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

描述（由申请人提供）：本申请，“癌症诊断作为个人破产风险因素的研究”，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。破产可能是健康差距的一个独特的、迄今未被研究的决定因素。2008年，有超过100万的个人破产申请，相当于每120个美国家庭中就有1个。此外，与最近的经济衰退相对应，破产申请正以惊人的速度增长，自2006年以来增长了一倍多。患有严重疾病后进入破产程序的人可能难以获得健康保险或获得保健服务提供者的服务，并且可能无法完成疾病的急性治疗或获得有关长期不利影响的护理。在最近的一项调查中，28%的申请破产的个人表示，疾病或受伤是主要原因。然而，由于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关注的问题。媒体报道强调了癌症导致经济困难，包括破产的案例。在每年被诊断为癌症的140万人中，申请破产的人数是未知的。该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，研究人员获得了美国华盛顿西区破产法院首席法官的特别授权，将个人层面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驶执照记录联系起来。这项创新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，从而克服了以往研究的固有弱点。采用回顾性队列设计，我们将估计1995年至2008年间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。我们将从华盛顿SEER记录中确定的癌症病例与驾驶执照记录中年龄和性别匹配的无癌症个体进行匹配。使用关联数据库，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、诊断年份和初始治疗）对破产风险的影响。在单独的分析中，我们将把社区一级的人口普查局记录联系起来，以评估社会经济变量（例如，平均收入、住房拥有率）的影响。我们还将研究区域因素的影响，如华盛顿州的破产豁免水平，人均律师和州收入增长。最后，我们将研究2005年破产滥用预防和消费者保护法对癌症患者破产申请的影响，包括一般情况和与非癌症患者的比较。我们的研究将为癌症和个人破产之间的关系提供严格的科学证据。我们期望这些结果为卫生保健政策讨论提供信息。破产可能是一种独特的、迄今尚未研究过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癌症登记处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无癌症对照人群联系起来。如果我们发现癌症患者的破产率高于未患癌症的人，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的经济和临床负担的政策制定者具有重要意义。

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.