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
基本信息
- 批准号:10340241
- 负责人:
- 金额:$ 27.18万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AddressAreaBehavioral Risk Factor Surveillance SystemBlack PopulationsBlack raceBudgetsCancer PatientCaringCensusesCharacteristicsClinical TrialsCodeCommutingComplexCountyDataData SetDatabasesDiagnosisEmergency department visitEvaluationExcess MortalityFibrinogenFutureGeographic FactorGeographic LocationsGeographyHealthHealth Information National Trends SurveyHealth InsuranceHealth Services AccessibilityHealth behaviorHealthcareHospitalizationIndividualInferiorInsuranceInterventionLinkMalignant NeoplasmsMapsMediatingMediationMethodologyModelingNatureOffice ManagementOutcomeParticipantPlayPoliciesPolicy DevelopmentsPolicy MakerPopulationPovertyPoverty AreasQuality of CareRaceReasons for Geographic And Racial Differences in StrokeReportingResearch PersonnelRoleRuralRural PopulationSEER ProgramSamplingSocial supportSocioeconomic StatusSpecialistStroke BeltSystemTransportationWorkcancer health disparitycohortcomorbiditycontextual factorsdata registrydeprivationevidence baseexperiencehealth literacyindexingmalignant breast neoplasmmortalitymortality disparitymultilevel analysisneoplasm registryprimary outcomerural arearural disparitiesrural patientsrural povertyrural residenceruralitysocial vulnerabilitysociodemographicsstatisticstherapy developmenturban areaurban disparityurban residencevirtual
项目摘要
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-
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
项目成果
期刊论文数量(0)
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KELLY KENZIK其他文献
KELLY KENZIK的其他文献
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{{ truncateString('KELLY KENZIK', 18)}}的其他基金
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:
10814517 - 财政年份:2023
- 资助金额:
$ 27.18万 - 项目类别:
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:
10711063 - 财政年份:2022
- 资助金额:
$ 27.18万 - 项目类别:
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