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 年至 2000 年的 Medicare 和 Medicaid 资格以及与密歇根癌症和死亡证明登记处关联的密歇根居民的索赔文件来创建新诊断癌症患者的初始队列。该队列将通过医疗补助资格状态（双重资格与仅医疗保险资格）来识别。我们建议检查乳腺癌、结直肠癌、肺癌和前列腺癌的发病率、这些疾病在诊断时所处的阶段、为患者提供的治疗和相关护理费用以及诊断后的生存时间之间的差异。这项研究旨在扩展有关社会、个人、种族和卫生系统变量之间复杂相互作用的知识，这些变量造成并影响癌症发展轨迹上的差异。我们测试了一组系统得出的假设，并试图确定轨迹早期发现的差异如何影响轨迹后期的差异。例如，诊断的后期是否会导致护理不当，从而导致成本更高和生存期更短？检查癌症检测和/或治疗差异对生存的影响是这项研究对科学现状的重要补充之一。我们有四个简单表述的目标，但分析起来却非常复杂。我们的目标针对两个感兴趣的人群——双重资格享受 Medicare 和全额 Medicaid 福利的人，以及有资格享受 Medicare 但没有 Medicaid 的人（就本申请而言，称为“仅 Medicare”。）这些目标是： 1) 测量双重资格受益人和仅 Medicare 受益人的癌症发病率； 2) 比较双重资格受益人和仅 Medicare 受益人的诊断阶段； 3）比较两组的治疗情况并估计护理费用； 4) 衡量双重资格受益人和仅 Medicare 受益人的生存率。

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.