A Study of Cancer Diagnosis as a Risk Factor for Personal Bankruptcy

描述(由申请者提供)：本申请名为“作为个人破产风险因素的癌症诊断研究”，涉及广泛的挑战领域(09)健康差异，以及挑战主题09-MD-102：整合健康的生物和非生物决定因素以解决健康差异的跨学科研究。破产可能代表了健康差距的一个独特且迄今未被研究过的决定因素。2008年，有100多万个人申请破产，相当于每120个美国家庭中就有一个申请破产。此外，与最近的经济低迷相对应，破产申请正在以惊人的速度增长，自2006年以来翻了一番以上。在严重疾病后进入破产程序的人可能会遇到获得医疗保险或获得医疗保健提供者的困难，并且可能无法完成疾病的急性治疗或获得相关长期不良影响的护理。在最近的一项调查中，28%的申请破产的人表示，疾病或受伤是主要原因。然而，由于对疾病和破产的调查在很大程度上依赖于自我报告，真正的关系仍然存在争议。对于被诊断患有癌症的人来说，破产可能是一个特别令人担忧的问题。媒体报道强调了癌症导致经济困难的案例，包括破产。在每年140万被诊断为癌症的人中，申请破产的人数不详。这个项目的总体目标是确定癌症诊断对个人破产风险的影响。为了实现这一目标，研究调查人员从华盛顿州西区美国破产法院首席法官那里获得了特殊许可，将个人级别的破产记录与西华盛顿监测流行病学和最终结果(SEER)癌症登记记录和华盛顿州驾照记录联系起来。这项创新的研究首次使用这些数据库来研究与癌症相关的破产。研究设计不依赖于自我报告的数据，从而克服了以前研究中的固有弱点。使用回溯性队列设计，我们将估计1995年至2008年期间被诊断为癌症的成年人与未患癌症的成年人相比，破产的相对风险。我们将把华盛顿SEER记录中发现的癌症病例与驾照记录中年龄和性别匹配的非癌症患者进行匹配。使用链接的数据库，我们将评估年龄、性别、种族和民族以及患者的癌症(包括癌症类型、诊断阶段、诊断年份和初步治疗)对破产风险的影响。在单独的分析中，我们将链接社区层面的人口普查局记录，以评估社会经济变量(例如，平均收入、住房拥有率)的影响。我们还将研究华盛顿州破产豁免水平、人均律师人数和州收入增长等地区性因素的影响。最后，我们将研究2005年《防止破产滥用和消费者保护法》对癌症患者破产申请的影响，无论是总体上还是与非癌症患者相比。我们的研究将提供严格的科学证据来描述癌症和个人破产之间的关系。我们希望这些结果能为医疗保健政策的讨论提供参考。破产可能代表着一个独特的、迄今未被研究的健康差距的潜在来源。在这项研究中，我们与联邦破产法院和国家癌症研究所的SEER癌症登记机构建立了一种新的合作伙伴关系，将癌症患者的破产记录与匹配的非癌症对照人群联系起来。如果我们发现与非癌症患者相比，癌症患者的破产率更高，我们的结果将对那些研究癌症差异原因的人以及寻求减轻癌症患者经济和临床负担的政策制定者产生重要影响。

DESCRIPTION (provided by applicant): This application, "A Study of Cancer Diagnosis as a Risk Factor for Personal Bankruptcy," addresses broad Challenge Area (09) Health Disparities, and Challenge Topic 09-MD-102: Trans-disciplinary Research to Integrate the Biological and Non-biological Determinants of Health to Address Health Disparities. Bankruptcy may represent a unique and heretofore unstudied determinant of health disparity. In 2008, there were more than 1 million personal bankruptcy filings, equivalent to 1 in 120 American households. Moreover, corresponding with the recent economic downturn, bankruptcy filings are increasing at an alarming rate, more than doubling since 2006. Persons entering bankruptcy following a severe illness may experience difficulties obtaining health insurance or accessing health care providers, and may not be able to complete acute treatment for the disease or obtain care for related long-run adverse effects. In a recent survey, 28% of individuals filing for bankruptcy indicated that illness or injury was a primary cause. However, because surveys of illness and bankruptcy have largely relied on self report, the true relationship remains controversial. Bankruptcy may be a particular concern for persons who are diagnosed with cancer. Media reports have highlighted cases where cancer has caused financial hardship, including bankruptcy. Among the 1.4 million persons diagnosed with cancer each year, the number filing for bankruptcy is unknown. The overall goal of this project is to determine the impact of a diagnosis of cancer on individuals' risk of incurring personal bankruptcy. To accomplish this goal, study investigators have obtained special dispensation from the Chief Judge of the U.S. Bankruptcy Court-Western District of Washington to link person-level bankruptcy records with Western Washington Surveillance Epidemiology and End Results (SEER) cancer registry records and Washington State driver's license records. This innovative study represents the first use of these databases to study cancer-related bankruptcy. The study design does not rely on self-reported data, thereby overcoming inherent weaknesses in previous research. Using a retrospective cohort design, we will estimate the relative risk of bankruptcy for adults diagnosed with cancer between 1995 and 2008 compared to adults without cancer. We will match cancer cases identified from Washington SEER records to age- and sex-matched individuals without cancer from driver's license records. Using the linked database, we will evaluate the impact of age, sex, race and ethnicity, and the patient's cancer (including cancer type, stage at diagnosis, year at diagnosis, and initial treatment) on bankruptcy risk. In separate analyses, we will link neighborhood-level Census Bureau records to evaluate the influence of socioeconomic variables (e.g., average income, percentage of home ownership). We will also examine the impact of regional factors such as the Washington State bankruptcy exemption level, lawyers per capita, and state income growth. Finally, we will examine the impact of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 on bankruptcy filings among cancer patients, both in general and compared to persons without cancer. Our study will provide rigorous scientific evidence characterizing the relationship between cancer and personal bankruptcy. We expect these results to inform health care policy discussions. Bankruptcy may represent a unique and heretofore unstudied potential source of health disparity. In this study, we have formed a novel partnership with the Federal Bankruptcy Court and the National Cancer Institute's SEER cancer registry to link bankruptcy records for cancer patients and a matched control population without cancer. If we find that cancer patients experience excess rates of bankruptcy compared to persons without cancer, our results will have important implications for those researching the causes of cancer disparity, and for policymakers seeking to mitigate the economic as well as clinical burden of persons with cancer.