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

项目摘要/摘要 了解结构性种族主义和歧视(SRD)对宫颈癌护理服务的影响 筛选过程以及它如何对小规模社区产生不同的结果是具有挑战性的 原因有很多。我们用来为医疗保健决策提供信息的大部分证据缺乏多样性 从患者群体和医疗保健环境的角度进行描述。现在的研究人员 认识到SRD不仅会造成健康差距，而且还会造成证据基础不足。 在我们的阶段中，CISNET-PROSPR指标工作组已经协作解决了这些问题 我补充说，我们概念化了结构性和体制性因素是如何导致准入差异的 关注，确定建模的机会(和复杂性)，以探索 不同子宫颈癌结果亚组间筛查实践的差异。在第二阶段，我们 建议对反映指标站点结构策略的多层次数据进行量化分析 宫颈筛查过程的措施和结果，并使用这些模型来预测 缓解(或加剧)宫颈癌健康差距的不同宫颈癌筛查做法 癌症发病率和死亡率。 承认将自发性精神分裂症与中间社会暴露直接联系起来的经验证据有限 (ISES)到宫颈癌筛查实践和结果、指标和CISNet-宫颈调查人员 建议继续他们的合作，以(1)测试和解释选定的SRD措施对两个 筛查结果；(2)预测宫颈癌不同类型的影响和贡献 黑人与所有女性宫颈癌预后不同的筛查、诊断和治疗 美国；以及(3)将SRD或ISES的关联度量从指标整合到CISNET-CIRCESS中 探索对观察到的宫颈癌预后差异的影响的模型。 这项工作将有助于现有关于如何测量SRD和ISES并对其进行建模的有限文献 促进宫颈癌筛查公平。

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.