Multilevel Mediation Analysis to Explore Racial Disparities in Breast Cancer Recurrence and Survival using CDC Special Studies

使用 CDC 特别研究进行多级中介分析以探索乳腺癌复发和生存的种族差异

基本信息

批准号：
9439441
负责人：
Qingzhao Yu
金额：
$ 43.8万
依托单位：
LSU HEALTH SCIENCES CENTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-24 至 2021-09-23
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9439441
关键词：
Address Adjuvant African American American Behavioral Breast Breast Cancer Detection Breast Cancer Patient Cancer Burden Cancer Etiology Cancer Patient Caring Censuses Centers for Disease Control and Prevention (U.S.)Cessation of life Characteristics Comorbidity Complex Computer software Data Data Set Data Sources Databases Death Rate Diet Economics Female Breast Carcinoma Funding Goals Health system Healthcare Healthy People 2020 Hospitals Incidence Individual Institute of Medicine (U.S.)Institutes Intervention Knowledge Link Louisiana Malignant Neoplasms Measures Mediation Mediator of activation protein Medicare Methodology Methods Modeling National Cancer Institute National Cancer Program Neighborhoods Outcomes Research Participant Patient Care Patient-Focused Outcomes Patterns of Care Physical activity Physicians Population Prostate Provider Public Health Race Recording of previous events Recurrence Reporting Research Research Personnel Research Project Grants Resources Risk Factors Series Societies Source Statistical Methods Structure Survival Rate Testing Trees United States United States Dept. of Health and Human Services Visual Aid Woman analytical method breast cancer survival cancer diagnosis cancer health disparity cancer recurrence cancer survival cancer type comparative effectiveness data registry data structure disorder prevention disparity reduction effective therapy effectiveness research hazard health disparity improved malignant breast neoplasm minority health modifiable risk neoplasm registry novel novel strategies precision medicine racial disparity research study residence response screening social standard of care survival outcome tumor tumor registry

项目摘要

Breast cancer is the most common cancer and the second leading cause of cancer death among American women of all races. Despite improvement of recurrence and survival rates of breast cancer in the United States, significant differences between white and black women remain. Previous studies have found that more advanced and aggressive tumors and less than optimal treatment may explain the higher recurrence and lower survival rates for black women as compared to white women. However, to the best of our knowledge, there has been no research that jointly considers potential factors that include not only individual level information such as treatment history and tumor characteristics, but also provider characteristics, and physical and social environmental information. Due to limitations of current analytic methods and the lack of comprehensive data sets, researchers have not been able to differentiate the relative effect each factor contributes to the overall racial disparities at different levels (census tract or individual levels). We will use the CDC-funded special studies, including Patterns of Care study, Enhancing Cancer Registry Data for Comparative Effectiveness Research (CER), and the Patient Centered Outcomes Research (PCOR), to examine the determinants of racial disparities in breast cancer survival and recurrence using a novel multilevel mediation analysis. The PoC, CER, and PCOR studies collected complete standard of care and tumor characteristic information for female breast cancer patients. The Louisiana Tumor Registry participated in all these studies and collected the required information from Louisiana breast cancer patients. We plan to link the datasets with census data and many other data sources to obtain environmental and provider information. We propose a novel statistical method that can jointly consider potentially correlated multiple mediators, and differentiate the indirect effect from every individual factor from different levels that may contribute to the race-breast cancer survival and recurrence relationship. If successful, this proposal will provide the most comprehensive exploration of racial disparities in breast cancer patients’ recurrence and survival in the United States.

乳腺癌是最常见的癌症，也是癌症死亡的第二大原因在各种种族的美国妇女中。尽管复发率提高了在美国，白人和黑人妇女之间存在显着差异。先前的研究发现，更高级和侵略性的肿瘤和少于最佳治疗可以解释黑人妇女的较高复发和较低的生存率与白人妇女相比。但是，据我们所知，没有研究共同考虑的潜在因素不仅包括个人级别信息，例如治疗史和肿瘤特征，以及提供者的特征，以及身体和社会环境信息。由于当前分析方法的局限性以及缺乏全面的数据集，研究人员无法区分每个因素有助于不同层面的总体种族分布（人口普查或个人级别）。我们将使用CDC资助的特殊研究，包括护理模式，增强比较有效性研究（CER）的癌症注册表数据，患者以中心为中心结果研究（PCOR），检查乳腺癌种族差异的决定者使用新颖的多级中介分析的生存和复发。 POC，CER和PCOR 研究收集了女性乳房的完整护理标准和肿瘤特征信息癌症患者。路易斯安那州肿瘤登记处参与了所有这些研究，并收集了需要路易斯安那州乳腺癌患者的信息。我们计划将数据集链接到人口普查数据和许多其他数据源，以获取环境和提供者信息。我们提出了一种新的统计方法，可以共同考虑潜在的相关性多个调解人，并将间接效应与每个单独因素与不同的不同因素区分开可能有助于种族胸癌的生存和复发关系的水平。如果成功，该提案将对种族分布提供最全面的探索乳腺癌患者在美国的复发和生存。