Neighborhood Effects on Colorectal Cancer Incidence and Stage of Diagnosis

描述(由申请人提供)：项目摘要建议的项目是一项纵向的观察性研究，包括地区和个人水平的变量，以评估社区对结直肠癌发病率和诊断阶段的背景影响。结直肠癌(CRC)是美国癌症相关死亡的第二大原因。少数群体受到的影响不成比例，并已知会产生不利后果。尽管有筛查指南，但很大一部分病例仍在晚期诊断。由于CRC潜伏期长，暴露于有害的社会环境和其他危险因素预示着预后不良。在这项研究中，对一个概念模型进行了修改，该模型描述了在多个领域中暴露于风险因素的不同程度，在获取资源方面具有不同的途径，从而导致一定程度的社区健康。此外，癌症登记和普查数据的二次分析绕过了一次数据收集的高昂成本，特别是对于小型研究项目。这项多层次的生态学研究的具体目的是利用SATScan中的Poisson模型检验环境变量与街区组和普查区域水平的CRC病例、多个水平的早期/晚期诊断的关系，以及1998-2003年休斯顿市CRC发病率和晚期诊断的时空趋势的地理变化。人口普查得出的容易获得的社会环境变量，如职业阶层、教育水平、贫困、过度拥挤、语言孤立等将成为自变量。将结直肠癌病例和早期/晚期诊断作为因变量进行分析。解决癌症病因学方面的差异是国家卫生研究所和国家癌症研究所的高度优先领域，对现有数据集的二次分析是R03机制和计划公告的重要要求。作为该国第四大城市的地方卫生部门，我们负责确定需要和缺乏获得资源的地理区域，并制定适当的干预战略来解决这些问题。我们预计，我们的结果将很容易被翻译到其他大城市，类似于我们的城市，人口多样化。这项研究将帮助我们更好地了解癌症的差异，并利用生态学、多层次和地理空间分析技术梳理出对不良结果起作用的社会环境因素。 公共卫生相关性：项目叙事公共卫生相关性：我们的研究将使我们更好地了解休斯顿结直肠癌(CRC)的分布、病因和时空模式，休斯顿是美国第四大城市。它还将确定该市利率高于预期的地区。这将有助于确定重要的社会、环境和行为危险因素，这些因素在该病的后期诊断中发挥作用。这项研究不仅将有助于为科学提供信息，而且还将有助于社区卫生专业人员在类似于我们的环境中设计计划以解决一些可修改的因素。此外，政府各级的政策影响，如市和州一级，以及通过在高危地区加强健康促进、健康素养和CRC筛查将研究转化为实践，都是将实现的一些潜在好处。

DESCRIPTION (provided by applicant): Project Summary The proposed project is a longitudinal, observational study incorporating both area and individual level variables to assess contextual effects of the neighborhood on colorectal cancer incidence and stage of diagnosis. Colorectal cancer (CRC) is the second highest cause of cancer related deaths in the US. Minority populations are disproportionately affected and are known to have adverse outcomes. Although screening guidelines exist, a large proportion of cases are still being diagnosed at late stages. Since CRC has a long latency period, exposure to a deleterious social environment along with other risk factors portend poor prognosis. For this study, a conceptual model depicting the varying levels of exposure to risk factors, in multiple domains, with differing pathways in access to resources, resulting in a certain level of community health was adapted for use. In addition, secondary analysis of Cancer Registry and Census data circumvents the prohibitive costs of primary data collection, particularly for small research projects. The specific aims of this multilevel and ecological study are to examine relationships between contextual variables and the cases of CRC at block group and census tract level, early/late stage diagnosis at multiple levels simultaneously and also to examine the geographic variation in spatial and temporal trends in CRC incidence and late stage diagnosis for the years 1998-2003 in Houston, using Poisson models in SaTScan. Census derived readily available social environment variables such as occupational class, education level, poverty, overcrowding, linguistic isolation etc. will be the independent variables. CRC cases and early/late stage diagnosis will be analyzed as the dependent variables. Addressing disparities in cancer etiology is a high priority area for National Institute of Health and National Cancer Institute and secondary analysis of existing datasets is an important requirement of the R03 mechanism and the program announcement. As the local health department in the fourth largest city in the country, we are responsible for identifying geographic areas of need and lack of access to resources and developing appropriate intervention strategies to address them. We anticipate that our results will be easily translatable to other large cities, similar to ours, with diverse populations. This study will help us better understand cancer disparities and tease out the socio-environmental factors that play a role in adverse outcomes using ecological, multilevel and geospatial analytic techniques. PUBLIC HEALTH RELEVANCE: Project Narrative Public Health Relevance: Our study will result in greater understanding of the distribution, etiology, spatio-temporal patterns of colorectal cancer (CRC) in Houston, the fourth largest city in the country. It will also identify areas of the city with greater than expected rates. This will help ascertain important social, environmental and behavioral risk factors that play a role in late stage diagnosis of this disease. This study will not only help inform science, but also community health professionals in designing programs to address some of the modifiable factors, in settings similar to ours. In addition, the policy implications at various levels of the government such as the City and State level and translation of research into practice by enhancing health promotion, health literacy and CRC screening in high risk areas are some of the potential benefits that will be achieved.