In-Depth Examination of Disparities in Cancer Outcomes

描述(由申请人提供)：这项拟议的研究使用1996至2000年的联邦医疗保险和医疗补助资格和索赔文件，将密歇根州居民与密歇根州癌症和死亡证书登记处联系起来，以创建新诊断的癌症患者的初始队列。这一群体将由医疗补助资格状态确定(仅限双重资格与联邦医疗保险)。我们建议检查乳腺癌、结直肠癌、肺癌和前列腺癌发病率的差异，这些疾病在诊断时的阶段，为患者提供的治疗和相关的护理费用，以及诊断后的生存时间。这项研究试图扩大关于社会、个人、种族和卫生系统变量之间复杂交互作用的知识，这些变量造成并影响癌症轨迹上的差异。我们测试了一组系统的假设，并试图确定轨迹早期识别的差异如何影响轨迹后期的差异。例如，在诊断的后期是否会导致不太适当的护理，从而导致更高的成本和更短的生存时间？检查癌症检测和/或治疗方面的差异对存活率的影响是这项研究对科学状况的重大补充之一。我们有四个简单明了的目标，但在分析上却非常复杂。我们的目标是针对两个相关人群--双重有资格享受Medicare和全额Medicaid福利的人，以及有资格享受Medicare而不享受Medicaid的人(在本申请中，仅指“Medicare”)。这些目标是：1)测量符合双重条件的受益人和仅符合联邦医疗保险的受益人的癌症发病率；2)比较符合双重条件的受益人和仅符合联邦医疗保险的受益人的诊断阶段；3)比较两组之间的治疗提供情况并估计护理成本；以及4)衡量符合双重资格的受益人和仅符合联邦医疗保险的受益人的存活率。

DESCRIPTION (provided by applicant): This proposed research uses 1996 through 2000 Medicare and Medicaid eligibility and claim files for Michigan residents linked with the Michigan Cancer and Death Certificate Registries to create an inception cohort of newly diagnosed cancer patients. This cohort will be identified by Medicaid eligibility status (dually eligible versus Medicare only). We propose to examine disparities in the incidence of breast, colorectal, lung, and prostate cancer, the stage of these diseases at diagnosis, treatment afforded to patients and associated costs of care, and the survival time following diagnosis. This research seeks to expand knowledge regarding the complex interactions among the social, personal, racial, and health system variables that create and influence disparities along the cancer trajectory. We test a systematically derived set of hypotheses and seek to determine how disparities identified early in the trajectory influence disparities at later points in the trajectory. For example, does later stage at diagnosis lead to less appropriate care that leads to higher costs and shorter survival? An examination of the impact of disparities in cancer detection and/or treatment on survival is one of the significant additions of this research to the state of the science. We have four simply stated aims that are analytically highly complex. Our aims are targeted at two populations of interest--persons dually eligible for Medicare and full Medicaid benefits and persons eligible for Medicare without Medicaid (for the purposes of this application, referred to as "Medicare only.") These aims are: 1) Measure the cancer incidence rates in dually eligible and Medicare only beneficiaries; 2) Compare stage of diagnosis for dually eligible and Medicare only beneficiaries; 3) Compare treatment delivery between the two groups and estimate the cost of care; and 4) Measure survival rates for dually eligible and Medicare only beneficiaries.