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

项目概要/摘要 肝细胞癌（HCC）是美国增长最快的癌症相关死亡原因 (US)低收入人群的发病率不断上升。由于诊断时癌症分期的重要性， 生存，我们应用小面积估计人口为基础的癌症登记在城市洛杉矶 县（LAC），以确定最高的晚期肝癌负担的干预领域。这些地理晚期阶段 HCC“热点”不成比例地集中在社会经济地位最低的地区。几 已经研究了促进HCC早期发现的策略，但大多数都不是针对低SES的 那些经历最大差异的人群。本提案的科学目标是解决这一问题 需要通过描述个人，组织和社区层面的决定因素的地理 晚期HCC在低SES社区的聚集。具体而言，我们建议使用地理空间技术 完善我们基于人群的晚期热点，并围绕空间、临床和 时间输入（目标1）。我们将分析一个多层次的数据集，该数据集由前瞻性调查、医疗记录和 700例HCC登记病例的地理空间联系，以确定SES差异的根本决定因素（Aim 2）。最后，半结构化面试将在多个层面进行（例如，患者、提供者和 社区领袖），以探索在低SES人群中完成HCC早期检测途径的障碍 人口（目标3）。研究结构在概念上是基于国家少数民族健康研究所 和健康差异框架，并在多层次健康成果框架指导下进行访谈。 总之，我们丰富的理论驱动的数据将直接为多层次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HCC热点进行干预，然后进行随机对照的分组研究。 R 01中的干预试验。本建议书中的培训目标将培养周博士成长为毒瘤 差异研究人员专注于早期检测战略中的地理空间创新，以减轻差异， 改善服务不足的HCC患者的预后。周博士培训的四大核心内容 计划联合收割机结合先进的教学与应用经验：（1）在空间方法和 地理可视化;（2）多层次建模和定性方法的基础，以支持有效的差异 研究;（3）介绍多层次干预设计和交付;（4）专业发展， 癌症差异周博士有机会进入一个学术研究环境， 和癌症控制研究，拉丁美洲和加勒比地区社会经济多样化的城市人口，以及强大的 跨学科导师团队，由主要导师Cockburn博士（空间科学和癌症 Mack博士（多层次建模）、Bastani博士（多层次干预）和Terrault博士 （职业发展）。总而言之，该建议将详细的培训目标嵌入到以下实际序列中： 研究旨在为Zhou博士提供一条明确的独立研究路径。

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.