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

项目总结/摘要 没有人应该死于宫颈癌这是一种可以预防的疾病。高达93%的宫颈癌病例 可以通过接种人乳头瘤病毒（HPV）疫苗和早期发现来预防，但仍有4，300多人 在美国每年死于子宫颈癌的人数HPV疫苗和宫颈癌筛查已经产生了 在过去的几十年里，发病率下降，但这些进展并没有改善所有人的生存率。 组种族和少数民族以及低收入妇女不太可能接受与指南一致的宫颈 癌症治疗，这与宫颈癌的死亡率增加有关。最近的研究， 包括我们的，表明有必要研究个人层面因素以外的影响，以更好地了解社会， 结构和卫生系统层面对服务不足人群的治疗和生存结果的影响 妇女我们之前的工作（通过癌症成功招募和随访病例 登记册、与行政数据集的联系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了不公平地获得及时和高质量的护理服务， 子宫颈癌的治疗为了解决知识方面的关键差距，拟议的研究试图审查 结构性种族主义的上游指标是导致在接受符合准则的宫颈癌治疗方面不平等的因素 癌症治疗和生存率在一个不同的研究样本从人口为基础的癌症登记。指导 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个 美国国家癌症研究所（NCI）监测、流行病学和最终结果（SEER）计划登记处（新 泽西州癌症登记处和洛杉矶癌症监测项目），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 子宫颈癌我们将收集一组多种族的宫颈癌患者 并从2021-2024年期间获得回顾性和前瞻性数据（基线后12个月收集）， 癌症登记记录、自我报告问卷、医疗记录和公开可用的数据集， 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- 宫颈癌的治疗方法有哪些？评估社会和结构因素的关联， 宫颈癌的预后，以及3.）确定应对社会和结构性风险的可行战略， 卫生系统层面的因素，通过一对一的深度，优化公平宫颈癌护理的提供 与主要利益相关者的访谈。本研究将阐明次优宫颈癌的多层次原因 边缘化群体的治疗和较差的生存结果，以制定可操作的系统一级做法 和政策变化，以解决持续的不平等宫颈癌的结果。

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.