Examining the Relationship between Residential History at Midlife and Prostate Cancer Outcomes

摘要 前列腺癌（PCa）是少数几种死亡率是黑人男性死亡率两倍以上的癌症之一， 癌症中最大的种族差异之一。尽管有记录表明PCa的发病率存在差异， 和死亡率与人们居住的地方有关，目前还不清楚患者的居住史如何影响他们的死亡率。 PCa结果。居住环境因种族和社会经济状况（SES）而有很大差异。仍然知之甚少 关于如何纵向暴露于邻里风险因素和结构性种族主义捕捉年前， 癌症诊断和存活率的差异导致了沿着癌症护理连续体的PCa差异。 此外，PCa的疾病结局和差异受患者年龄的影响。居住历史 是可能影响PCa发病率、进展、死亡率和整体护理的因素之一 幸存者。我们提出了一个创新的联系PA癌症登记数据的医院计费记录， PA医疗保健成本控制理事会和约30年的LIGHTNEXIS地址数据，以提供特征 病人居住的人口普查区域。我们将使用宾夕法尼亚州（PA）癌症登记数据（N~ 20，000例患者 在PA东南部），以确定纵向邻里特征（贫困）之间的关系 轨迹，历史红线，贷款偏见和中产阶级化）和PCa结果在关键点沿着 癌症护理连续体在一个多样化的和历史悠久的地区。这些不同的特征将用于确定 在PCa结果的风险建模中检查居住历史的最佳实践。我们会过一种新奇的生活 课程的方法来解决住宅历史的作用， PCa差异。我们假设累积的暴露量 在关键时期暴露于邻里风险因素， PCa护理轨迹影响疾病特征， 诊断和PCA死亡率。多层次回归模型将 进行评估的多层次的独立协会 影响PCa结果的因素。我们还将检查修改， 年龄我们从这项研究中了解到的信息将有助于我们 了解如何将居住史纳入癌症研究 制定有效的干预措施， 高危成年人的健康 我们提出了一个纵向的双向研究，以解决 目的1：研究PCa与 诊断时的差异和居住特征;目标2：我们将采用生命历程框架， 检查PCa差异和累积癌症差异研究之间的关系（基于Ory，et al. 居住史;目标3：研究居住暴露如何影响（AJPM，2014年）。差异发生在 特别是在中年期间积累的PCa与环境背景有关。研究主要集中在 目标4：在特定的生命阶段进行社区需求评估，提供独特的机会 与专家临床医生和社区规划利益相关者建立伙伴关系，为政策，实践和健康提供信息。 改善PCa外展和护理社区。

ABSTRACT Prostate cancer (PCa) is one of a few cancers with more than double the mortality for black men, making this one of the greatest racial disparities in cancer. Although there are documented disparities in PCa incidence and mortality related to where people live, it is unclear how residential histories of patients contribute to their PCa outcomes. Residential environments vary greatly by race and socioeconomics (SES). Still little is known about how longitudinal exposures to neighborhood risk factors and structural racism captured years before a cancer diagnosis and into survivorship contribute to PCa disparities along the cancer care continuum. Additionally, disease outcomes and disparities in PCa are moderated by patient age. Residential history during midlife is one of the factors that likely influences PCa incidence, progression, mortality, and overall care of survivors. We propose an innovative linkage of PA cancer registry data to hospital billing records from the PA Healthcare Cost Containment Council and ~30 years of LexisNexis address data to provide characteristics of census tracts where patients live. We will use Pennsylvania (PA) Cancer Registry data (N~20,000 patients in Southeastern PA) to determine the relationship between longitudinal neighborhood characteristics (poverty trajectories, historical redlining, lending bias, and gentrification) and PCa outcomes at critical points along the cancer care continuum in a diverse and historic region. These various characteristics will be used to determine best practices to examine residential histories in risk modeling for PCa outcomes. We will take a novel life course approach to addressing the role of residential history on PCa disparities. We hypothesize that cumulative exposures as well as exposures to neighborhood risk factors during critical periods in the PCa care trajectory influence disease characteristics at diagnosis and PCa-mortality. Multilevel regression models will be conducted to evaluate independent associations of multi-level factors with PCa outcomes. We will also examine modification by age. The information that we learn from this study will help us to understand ways to integrate residential history in cancer research and strategize about effective interventions to promote prostate health among high-risk adult populations We propose a longitudinal, ambidirectional study to address the following aims: Aim 1: To examine the relationships between PCa disparities and residential characteristics at diagnosis; Aim 2: To We will employ a life-course framework in this examine relationships between PCa disparities and accumulated cancer disparities research (based on Ory, et al. residential history; Aim 3: To examine how residential exposures 2014, AJPM). Disparities occur within an accumulated specifically during midlife are associated with PCa environmental context. Research focused on disparities; Aim 4: Conduct a community needs assessment in particular life stages provide unique opportunities partnership with expert clinician and community planning stakeholders to inform policy, practice, and the health of the to improve PCa outreach and care community.