Health System and Contextual Factors Associated with Racial Equity in Lung Cancer Care

与肺癌护理中种族公平相关的卫生系统和背景因素

• 批准号: 10708007
• 负责人: Cary P. Gross
• 金额: $ 63.08万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-21 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708007
• 关键词: Accidents; Accounting; Address; Administrator; Adopted; Area; Black race; Cancer Patient; Caring; Cause of Death; Characteristics; Cluster Analysis; Communities; Community Healthcare; County; Data; Diagnosis; Dimensions; Disease; Disparity; Ensure; Equity; Geographic Locations; Geography; Goals; Health Policy; Health Service Area; Health Services Research; Health system; Healthcare; Healthcare Systems; Hospitals; Individual; Interview; Knowledge; Learning; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Medicaid; Medicaid eligibility; Medicare; Methods; Modeling; Non-Small-Cell Lung Carcinoma; Outcome; Patient-Focused Outcomes; Patients; Policies; Politics; Population Study; Provider; Public Health; Quality of Care; Race; Racial Equity; Research; Resources; Sampling; Social Environment; Social Workers; Socioeconomic Factors; Structural Racism; Structure; Supportive care; System; United States; United States National Institutes of Health; Variant; World Health Organization; beneficiary; black patient; cancer care; cancer diagnosis; cancer health disparity; community setting; contextual factors; disparity reduction; experience; health assessment; health care delivery; health care settings; health equity; health service use; improved; innovation; lens; long-standing disparities; multilevel analysis; novel; population health; public policy on tobacco; racial disparity; segregation; social; social factors; social health determinants; socioeconomic disparity; socioeconomics; treatment disparity

Significance: Non-small cell lung cancer (NSCLC), the leading cause of death from cancer in the U.S., is plagued by racial disparities across the spectrum of care. Despite the fact that racial cancer disparities are long- standing and well-described, fundamental knowledge gaps remain. First, the degree to which racial disparities in NSCLC care and outcomes vary across geographic regions has not been thoroughly explored. Second, little is known about how contextual factors contribute to racial disparities at the regional level. Historically, health services research has focused on the healthcare system as the primary driver of racial disparities, with a limited exploration of contextual factors such as health care segregation and structural racism. Further, it is unclear how key stakeholders within the healthcare and community settings address and overcome barriers to equitable NSCLC care. Objective: We will address these critical knowledge gaps, with the overarching goal of mitigating racial disparities in NSCLC diagnosis, treatment, and outcomes, by identifying modifiable structural and health system/intermediary factors and strategies that influence equity in lung cancer care. We intend to conduct an explanatory sequential mixed methods study, combining novel retrospective, population-based studies of racial disparity in lung cancer care with a positive deviance analysis. Through qualitative interviews with key stakeholders in regions with high versus low racial disparities, we will reveal strategies and structures that influence equity in lung cancer care and outcomes. Our hypothesis is that the magnitude of racial disparities varies substantially across counties, and this variation does not arise by accident – there are specific contextual factors, such as structural racism, segregation, and health system factors, that exacerbate disparities. Specific Aims: We propose an explanatory sequential mixed methods study of Medicare beneficiaries diagnosed with NSCLC from 2013 through 2017: (1) To assess variation in racial disparities in NSCLC care (non-Latinx Black vs. non-Latinx White) across counties within SEER regions. (2) To assess structural/foundational factors (e.g. structural racism, socioeconomic inequality) associated with area-level racial disparities in NSCLC care. (3) To assess health system/intermediary determinants (e.g. hospital characteristics and competition, patient segregation) of area-level racial disparities in NSCLC care. (4) To identify stakeholder strategies associated with ensuring equitable NSCLC care in counties that have similar socioeconomic characteristics, yet higher versus lower racial disparities. The proposed mixed methods study will have a high impact, using a combination of innovative methods to move beyond traditional health system factors to identify modifiable structural, socioeconomic, and social factors that contribute to lung cancer disparities. Furthermore, we will elucidate strategies that stakeholders have used to decrease racial disparities, identifying approaches that can be adopted more broadly to improve equity in NSCLC care.

意义：非小细胞肺癌（NSCLC）是美国癌症死亡的主要原因