Time-varying relationships between built environment factors, colon and rectum cancer prognosis, and survival

结直肠癌（CRC）的负担在不同种族/族裔群体之间一直不平等， 非西班牙裔黑人（NHB）比非西班牙裔白人（NHW）高出30%。此外，差距 校正CRC生存的重要危险因素后，包括肿瘤亚部位、分级、分期、 诊断、健康保险和治疗利用。《儿童权利公约》种族/族裔差异的持续存在， 试图解释医疗保健和预后指标的变化，越来越多地关注 居住环境因素。住宅社交（例如，居住地种族/民族隔离、社会经济 剥夺）和建筑环境（例如，住宅步行能力，身体障碍）被概念化为主要的 癌症的种族差异。然而，目前有几个限制妨碍了稳健和可翻译的结果， 包括：过度依赖邻里社会经济贫困作为暴露的标志;缺乏个人 居住历史，以估计随时间变化的协变量，居住流动模式，和“健康选择”， 社区;以及新兴技术和癌症登记联系的利用不足，这可能导致更大的癌症风险。 统计能力和新的翻译目标。这项研究的目的是利用新兴的方法- 住宅历史计算和虚拟邻里审计-调查纵向关系之间 可改变的，居住建筑环境因素和CRC的种族和地理差异。住宅建筑 环境接触历史将通过结合单独开发的方法进行评估： 新泽西州癌症登记处（NJCSR）内癌症病例的居住史计算，以及大型- 在新泽西州范围内对超过23，000个谷歌街景（GSV）场景进行虚拟社区审计。CRC特定病例构建 环境暴露历史将根据CRC病例的居住历史和时空构建 在2009-2023年期间，在每个GSV地点的多个日期重复进行建筑环境评估的模型。 具体目标是：1）构建住宅步行性的建成环境暴露历史（2009-2023）， 2014-2019年期间被诊断患有CRC的人的身体障碍和建立的测试关系 环境因素和CRC预后因素（微卫星不稳定性检测、亚位点、分级、分期） 诊断）; 2）测试随时间变化的建筑环境因素和CRC生存之间的关系;和3）测试 人种/种族与CRC结局之间的关系是否受时变建筑环境的影响 步行能力和身体障碍的暴露因素。有机会建立一个更完整的 通过整合建筑环境暴露，按种族和地理特征描述CRC差异 癌症监测的历史。这些新的和严格的方法的结果将激励更多的注册 联系和更全面的流行病学研究，反过来，通知癌症监测系统， 卫生干预措施。

The burden of colorectal cancer (CRC) has been persistently unequal across racial/ethnic groups with mortality 30% higher among non-Hispanic Blacks (NHB) compared to non-Hispanic Whites (NHW). Moreover, the disparity remains after adjustment for important risk factors of CRC survival including tumor subsite, grade, stage at diagnosis, health insurance, and treatment utilization. The persistence of racial/ethnic CRC disparities despite attempts to account for variation in healthcare and prognostic indicators has increased focus on the role of residential environmental factors. The residential social (e.g., residential racial/ethnic segregation, socioeconomic deprivation) and built environments (e.g., residential walkability, physical disorder) are conceptualized as main drivers of cancer disparities by race. Several limitations, however, currently prevent robust and translatable results, including: overreliance on neighborhood socioeconomic deprivation as a marker of exposure; lack of individual residential histories to estimate time-varying covariates, residential mobility patterns, and ‘health selection’ into neighborhoods; and underutilization of emerging technologies and cancer registry linkages that could lead to larger statistical power and novel translational targets. The purpose of this study is to utilize emerging methodologies – residential history calculation and virtual neighborhood auditing – to investigate longitudinal relationships between modifiable, residential built environment factors and CRC disparities by race and geography. Residential built environment exposure histories will be assessed through the combination of separately developed methodologies: residential history calculation of cancer cases within the New Jersey State Cancer Registry (NJCSR), and large- scale virtual neighborhood audits of >23,000 Google Street View (GSV) scenes across NJ. CRC case-specific built environment exposure histories will be constructed based on CRC cases’ residential histories and spatio-temporal models of built environment assessments repeated at multiple dates between 2009-2023 per a GSV location. Specific aims are: 1) to construct built environment exposure histories (2009-2023) of residential walkability and physical disorder for those diagnosed with CRC between 2014-2019 and test relationships between built environment factors and CRC prognostic factors (microsatellite instability testing, subsite, grade, stage at diagnosis); 2) to test relationships between time-varying built environment factors and CRC survival; and 3) to test whether relationships between race/ethnicity and CRC outcomes are mediated by time-varying built environment exposure factors of walkability and physical disorder. An opportunity exists to build a more complete characterization of CRC disparities by race and geography through integration of built environment exposure histories into cancer surveillance. Findings from these novel and rigorous methods will motivate additional registry linkages and more comprehensive epidemiologic studies, in turn, informing cancer surveillance systems, and public health interventions.