Geospatial drivers of cancer care disparities and their susceptibility to health policy changes

项目摘要 缺乏保险覆盖面和个人收入与就业方面的巨大差距有关。 实体器官恶性肿瘤患者的癌症护理，包括出现时的晚期疾病， 降低了接受癌症导向手术的可能性，并降低了生存率。然而， 了解影响获得和接受保健的上游地理空间健康决定因素， 20%的美国人生活在农村社区。此外，最近的卫生政策在多大程度上 这些变化影响了生活在农村和社会经济弱势群体的患者的癌症护理提供 社区仍然不清楚。为了解决这些差距，Loehrer博士计划进行一项基于人群的研究， 观察性和准实验性队列研究，以评估农村居民、社区和社区的影响， 水平的社会经济剥夺，以及他们与保险覆盖面的相互作用， 实体器官恶性肿瘤的管理。此外，我们将评估负担得起的医疗服务 法案相关的保险扩展影响了农村和社会经济上的癌症护理提供 多样化的社区。这项研究利用了选择州癌症登记处的新用途， 在地理上联系起来的社区一级社会经济贫困的衡量标准。多级定量 方法、地理可视化、地理计算方法、时空分析和计量经济学 建模将全部用于描述和可视化保险覆盖范围、农村 居住地，当地社区一级的社会经济因素，除了决定国家一级的影响 扩大癌症护理服务差距的保险。该研究将提供以下重要信息： 癌症护理差异的上游地理空间驱动因素，同时评估 关于农村癌症差异的卫生政策。 博士Loehrer是达特茅斯-希区柯克医学中心的外科肿瘤学家和卫生服务研究员， 达特茅斯卫生政策和临床实践研究所。他的临床实践包括照顾病人 皮肤，软组织和肝脏恶性肿瘤，而他的学术重点是在交叉卫生政策，社会 健康的决定因素和癌症护理提供的公平性。他的长期职业目标是成为一名 创新和独立资助的卫生政策研究人员，重点是弱势群体。的 提出的研究计划补充了职业发展和培训计划，重点是 地理空间方法和应用。该奖项将奠定方法和政策基础， 对医疗补助提供中各州特定豁免的后续研究，目前尚为时过早。

Project Summary Lack of insurance coverage and individual income have been associated with considerable disparities in cancer care for patients with solid organ malignancies, including later stage disease at time of presentation, decreased probability of undergoing cancer-directed surgery, and decreased survival. However, much less is understood about upstream geospatial determinants of health that influence access to and receipt of care for the 20% of Americans that live in rural communities. Furthermore, the degree to which recent health policy changes have impacted cancer care delivery for patients living in rural and socioeconomically vulnerable communities remains unclear. To address these gaps, Dr. Loehrer plans to conduct a population-based observational and quasi-experimental cohort study to evaluate the influence of rural residence, community- level socioeconomic deprivation, and their interaction with insurance coverage on presentation with and management of solid organ malignancies. Additionally, we will evaluate the degree to which Affordable Care Act associated insurance expansion influenced cancer care delivery across rural and socioeconomically diverse communities. The study capitalizes on the novel use of select state cancer registries with geographically linked measures of community-level socioeconomic deprivation. Multilevel quantitative methods, geovisualization, geocomputational approaches, spatiotemporal analyses, and econometric modelling will all be used to describe and visualize complex relationships between insurance coverage, rural residence, local community-level socioeconomic factors in addition to determining the influence of state-level insurance expansion on disparities in cancer care delivery. The study will provide important information on upstream geospatial drivers of cancer care disparities while also evaluating the heterogeneous influence of health policy on rural cancer disparities. Dr. Loehrer is a surgical oncologist and health services researcher at Dartmouth-Hitchcock Medical Center and The Dartmouth Institute for Health Policy and Clinical Practice. His clinical practice includes care for patients with skin, soft-tissue, and liver malignancies while his academic focus is at the intersection health policy, social determinants of health, and equity of cancer care delivery. His long-term career goal is to become an innovative and independently funded health policy researcher with a focus on vulnerable populations. The research plan presented complements both career development and training plans that are focused on geospatial methodologies and application. The award will lay the methodological and policy foundation for follow-up studies on state-specific waivers in Medicaid delivery that are too early to be evaluated at present.