Multilevel factors for racial/ethnic and socioeconomic disparities in prognosis of hepatocellular carcinoma

肝细胞癌是美国与癌症相关的死亡增长最快的原因。 不成比例地影响种族/少数民族和社会经济弱势群体，其比例较高 在非西班牙裔黑人和西班牙裔白人中观察到的年龄调整死亡率高于非西班牙裔白人。至 评估这些差异，我们将使用经过调整的沃内克/人口健康和健康中心 将不同的健康结果归因于生物-环境的差异生态多水平模型 远距离(人口、社会状况和政策)、中间(社会和 物理环境，包括社会关系)和近端(个人人口统计和生物学 回答)决定因素。将该模型应用于肝细胞癌差异将有助于确定 预后差异，这是制定旨在改善的干预战略的第一个必要步骤 肝细胞癌诊断后的存活率和缩小差异。具体地说，我们的提案将描述 近端、中间和远端决定因素对3种已知的肝细胞癌指标差异的影响 预后：a)诊断时的肿瘤分期，b)及时接受符合指南的肝细胞癌治疗，c) 总体存活率。利用现有的临床数据库和储存血清的生物储存库，我们将进行 使用电子病历、患者报告、提供者报告和血清的多中心研究- 基于13年期间约5000名新诊断为肝细胞癌患者的生物学因素： 目标1：描述近端、中间端和远端决定因素的作用 人肝细胞癌诊断阶段的种族/民族和社会经济差异 目标2：确定种族/族裔和社会经济差距，及时收到指导意见-- 包括近端、中间和远端决定因素的协调性肝细胞癌治疗 目标3：确定种族/民族和社会经济的近端、中间和远端决定因素 肝细胞癌确诊后总存活率的差异 总体而言，我们将确定与肝癌预后差异有关的跨水平和多水平内的因素。 在非西班牙裔白人、西班牙裔白人和非西班牙裔黑人患者之间以及SES低与高之间 在一个庞大的、种族/民族和社会经济多样化的约5000名肝细胞癌患者队列中属于这一类别。我们的 研究将提供对为什么存在肝癌预后差异以及在什么水平上的干预的理解 应采取措施缩小差距，提高总体存活率。

Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer-related death in the U.S. HCC disproportionally affects racial/ethnic minority and socioeconomically disadvantaged populations, with higher age-adjusted mortality observed in non-Hispanic blacks and Hispanic whites than non-Hispanic whites. To evaluate these disparities, we will use an adapted Warnecke/Centers for Population Health and Health Disparities ecological multi-level model attributing disparate health outcomes to biological-environmental interactions between and across distal (population social conditions and policies), intermediate (social and physical contexts including social relationships), and proximal (individual demographics and biological responses) determinants. Applying this model to HCC disparities will facilitate identification of key drivers of disparities in prognosis, which is the first necessary step to develop intervention strategies aimed at improving survival and reducing disparities following HCC diagnosis. Specifically, our proposal will characterize the contribution of proximal, intermediate, and distal determinants to disparities in 3 known measures of HCC prognosis: a) tumor stage at diagnosis, b) receipt of timely and guideline-concordant HCC treatment, and c) overall survival. Leveraging existing clinical databases and a biorepository of stored serum, we will conduct a multi-center study using electronic medical record-derived, patient-reported, provider-reported, and serum- based biological factors in a cohort of ~5000 patients newly diagnosed with HCC over a 13-year period to: Aim 1: Characterize the contribution of proximal, intermediate, and distal determinants of racial/ethnic and socioeconomic disparities in HCC tumor stage at diagnosis Aim 2: Determine racial/ethnic and socioeconomic disparities in receipt of timely and guideline- concordant HCC treatment including proximal, intermediate, and distal determinants Aim 3: Identify proximal, intermediate, and distal determinants of racial/ethnic and socioeconomic disparities in overall survival following HCC diagnosis Overall, we will identify factors across and within multiple levels associated with disparities in HCC prognosis between non-Hispanic white, Hispanic white, and non-Hispanic black patients as well as low versus high SES class in a large, racial/ethnically and socioeconomically diverse diverse cohort of ~5000 HCC patients. Our study will provide an understanding of why HCC prognosis disparities exist and at what level interventions should be implemented to reduce disparities improving overall survival.