Assessing Cervical Cancer Healthcare Inequities in Diverse Populations: The ACHIEVE Study

评估不同人群的宫颈癌医疗保健不平等：ACHIEVE 研究

• 批准号: 10599412
• 负责人: Adana A. M. Llanos
• 金额: $ 72.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-05 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10599412
• 关键词: Accreditation; Address; Advocate; Age; Area; Caring; Cervical Cancer Screening; Characteristics; Clinic; Communities; Continuity of Patient Care; Data; Data Collection; Data Set; Development; Diagnosis; Discrimination; Disease; Early Diagnosis; Economics; Equity; Ethnic Origin; Guidelines; Gynecologic Oncology; Health Disparities Research; Health care facility; Health system; Healthcare Systems; Housing; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Immigrant; Incidence; Individual; Inequity; Insurance Coverage; Intervention; Interview; Knowledge; Linguistics; Logic; Los Angeles; Low income; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measures; Medical Records; Methods; Modeling; National Cancer Institute; National Institute on Minority Health and Health Disparities; New Jersey; Outcome; Patient Self-Report; Patients; Police; Policies; Population Heterogeneity; Population Study; Poverty; Predictive Factor; Provider; Quality of Care; Questionnaires; Race; Records; Registries; Research; Risk; SEER Program; Sampling Studies; Screening Result; Socioeconomic Status; Specialist; Structural Models; Structural Racism; Surveillance Program; System; Testing; Translating; Underinsured; Uninsured; United States; Violence; Vulnerable Populations; Woman; Work; access disparities; cancer care; cancer survival; cancer therapy; care delivery; cohort; cultural competence; deprivation; ethnic minority; follow-up; food insecurity; health care delivery; health care disparity; health illiteracy; health literacy; implementation research; improved outcome; low socioeconomic status; marginalization; marginalized population; mortality; multi-ethnic; multimodal data; neoplasm registry; optimal treatments; population based; prospective; racial minority; recruit; residence; residential segregation; screening; social; social factors; social structure; structural determinants; survival outcome; survivorship; vaccine acceptance

PROJECT SUMMARY/ABSTRACT No one should die from cervical cancer—a preventable disease. Up to 93% of invasive cervical cancer cases are preventable through human papillomavirus (HPV) vaccination and early detection, yet over 4,300 individuals die from cervical cancer annually in the United States. HPV vaccines and cervical cancer screening have yielded declining incidence over the past several decades but these advances have not improved survival across all groups. Racial and ethnic minority and low-income women are less likely to receive guideline-concordant cervical cancer treatment, which is associated with increased cervical cancer-specific mortality. Recent research, including ours, indicate a need to examine influences beyond individual-level factors, to better understand social, structural, and health system-level influences on treatment and survivorship outcomes among underserved women. Our prior work (which demonstrates successful recruitment and follow-up of cases through cancer registries, linkage with administrative datasets, and multi-modal data collection), and data from others show that healthcare system characteristics contribute to inequitable access to timely and high-quality care delivery across the cervical cancer care continuum. To address critical gaps in knowledge, the proposed study seeks to examine upstream indicators of structural racism as contributors to inequities in receipt of guideline-concordant cervical cancer treatment and survival in a diverse study sample drawn from population-based cancer registries. Guided by the NIMHD research framework and socio-structural models, this mixed-methods study will leverage two National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program registries (New Jersey State Cancer Registry and Los Angeles Cancer Surveillance Program), to prospectively examine the impact of micro- mezzo-, and macro-level factors on receipt of guideline-concordant treatment for and survival from cervical cancer. We will assemble a multiethnic cohort of individuals diagnosed with cervical cancer between 2021-2024 and obtain retrospective and prospective data (collected 12 months after baseline) from cancer registry records, self-reported questionnaires, medical records, and publicly available datasets to address these specific aims: 1.) Evaluate the association of social and structural factors on receipt of guideline- concordant care for invasive cervical cancer, 2.) Evaluate the association of social and structural factors on cervical cancer outcomes, and 3.) Identify actionable strategies for addressing social and structural risks and health system-level factors to optimize delivery of equitable cervical cancer care through one-on-one depth interviews with key stakeholders. This study will elucidate the multilevel causes of suboptimal cervical cancer treatment and poorer survival outcomes among marginalized groups to develop actionable system-level practice and policy change to address the persistent inequities cervical cancer outcomes.

项目概要/摘要 没有人应该死于宫颈癌——一种可以预防的疾病。高达 93% 的浸润性宫颈癌病例 可以通过人乳头瘤病毒 (HPV) 疫苗接种和早期检测来预防，但超过 4,300 人 在美国，每年都有人死于宫颈癌。 HPV疫苗和宫颈癌筛查已取得成果 过去几十年来发病率不断下降，但这些进步并没有提高所有人的生存率 组。种族和族裔少数群体以及低收入女性接受符合指南的宫颈癌治疗的可能性较小 癌症治疗，这与宫颈癌特异性死亡率的增加有关。最近的研究， 包括我们在内，表明需要检查个人层面因素之外的影响，以更好地理解社会、 结构和卫生系统层面对服务不足者的治疗和生存结果的影响 女性。我们之前的工作（证明了通过癌症成功招募和跟踪病例 登记处、与行政数据集的链接以及多模式数据收集）以及来自其他方面的数据表明 医疗保健系统的特点导致各国无法公平地获得及时和高质量的医疗服务 宫颈癌护理连续体。为了解决知识方面的关键差距，拟议的研究旨在审查 结构性种族主义的上游指标是导致接受符合指南的宫颈癌不平等的因素 来自基于人群的癌症登记处的多样化研究样本中的癌症治疗和生存情况。引导 通过 NIMHD 研究框架和社会结构模型，这项混合方法研究将利用两种方法 美国国家癌症研究所 (NCI) 监测、流行病学和最终结果 (SEER) 计划登记（新 泽西州癌症登记处和洛杉矶癌症监测计划），前瞻性地检查 微观、中观和宏观因素对接受指南一致治疗和生存的影响 来自宫颈癌。我们将组建一个被诊断患有宫颈癌的多种族人群队列 2021-2024 年间，并从以下机构获取回顾性和前瞻性数据（在基线后 12 个月收集） 癌症登记记录、自我报告问卷、医疗记录和公开数据集来解决 这些具体目标： 1.) 在收到指南后评估社会和结构因素的关联 - 浸润性宫颈癌的协调护理，2.) 评估社会和结构因素与 宫颈癌的结果，以及 3.) 确定解决社会和结构性风险的可行策略，以及 卫生系统层面的因素，通过一对一的深度优化提供公平的宫颈癌护理 与主要利益相关者的访谈。这项研究将阐明宫颈癌不理想的多层次原因 边缘化群体的治疗和较差的生存结果，以制定可行的系统级实践 以及政策变化，以解决宫颈癌结果持续存在的不平等问题。