Policy-relevant mechanisms of socioeconomic disparities in adherence to oral hormonal therapy for breast cancer

乳腺癌口服激素治疗依从性社会经济差异的政策相关机制

• 批准号: 9153150
• 负责人: JOAN Marie NEUNER
• 金额: $ 65.33万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-11 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9153150
• 关键词: Address; Adherence; Adjuvant; Administrator; Advocacy; Affect; Age; Area; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer survivor; Breast Cancer therapy; Cancer Patient; Caring; Chronic; Chronic Care; Chronic Disease; Communities; Complex; Data; Data Set; Diagnosis; Dosage Forms; Economics; Eye; Frequencies; Goals; Health; Hormonal; Hormone Receptor; Incentives; Income; Insurance; Intervention; Lead; Life; Link; Literature; Low income; Malignant Neoplasms; Measures; Medicaid; Medical; Medical Economics; Morbidity - disease rate; Oral; Outcome; Outpatients; Patients; Persons; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacy facility; Policies; Policy Maker; Provider; Public Health; Public Policy; Regimen; Research; Research Personnel; Resources; Risk; Role; Societies; Socioeconomic Status; Source; Treatment Effectiveness; Treatment outcome; Visit; Woman; Work; aged; base; burden of illness; cancer therapy; cohort; compliance behavior; cost; design; disparity reduction; dosage; experience; health care delivery; hormone therapy; improved; low socioeconomic status; malignant breast neoplasm; medication compliance; mortality; mortality disparity; pill; segregation; socioeconomic disparity; socioeconomics; therapy adherence

PROJECT SUMMARY-ABSTRACT Poor medication adherence is a leading cause of preventable morbidity and mortality, and patients of low socioeconomic status (SES) are up to 65% more likely to be non-adherent. Breast cancer patients living in high SES areas have 84% five-year survival compared with 68% for low SES, and there are large SES-based differences in breast cancer treatment, particularly use and adherence to hormonal therapy (HT), that likely contribute to these survival differences. In this proposal, we seek to investigate mechanisms for the differences in HT adherence, focusing on potentially remediable health delivery issues. Specifically, we aim to 1) Examine the extent of SES disparities in adherence to oral hormonal breast cancer therapies, and their association with mortality disparities among an all-age, national cohort of women with incident breast cancer, 2) Decompose potential mechanisms (ability to pay, medication complexity, and pharmacy accessibility) of adherence disparities and 3) Simulate the effect of alternative care strategies and policies on HT adherence, breast cancer mortality and SES disparities therein. These aims will be carried out by analyzing a contemporary cohort of women with incident breast cancer identified from the Optum U.S. dataset, which contains sociodemographic, economic (including net worth), medical, and pharmaceutical information for over 35 million patients covered by private and public insurance, which we will link to pharmacy distance measures. We will begin by examining the relationship between measures of SES, adherence and mortality, and then seek to apportion the SES disparities in adherence according to the contribution of each potential factor (or set of factors), using the Oaxaca-Blinder regression-based decomposition approach. Finally, having quantified the net contribution of each factor on SES-specific adherence and differentials therein, we will use parameter estimates generated in Aim 1 to simulate the anticipated effect of alternative policies or interventions (changing subsidy thresholds, improving refill synchronization) in reducing disparities in breast cancer treatment and outcomes. Our goal is to provide policymakers, plan administrators, researchers and advocacy societies with an improved understanding of the health delivery factors that might explain SES disparities in breast cancer outcomes, with an eye to developing effective strategies to eliminate them. By focusing on the experience of a large and diverse cohort of breast cancer patients of all ages, this study will address an important and timely issue, and directly inform efforts to determine how best to allocate resources in cancer as well as other chronic conditions in order to obtain the greatest value and equity.

项目概要-摘要 药物依从性差是可预防的发病率和死亡率的主要原因，而低水平患者 社会经济地位 (SES) 不依从的可能性高达 65%。生活在高处的乳腺癌患者 SES 地区的五年生存率为 84%，而低 SES 地区的五年生存率为 68%，并且存在大量基于 SES 的地区 乳腺癌治疗的差异，特别是激素治疗 (HT) 的使用和依从性，可能 造成这些生存差异。在本提案中，我们寻求调查差异的机制 在 HT 依从性方面，重点关注潜在可补救的健康交付问题。具体来说，我们的目标是 1）检查 坚持口服激素乳腺癌治疗的 SES 差异程度及其与 全国所有年龄的乳腺癌女性队列中的死亡率差异，2) 分解 依从性的潜在机制（支付能力、药物复杂性和药房可及性） 3) 模拟替代护理策略和政策对 HT 依从性、乳房 癌症死亡率和其中的社会经济地位差异。这些目标将通过分析当代的 从 Optum U.S. 数据集中发现的患有乳腺癌的女性队列，其中包含 为超过 3500 万人提供社会人口统计、经济（包括净资产）、医疗和制药信息 受私人和公共保险覆盖的患者，我们将其与药房距离措施联系起来。我们将 首先检查 SES、依从性和死亡率之间的关系，然后寻求 根据每个潜在因素（或一组因素）的贡献来分配 SES 依从性差异 因子），使用基于 Oaxaca-Blinder 回归的分解方法。最后，量化了 每个因素对 SES 特定依从性和其中差异的净贡献，我们将使用参数 目标 1 中生成的估计值用于模拟替代政策或干预措施的预期效果（改变 补贴阈值、改善补充同步），以减少乳腺癌治疗的差异和 结果。我们的目标是为政策制定者、计划管理者、研究人员和倡导团体提供 更好地了解可能解释乳腺癌中社会经济地位差异的健康提供因素 成果，着眼于制定有效的策略来消除它们。通过专注于一个人的经历 由于所有年龄段的乳腺癌患者规模庞大且多样化，这项研究将解决一个重要且及时的问题 问题，并直接为确定如何最好地分配癌症及其他慢性病资源的努力提供信息 从而获得最大的价值和权益。