Comparative Modeling to Inform Cervical Cancer Control Policies: METRICS PROSPR Supplement Phase 2

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Project Abstract/Summary Understanding the impact of structural racism and discrimination (SRD) on care delivery in the cervical cancer screening processes and how it may produce disparate outcomes for minoritized communities is challenging for many reasons. Much of the evidence that we use to inform health care decisions lacks diverse representation from both a patient population and a healthcare setting perspective. Researchers now recognize that SRD, not only contribute to health disparities, but also to an inadequate evidence base. The CISNET-PROSPR METRICS Working Group has collaborated to address these issues during our Phase I supplement where we conceptualized how structural and institutional factors can lead to differences in access to care, identifying opportunities (and complexities) for modeling to explore the relative contributions of differences in screening practice among subgroups on disparate cervical cancer outcomes. In Phase II, we propose to quantitatively analyze multi-level data that reflect structural policies from the METRICS sites on cervical screening process measures and outcomes, and use the models to project the health impact of differential cervical cancer screening practices on alleviation (or exacerbation) of health disparities in cervical cancer incidence and mortality. Acknowledging the limited empirical evidence directly associating SRD and intermediate social exposures (ISEs) to cervical cancer screening practice and outcomes, the METRICS and CISNET-Cervical investigators propose to continue their collaboration to (1) test and interpret the influence of selected SRD measures on two screening outcomes; (2) project the impact and contributions of differential patterns of cervical cancer screening, diagnosis, and treatment on disparate cervical cancer outcomes among Black versus all women in the U.S.; and (3) integrate measures of association of SRD or ISEs from METRICS into the CISNET-Cervical models to explore the impacts on observed disparities in cervical cancer outcomes. This work would contribute to the limited existing literature on how to measure and model SRD and ISEs to promote equity in cervical cancer screening.