The Social Environment and Colorectal Cancer in the United States

美国的社会环境与结直肠癌

• 批准号: 10230901
• 负责人: Eduardo Jose Santiago-Rodriguez
• 金额: $ 3.78万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10230901
• 关键词: Adult; Affordable Care Act; American; Area; Behavior; Cancer Control; Cancer Etiology; Cancer Intervention; Cessation of life; Characteristics; Colorectal Cancer; Community Surveys; Country; County; Data; Data Set; Databases; Detection; Development; Disease Management; Economics; Education; Elements; Employment Opportunities; Environment; Epidemiologist; Ethnic Origin; Ethnic group; Future; Geography; Goals; Health Food; Health Insurance; Health Policy; Incidence; Individual; Insurance Coverage; Low income; Malignant Neoplasms; Malignant neoplasm of lung; Measurement; Measures; Medicaid; Mentorship; Methodology; Methods; Mission; National Health Interview Survey; Neighborhoods; Not Hispanic or Latino; Patients; Pattern; Phase; Population; Population Group; Prevention; Public Health; Race; Reporting; Research; Research Personnel; Resources; Risk Behaviors; Risk Reduction Behavior; Role; Sampling; Social Environment; Socioeconomic Status; Stage at Diagnosis; Statistical Methods; Time; Training; Transportation; United States; Woman; anticancer research; cancer health disparity; cancer risk; cancer statistics; career; colorectal cancer screening; contextual factors; econometrics; ethnic minority population; health assessment; health care service; health disparity; indexing; low socioeconomic status; men; mortality; multilevel analysis; prevent; racial and ethnic; racial difference; racial disparity; racial minority; residential segregation; screening; screening guidelines; segregation; social; social determinants; social factors; training opportunity; tv watching; uptake

Project Summary/Abstract The overarching goal of this proposal is to evaluate the relationship between the social environment and health disparities in colorectal cancer (CRC) in the United States, and determine the role of public health policy in reducing them. CRC is the third most common cancer in women and men in the US, and it is the second leading overall cause of cancer mortality, with a total of 53,200 deaths estimated for 2020. While improvements in screening uptake, advances in treatment and reduction of risky behaviors have resulted in lowering CRC incidence and mortality in recent years, people of low socioeconomic status (SES), racial/ethnic minorities, and those without health insurance still have a greater burden of CRC. Due to the interplay of all these characteristics, it is challenging to unpack the role of SES as a driver of CRC health disparities. Recent developments in cancer research have highlighted the need for evaluating neighborhood-level and other social level factors, in addition to individual characteristics as they capture information on access to resources that are key elements of cancer risk, such as: transportation, recreational places, healthy food, healthcare services and education and employment opportunities. The Index of Concentration at the Extremes (ICE) permits the measurement of different aspects of spatial and social polarization, including racial/ethnic, economic and racialized economic residential segregation, and provide a comprehensive assessment of the social environment of individuals. In 2014, the implementation of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), made health insurance coverage accessible to people of low income, and was expected to reduce CRC health disparities. Prior research evaluating the early years of ACA has shown an increase in insurance coverage, but studies evaluating its effect on CRC screening, incidence and stage at diagnosis have had inconsistent results, and it is not well-understood within racial/ethnic groups. Therefore, this study will use data from a nationally representative sample of adults in the National Health Interview Survey for years 2010-2018, and the United States Cancer Statistics database for 2009-2017, which includes all incident cancer cases in the country, to employ multilevel modeling and econometric methods with these specific aims: 1) determine the presence of health disparities in CRC screening, incidence and stage at diagnosis and 2) elucidate the role of Medicaid expansion in reducing these health disparities. Results from this study will be valuable in informing the effect of health policy and for which groups CRC interventions are most needed to contribute to the NCI mission of “helping all people live longer, healthier lives”. The interdisciplinary training environment and the expert mentorship team for this proposal will provide the applicant an excellent training opportunity to develop methodological and content expertise for a future career as cancer epidemiologist and health disparities researcher.

项目摘要/摘要 这项建议的首要目标是评估社会环境与健康之间的关系 美国结直肠癌(CRC)的差异，并决定公共卫生政策在 减少他们的数量。结直肠癌是美国女性和男性中第三常见的癌症，也是第二大常见癌症 癌症死亡的主要原因，2020年估计死亡总人数为53,200人。在改进的同时 在筛查吸收方面，治疗的进步和危险行为的减少导致了结直肠癌的降低 发病率和死亡率近年来，社会经济地位低的人、种族/少数民族和 那些没有医疗保险的人仍然有更大的CRC负担。由于所有这些因素的相互作用 然而，由于其自身的特点，要弄清社会经济地位是造成儿童健康差距的驱动因素，是一项具有挑战性的工作。近期 癌症研究的发展突显了评估邻里层面和其他社会层面的必要性 级别因素，以及个人特征，因为它们捕获有关访问以下资源的信息 是癌症风险的关键因素，例如：交通、娱乐场所、健康食品、医疗服务 以及教育和就业机会。极值集中度指数(ICE)允许 衡量空间和社会两极分化的不同方面，包括种族/族裔、经济和 种族隔离的经济住宅，并提供了一个全面的社会评估 个人的环境。 2014年，根据《患者保护和平价医疗法案》扩大医疗补助的实施 (ACA)，使低收入者能够获得医疗保险，预计将减少CRC 健康差距。先前评估ACA早期的研究表明，保险增加了 覆盖范围，但评估其对结直肠癌筛查、发病率和诊断阶段的影响的研究已有 结果不一致，而且在种族/族裔群体中没有得到很好的理解。因此，这项研究将使用数据 从2010-2018年全国健康访谈调查中具有全国代表性的成年人样本中， 和2009-2017年美国癌症统计数据库，其中包括#年所有癌症事件 国家，采用多层次建模和计量经济学方法，以实现以下具体目标：1)确定 在结直肠癌筛查、发病率和诊断阶段方面存在的健康差异，以及2)阐明 扩大医疗补助，缩小这些健康差距。这项研究的结果将是有价值的 卫生政策的影响以及哪些群体最需要儿童权利公约干预措施来促进国家预防传播活动 “帮助所有人活得更长、更健康”的使命。跨学科的培训环境和 本建议书的专家导师团队将为申请者提供极好的发展培训机会 作为癌症流行病学家和健康差距未来职业的方法和内容专业知识 研究员。