Characterizing Disparities and Elucidating Opportunities Across the Cervical Cancer Continuum among Native American Women

项目总结/摘要 虽然宫颈癌是一种可预防的疾病，但美国印第安人/阿拉斯加原住民（AI/AN） 妇女的宫颈癌筛查率低得多， 宫颈癌的发病率;并且更经常在疾病的遥远阶段被诊断出来 比非原住民的人多。尽管在降低总体宫颈癌发病率方面取得了进展， 在美国，AI/AN女性的发病率较高（且不断增加）， 诊断时局部与晚期疾病的不利特征，表明持续的 需要进行积极和全面的筛查，并对异常结果进行及时随访。在 在这个时期，有效和众所周知的宫颈癌控制干预措施，如巴氏涂片， 筛查、人乳头瘤病毒（HPV）检测和HPV疫苗接种是广泛可用的， 宫颈癌连续体之间的这些明显差异对AI/AN妇女来说是令人震惊的， 反映了一个重大的公共卫生问题。本研究旨在填补这些关键空白， 通过利用IHS中AI/AN女性的关联数据来了解，理解和翻译 Epi Data Mart与高度独特的新墨西哥州HPV Pap登记处（NMHPVPR）的女性合作， 描述宫颈癌筛查的覆盖率、比率和强度、宫颈癌筛查失败率 筛查、诊断和治疗，以及宫颈筛查与HPV疫苗接种的相关性 在AI/AN女性中。我们的目标是使用链接数据集：a）减少任何种族 NMHPVPR中AI/AN妇女的错误分类和宫颈癌筛查的特征 覆盖率、强度、间隔时间和年筛查率，并确定筛查中的差异 在新墨西哥州的IHS/部落/城市（I/T/U）卫生保健机构登记的印第安人/非印第安人妇女中; B）评估对异常巴氏/HPV检测的随访失败，以及诊断后的治疗 新墨西哥AI/AN妇女宫颈癌前病变的发病率，并对 失败，以便在最需要的领域指导有针对性的干预措施;以及c）估计HPV 根据HPV疫苗接种状态划分的疫苗接种覆盖率、疫苗剂量递送和筛查启动 在印第安人/印第安纳州，妇女在印第安人/印第安纳州/印第安纳州设施中上学。这项研究的首要前提是， 全面阐明AI/AN之间发生故障的具体途径 整个宫颈癌连续体的妇女将告知成本效益和数据驱动 干预战略，可以减轻普遍存在的健康差距， 这一弱势群体。研究结果将被翻译成几个同行评审 这些手稿将被翻译成报告和演示文稿，以告知部落领导人， I/T/U管理员/供应商了解关键的改进机会。

PROJECT SUMMARY/ABSTRACT Although cervical cancer is a preventable disease, American Indian/Alaska Native (AI/AN) women suffer from substantially lower cervical cancer screening rates, disproportionately higher cervical cancer incidence rates; and are more often diagnosed at distant stages of the disease than their non-Native counterparts. Despite progress in reducing the overall cervical cancer rate in the U.S., the higher (and increasing) incidence rate among AI/AN women, and the unfavorable profile of local versus advanced stage of disease at diagnosis, indicate a continued need for aggressive and comprehensive screening and timely follow-up of abnormal results. At a time when efficacious and well-known cervical cancer control interventions such as Pap screening, testing for human papillomavirus (HPV), and HPV vaccinations are widely available, these stark disparities across the cervical cancer continuum are alarming for AI/AN women and reflect a significant public health problem. This study will aim to fill in these critical gaps in knowledge, understanding, and translation by utilizing linked data for AI/AN women in the IHS Epi Data Mart with women in the highly unique New Mexico HPV Pap Registry (NMHPVPR) to characterize cervical cancer screening coverage, rates and intensity, failures in cervical cancer screening, diagnosis and treatment, and correlates of cervical screening with HPV vaccination among AI/AN women. Our aims are to use the linked dataset to: a) reduce any racial misclassification of AI/AN women in the NMHPVPR and characterize cervical cancer screening coverage, intensity, intervals, and annual screening rates and to identify disparities in screening among AI/AN women registered at IHS/Tribal/Urban (I/T/U) health care facilities in New Mexico; b) assess failures in follow-up to abnormal Pap/HPV tests, and treatment following a diagnosis of cervical precancer among New Mexican AI/AN women and to geospatially analyze the failures so as to guide targeted interventions in the areas of most need; and c) to estimate HPV vaccination coverage, vaccine dose delivery, and screening initiation by HPV vaccination status in AI/AN women attending I/T/U facilities. The overarching premise of this study is that comprehensive elucidation of the specific pathways through which failures occur among AI/AN women across the cervical cancer continuum will inform cost-effective and data-driven strategies for intervention that can mitigate the pervasive health disparities witnessed among this underserved population. Study findings will be translated into several peer-reviewed manuscripts and will be translated into reports and presentations to inform tribal leadership and I/T/U administrators/providers about key opportunities for improvement.