Multilevel factors for racial/ethnic and socioeconomic disparities in prognosis of hepatocellular carcinoma

肝细胞癌预后中种族/民族和社会经济差异的多层次因素

• 批准号: 10058774
• 负责人: Amit Singal
• 金额: $ 92.28万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-03 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10058774
• 关键词: Affect; Age; Biological; Biological Factors; Cancer Etiology; Centers for Population Health; Cessation of life; Clinic; Clinical; Computerized Medical Record; Cuban; Data; Data Reporting; Databases; Diagnosis; Distal; Epidemiology; Ethnic Origin; Grant; Guidelines; Health; Health Services; Hepatology; Hispanics; Hospitals; Income; Individual; Inequality; Intervention; Knowledge; Liver Dysfunction; Malignant Neoplasms; Measures; Mexican; Minority Groups; Modeling; Multicenter Studies; Neighborhoods; Newly Diagnosed; Not Hispanic or Latino; Outcome; Pathway interactions; Patients; Persons; Population; Population Heterogeneity; Primary carcinoma of the liver cells; Prognosis; Provider; Public Health; Race; Registries; Reporting; Research; Serum; Site; Social Conditions; Social Policies; Social support; Socioeconomic Status; Stage at Diagnosis; Statistical Methods; Subgroup; System; Time; Translational Research; Tumor Biology; Tumor stage; Universities; base; biobank; black patient; clinical database; cohort; demographics; disadvantaged population; disparity reduction; ethnic minority population; health care service utilization; health disparity; health disparity populations; health literacy; implicit bias; improved; interest; intersectionality; low socioeconomic status; mortality; multidisciplinary; multilevel analysis; prognostic; prospective; racial and ethnic; racial and ethnic disparities; response; segregation; social; social relationships; socioeconomic disadvantage; socioeconomic disparity; socioeconomics; survival disparity; tumor

Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer-related death in the U.S. HCC disproportionally affects racial/ethnic minority and socioeconomically disadvantaged populations, with higher age-adjusted mortality observed in non-Hispanic blacks and Hispanic whites than non-Hispanic whites. To evaluate these disparities, we will use an adapted Warnecke/Centers for Population Health and Health Disparities ecological multi-level model attributing disparate health outcomes to biological-environmental interactions between and across distal (population social conditions and policies), intermediate (social and physical contexts including social relationships), and proximal (individual demographics and biological responses) determinants. Applying this model to HCC disparities will facilitate identification of key drivers of disparities in prognosis, which is the first necessary step to develop intervention strategies aimed at improving survival and reducing disparities following HCC diagnosis. Specifically, our proposal will characterize the contribution of proximal, intermediate, and distal determinants to disparities in 3 known measures of HCC prognosis: a) tumor stage at diagnosis, b) receipt of timely and guideline-concordant HCC treatment, and c) overall survival. Leveraging existing clinical databases and a biorepository of stored serum, we will conduct a multi-center study using electronic medical record-derived, patient-reported, provider-reported, and serum- based biological factors in a cohort of ~5000 patients newly diagnosed with HCC over a 13-year period to: Aim 1: Characterize the contribution of proximal, intermediate, and distal determinants of racial/ethnic and socioeconomic disparities in HCC tumor stage at diagnosis Aim 2: Determine racial/ethnic and socioeconomic disparities in receipt of timely and guideline- concordant HCC treatment including proximal, intermediate, and distal determinants Aim 3: Identify proximal, intermediate, and distal determinants of racial/ethnic and socioeconomic disparities in overall survival following HCC diagnosis Overall, we will identify factors across and within multiple levels associated with disparities in HCC prognosis between non-Hispanic white, Hispanic white, and non-Hispanic black patients as well as low versus high SES class in a large, racial/ethnically and socioeconomically diverse diverse cohort of ~5000 HCC patients. Our study will provide an understanding of why HCC prognosis disparities exist and at what level interventions should be implemented to reduce disparities improving overall survival.

肝细胞癌（HCC）是美国HCC癌症相关死亡的增长最快的原因 不成比例地影响种族/族裔少数民族和社会经济处境不利的人群，较高 与非西班牙裔白人相比，在非西班牙裔黑人和西班牙白人中观察到的年龄调整后的死亡率。到 评估这些差异，我们将使用改编的WARNECKE/中心进行人口健康与健康 差距生态多层模型将不同的健康结果归因于生物环境 远端（人口社会条件和政策）之间的相互作用，中级（社会和 包括社会关系在内的物理背景）和近端（个人人口统计学和生物学 响应）决定因素。将此模型应用于HCC差异将有助于识别 预后差异，这是制定旨在改善干预策略的第一步 HCC诊断后的生存和减少差异。具体来说，我们的建议将表征 近端，中间和远端决定因素对3种已知措施的差异的贡献 预后：a）诊断时的肿瘤阶段，b）及时和指南符合的HCC治疗以及C） 总体生存。利用现有的临床数据库和储存的血清生物孔，我们将进行一次 多中心研究使用电子病历衍生的，患者报告的，提供者报告和血清的研究 在约5000名在13年内新诊断为HCC的患者的队列中，基于生物学因素为： 目标1：表征近端，中间和远端决定因素的贡献 诊断时HCC肿瘤阶段的种族/种族和社会经济差异 目标2：确定种族/种族和社会经济差异，以获得及时和准则 - 一致的HCC治疗包括近端，中间和远端决定因素 目标3：确定种族/种族和社会经济的近端，中间和远端决定因素 HCC诊断后总生存的差异 总体而言，我们将确定与HCC预后差异相关的多个层次的因素 在非西班牙裔白人，西班牙裔白人和非西班牙裔黑人患者之间 大型，种族/种族和社会经济多样化的队列中的大型，种族/种族和社会经济多样性的班级。我们的 研究将了解为什么HCC预后差异以及在何种级别的干预措施中 应实施以减少差异，以改善整体生存。