Multilevel Determinants of Socioeconomic Disparities in Geographic Late Stage Hepatocellular Carcinoma Hotspots

项目摘要/摘要 肝细胞癌(HCC)是美国癌症相关死亡人数增长最快的原因 (美国)，低收入个人的发病率不断上升。由于癌症分期在诊断中的重要性 存活率，我们将小区域估计应用于洛杉矶市区基于人群的癌症登记。 县(LAC)确定晚期肝癌负担最高的地区进行干预。这些地理上的晚期 肝癌“热点”不成比例地集中在社会经济地位(SES)最低的地区。一些 已经研究了促进肝癌早期发现的策略，但大多数都不是为低SES量身定做的 经历最大差距的人口。这项提议的科学目标就是解决这个问题。 需要通过描述地理位置的个人、组织和社区级别的决定因素来实现 晚期肝癌在低SES社区的聚集。具体来说，我们建议使用地理空间技术 提炼以人口为基础的晚期热点，并围绕空间、临床和 时间投入(目标1)。我们将分析从前瞻性调查、医疗记录和 700个肝癌事件登记案例的地理空间联系，以确定SES差异的根本决定因素(AIM 2)。最后，半结构化访谈将在多个层面上进行(例如，患者、提供者和 社区领袖)探索在低SES地区完成肝细胞癌早期检测途径的障碍 人口(目标3)。研究结构在概念上植根于国家少数民族健康研究所 和健康差异框架，访谈遵循多层次健康结果框架。 总之，我们丰富的理论驱动的数据将直接为多级别早期检测试点的战略计划提供信息 在未来的R34中针对晚期肝癌热点进行干预，随后进行随机分组对照 R01中的干预试验。这项提案中的培训目标将促进周博士作为癌症患者的成长 差异研究人员专注于早期检测战略中的地理空间创新，以缓解差异和 改善未得到充分服务的肝癌患者的预后。周博士培训的四个核心组成部分 Plans将先进的教学方法与应用经验相结合：(1)精通空间方法和 地理可视化；(2)支持有效差异的多层次建模和定性方法基础 研究；(3)多水平干预设计和实施的介绍；(4)专业发展 癌症差异。周博士可以接触到丰富的癌症差异的学术研究环境 和癌症控制研究，拉丁美洲和加勒比社会经济多元化的城市人口，以及强大的 跨学科导师小组，由主要导师Cockburn博士(空间科学和癌症)组成 对照)和共同导师Mack博士(多水平建模)、Bastani博士(多水平干预)和Terrault博士 (职业发展)。总而言之，这项建议将详细的培训目标嵌入了一系列实际的 这项研究旨在为周博士提供一条通向调查人员独立性的明确道路。

PROJECT SUMMARY/ABSTRACT Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer-related deaths in the United States (US), with rising incidence among low-income individuals. Due to importance of cancer stage at diagnosis to survival, we applied small area estimation to the population-based cancer registry in urban Los Angeles County (LAC) to identify areas of highest late stage HCC burden for intervention. These geographic late stage HCC “hotspots” were disproportionately concentrated in areas of lowest socioeconomic status (SES). Few strategies to promote the early detection of HCC have been studied and most are not tailored to the low SES populations that experience the greatest disparity. The scientific objective of this proposal is to address this need by characterizing the individual-, organizational-, and community-level determinants of the geographic aggregation of late stage HCC in low SES communities. Specifically, we propose to use geospatial techniques to refine our population-based late stage hotspots and perform sensitivity analyses around spatial, clinical, and temporal inputs (Aim 1). We will analyze a multilevel dataset built from prospective survey, medical record, and geospatial linkage of 700 incident HCC registry cases to identify the root determinants of SES disparities (Aim 2). Last, semi-structured interviews will be conducted at multiple levels (e.g., patients, providers, and community leaders) to explore barriers to completion of the early detection pathway for HCC in low SES populations (Aim 3). Study constructs are conceptually grounded in the National Institute on Minority Health and Health Disparities Framework, with interviews guided by the Multi-Level Health Outcomes Framework. Together, our rich theory-driven data will directly inform the strategic plan for a multilevel early detection pilot intervention targeting late stage HCC hotspots in a future R34, followed by a cluster randomized controlled intervention trial in a R01. The training objectives in this proposal will foster Dr. Zhou’s growth as a cancer disparities researcher focused on geospatial innovation in early detection strategies to mitigate disparities and improve outcomes among underserved populations with HCC. The four core components of Dr. Zhou’s training plan combine advanced didactics with applied experience: (1) proficiency in spatial methodology and geovisualization; (2) foundation in multilevel modeling and qualitative methods to support effective disparities research; (3) introduction to multilevel intervention design and delivery; and (4) professional development in cancer disparities. Dr. Zhou has access to an academic research environment enriched for cancer disparities and cancer control research, a socioeconomically diverse urban population in LAC, and a strong transdisciplinary mentorship team, comprised of primary mentor Dr. Cockburn (spatial sciences and cancer control) and co-mentors Dr. Mack (multilevel modeling), Dr. Bastani (multilevel interventions), and Dr. Terrault (career development). In summary, this proposal embeds detailed training goals within a practical sequence of research aims to provide Dr. Zhou with a clear path to investigator independence.