Understanding rural mortality disparities in cancer: a multi-level approach

了解农村癌症死亡率差异：多层次方法

• 批准号: 10340241
• 负责人: KELLY KENZIK
• 金额: $ 27.18万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10340241
• 关键词: Address; Area; Behavioral Risk Factor Surveillance System; Black Populations; Black race; Budgets; Cancer Patient; Caring; Censuses; Characteristics; Clinical Trials; Code; Commuting; Complex; County; Data; Data Set; Databases; Diagnosis; Emergency department visit; Evaluation; Excess Mortality; Fibrinogen; Future; Geographic Factor; Geographic Locations; Geography; Health; Health Information National Trends Survey; Health Insurance; Health Services Accessibility; Health behavior; Healthcare; Hospitalization; Individual; Inferior; Insurance; Intervention; Link; Malignant Neoplasms; Maps; Mediating; Mediation; Methodology; Modeling; Nature; Office Management; Outcome; Participant; Play; Policies; Policy Developments; Policy Maker; Population; Poverty; Poverty Areas; Quality of Care; Race; Reasons for Geographic And Racial Differences in Stroke; Reporting; Research Personnel; Role; Rural; Rural Population; SEER Program; Sampling; Social support; Socioeconomic Status; Specialist; Stroke Belt; System; Transportation; Work; cancer health disparity; cohort; comorbidity; contextual factors; data registry; deprivation; evidence base; experience; health literacy; indexing; malignant breast neoplasm; mortality; mortality disparity; multilevel analysis; neoplasm registry; primary outcome; rural area; rural disparities; rural patients; rural poverty; rural residence; rurality; social vulnerability; sociodemographics; statistics; therapy development; urban area; urban disparity; urban residence; virtual

Abstract Cancer mortality rates in the US declined by 26% between 1991 and 2015, but the decline has not been equal across all populations. Approximately 19% of the US population resides in rural areas; for over three decades, this population has experienced increasingly inferior outcomes when compared with their urban counterparts. The underlying cause(s) of the widening rural/urban gap in cancer outcomes is hypothesized to be multifactorial, with socioeconomic status (SES) both at the individual-level and geographic area-level likely playing a significant role. Gaps in evidence include the use of multiple “rural” definitions, a lack of evidence on associated geographic factors, and limited evidence based on multi-level approaches to understand the complex nature of rural disparities. Therefore, the overall objective of this study is to conduct a comprehensive examination of the underlying causes of rural/urban disparities in mortality among individuals diagnosed with cancer. In the first aim, the Surveillance, Epidemiology, and End Results (SEER) population-level data will be used to examine mortality among individuals diagnosed with cancer across three definitions of rurality, providing researchers and policy makers with the magnitude of differences by each definition. In the second aim, SEER will be linked via county- indicators to 16 databases (US Census Bureau, Area Deprivation Index, Bureau of Labor Statistics, County Health Rankings and Roadmaps, AMA Healthcare Workforce Mapper, BRFSS, Social Vulnerability Index, Health Information National Trends Survey, etc.). These linkages will allow us to estimate the contribution of specific area- level factors (e.g., area-level SES, access to high-quality care) on rural/urban mortality differences using effect decomposition methodology. In the third aim, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort (U01 NS041588) will be linked to state level cancer registry data using the Virtual Pooled Registry Cancer Linkage System (VPR-CLS). REGARDS includes longitudinally collected data for 30,239 participants (44% blacks), oversampled from stroke belt/buckle states (56% of participants from NC, SC, GA, TN, AL, MS, AK, LA) with large rural populations experiencing the highest mortality. REGARDS collects information at the individual level on sociodemographics, health literacy, and distance to healthcare, transportation, and risky health behaviors. Multi-level modeling and mediation modeling approaches will allow for the examination of the contribution of individual-level characteristics and the area-level characteristics simultaneously. Results will provide estimates of how much of the mortality disparity is explained by differences in urban and rural geographic characteristics overall as well estimates that describe the potential impact of hypothetical interventions on specific mediating factors. Findings will provide the critical evidence needed to inform policy and intervention development aimed at addressing the systemic disparities in mortality experienced by rural patients with cancer.

摘要 1991年至2015年间，美国的癌症死亡率下降了26%，但下降幅度并不相等。 在所有人群中。大约19%的美国人口居住在农村地区;三十多年来， 与城市居民相比，这一群体的生活质量越来越差。 据推测，癌症结局城乡差距扩大的根本原因是多因素的， 社会经济地位（SES）在个人层面和地理区域层面可能发挥重要作用， 作用证据方面的差距包括使用了多种“农村”定义，缺乏相关的地理证据， 因素和有限的证据基础上的多层次的方法来了解农村的复杂性， 差距。因此，本研究的总体目标是全面审查 农村/城市癌症患者死亡率差异的根本原因。在第一个目标中， 人口水平的监测、流行病学和最终结果（SEER）数据将用于研究死亡率 在被诊断患有癌症的个人中，农村的三种定义，为研究人员和政策提供了 制造商与每个定义的差异的大小。在第二个目标中，SEER将通过县连接- 指标到16个数据库（美国人口普查局，地区人口普查指数，劳工统计局，县 健康排名和路线图，AMA医疗保健劳动力映射器，BRFSS，社会脆弱性指数，健康 信息全国趋势调查等）。这些联系将使我们能够估计具体领域的贡献- 水平因子（例如，地区一级的社会经济地位、获得高质量护理的机会）对农村/城市死亡率差异的影响 分解方法在第三个目标中，中风的地理和种族差异的原因 （REGARDS）队列（U 01 NS 041588）将使用虚拟汇总数据库与州级癌症登记数据相关联。 登记癌症连锁系统（VPR-CLS）。REGARDS包括纵向收集的30，239份数据 参与者（44%黑人），从中风带/扣状态过采样（56%的参与者来自NC，SC，GA， TN，AL，MS，AK，LA），大量农村人口死亡率最高。关注收藏 个人层面的社会人口统计信息、健康素养和医疗保健距离， 交通和危险的健康行为。多层建模和中介建模方法将允许 同时考察个体水平特征和区域水平特征的贡献。 研究结果将提供估计，说明死亡率差异在多大程度上是由城市和 农村地理特征总体以及描述假设的潜在影响的估计 对特定中介因素的干预。调查结果将提供为政策提供信息所需的关键证据， 制定干预措施，旨在解决农村患者死亡率方面的系统性差异 得了癌症