Neighborhood Effects on Colorectal Cancer Incidence and Stage of Diagnosis

社区对结直肠癌发病率和诊断阶段的影响

• 批准号: 7790054
• 负责人: Deborah Banerjee
• 金额: $ 6.11万
• 依托单位: HOUSTON DEPARTMENT/HEALTH/HUMAN SRVS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-07 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7790054
• 关键词: Address; Adult; Affect; Area; Behavioral; Cancer Etiology; Censuses; Cessation of life; Childhood; Cities; Colorectal Cancer; Communities; Community Developments; Community Health; Country; County; Data; Data Collection; Data Set; Diagnosis; Early Diagnosis; Educational Background; Environment; Environmental Risk Factor; Epidemiology; Etiology; Exposure to; Future; Geographic Locations; Government; Guidelines; Health; Health Professional; Health Promotion; Improve Access; Incidence; Individual; Intervention; Learning; Life; Linguistics; Link; Malignant Neoplasms; Marmota; Minority; Modeling; NIH Program Announcements; National Cancer Institute; Neighborhoods; Observational Study; Occupational; Onset of illness; Outcome; Pathway interactions; Pattern; Play; Policies; Population; Population Heterogeneity; Positioning Attribute; Poverty; Program Development; Research; Research Project Grants; Resource Allocation; Resources; Risk Factors; Role; Science; Screening procedure; Services; Social Conditions; Social Environment; Social support; Socioeconomic Status; Stage at Diagnosis; Staging; Stratification; Stress; Structure; Techniques; Texas; Translating; Translational Research; United States National Institutes of Health; Work; adverse outcome; base; cancer health disparity; colorectal cancer screening; cost; design; disease diagnosis; falls; geographic difference; health literacy; high risk; infrastructure development; knowledge base; neoplasm registry; outcome forecast; policy implication; population based; programs; public health relevance; research to practice; social; social integration; trend; urban area

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.

描述（由申请人提供）：项目摘要拟议的项目是一个纵向的，观察性研究，结合区域和个人水平的变量，以评估结直肠癌的发病率和诊断阶段的邻居的背景影响。结直肠癌（CRC）是美国癌症相关死亡的第二大原因。少数群体人口受到的影响不成比例，而且众所周知会产生不利后果。尽管有筛查指南，但大部分病例仍在晚期被诊断。由于CRC具有较长的潜伏期，暴露于有害的社会环境沿着其他危险因素预示预后不良。在这项研究中，采用了一个概念模型，该模型描述了在多个领域中不同程度的风险因素暴露，以及获得资源的不同途径，从而达到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规避了原始数据收集的高昂成本，特别是对于小型研究项目。这个多层次和生态研究的具体目的是检查上下文变量和CRC的情况下，在块组和人口普查区水平，早期/晚期诊断在多个级别同时，也检查的空间和时间趋势的地理变化，CRC的发病率和晚期诊断为1998-2003年在休斯顿，使用泊松模型在SaTScan。人口普查得出的现成的社会环境变量，如职业类别、教育水平、贫困、过度拥挤、语言隔离等，将是自变量。CRC病例和早期/晚期诊断将作为因变量进行分析。 解决癌症病因学的差异是国家卫生研究所和国家癌症研究所的一个高度优先领域，对现有数据集的二次分析是R 03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，我们的研究结果将很容易转化为其他大城市，类似于我们的，不同的人口。这项研究将帮助我们更好地了解癌症差异，并利用生态，多层次和地理空间分析技术梳理出在不良后果中发挥作用的社会环境因素。 公共卫生关系：项目叙述公共卫生相关性：我们的研究将导致更好地了解美国第四大城市休斯顿结直肠癌（CRC）的分布，病因，时空模式。它还将确定城市中利率高于预期的地区。这将有助于确定在这种疾病的晚期诊断中发挥作用的重要社会，环境和行为风险因素。这项研究不仅有助于为科学提供信息，而且有助于社区卫生专业人员在类似于我们的环境中设计解决一些可改变因素的方案。此外，在市和州等各级政府的政策影响，以及通过在高风险地区加强健康促进、健康知识普及和CRC筛查将研究转化为实践，是将实现的一些潜在效益。