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

• 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
• 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

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 在所有种族的美国女性中。尽管复发率和生存率有所改善 在美国，白人和黑人女性的乳腺癌发病率仍然存在显着差异。 先前的研究发现，更晚期和更具侵袭性的肿瘤和不太理想的肿瘤 治疗可以解释黑人女性较高的复发率和较低的生存率 与白人女性相比。然而，据我们所知，尚无研究 共同考虑潜在因素，不仅包括个人层面的信息，例如 治疗史和肿瘤特征，还有提供者特征以及身体和健康状况 社会环境信息。由于目前分析方法的局限性以及缺乏 综合数据集，研究人员无法区分每个数据集的相对影响 因素导致不同层面（人口普查区或个人）的总体种族差异 水平）。 我们将利用 CDC 资助的特别研究，包括护理模式研究、增强 用于比较有效性研究 (CER) 和以患者为中心的癌症登记数据 结果研究 (PCOR)，旨在检查乳腺癌种族差异的决定因素 使用新颖的多级中介分析来评估生存和复发。 PoC、CER 和 PCOR 研究收集了女性乳房完整的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来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 多个中介因素，并将每个单独因素的间接影响与不同因素区分开来 可能有助于种族乳腺癌生存和复发关系的水平。如果 如果该提案获得成功，将对种族差异进行最全面的探讨 美国乳腺癌患者的复发和生存。