少数民族；中产阶级郊区/远郊家庭）。原型方法是最大限度地整合有关社区特征的多个可用信息源的有效方法，并且有可能确定干预和减少健康差异的改进机会。利用有关社会和建成社区环境的小区域数据的综合数据库并应用新颖的统计方法，该应用程序建议为加利福尼亚州这个庞大而多样化的州开发大约两个时间段（2000 年和 2010 年）的社区原型。中心假设是：1）多个邻域因素可以组合在一起形成邻域原型； 2）乳腺癌和前列腺癌患者的癌症死亡率将因这些社区原型而异，并且这些关联将因种族/民族和出生地而异。本研究的具体目标是： 1) 调查原型方法的实用性，以描述加州不同社区的特征。具体来说，我们将使用验证性潜在类别分析（LCA）将先前开发的人口普查区邻里原型扩展到人口普查区块组级别。我们还将使用探索性 LCA 来扩展先前的社区原型，并添加额外的建筑和社会环境特征。 2) 检查社区原型与基于人群、种族/民族多样化的乳腺癌和前列腺癌患者的生存率之间的关联。具体来说，我们将测试社区原型是否与全因死亡率和癌症特异性死亡率相关，以及这种关联是否受到种族/民族的调节。我们还将测试出生是否会调节西班牙裔和亚裔美国人之间的邻里原型关联。由此产生的社区原型将为未来的研究提供创新资源。这项研究应用这些原型来调查加州不同人群中乳腺癌和前列腺癌的生存情况，将深入了解社区特征如何相互协同作用以及如何与个体特征相互作用以影响健康。这项研究有可能有助于更广泛、更根本地了解地方对健康的影响，并应用于人口健康和健康差异研究。