Cancer-Related Disparities in the Elderly Population

描述（由申请人提供）：虽然癌症是老年人死亡的第二大原因，但有证据表明，美国老年人在癌症早期被诊断出来的可能性较小，或者接受癌症早期治疗的可能性较小。 这种差异在社会经济地位较低的群体中尤为明显。 尽管医疗保险几乎覆盖全民，但自付费用可能会给资源有限的老年人带来重大的经济负担，这意味着更有可能推迟或不寻求预防，常规或筛查服务。 关于癌症相关的结果，这转化为诊断时的晚期癌症，以及次优的治疗和后续护理，因此预后不良。 拟议的研究将比较1998 - 2002年研究期间年龄≥ 65岁诊断为乳腺癌、前列腺癌或结肠癌的个体的癌症相关结局（诊断、治疗和随访阶段）。 比较的目的是确定年龄，种族，合并症，社会经济地位和医疗补助状况的差异。 本研究将把俄亥俄州癌症发病率监测系统（OCISS）与医疗保险和医疗补助文件联系起来，以确定仅符合医疗保险和双重符合医疗保险-医疗补助条件的个人。 来自美国人口普查的数据将被用来衡量只接受医疗保险的人口的社会经济地位。 本提案中概述的研究计划将辅之以详细的培训计划，以提高候选人在衡量癌症差异方面的技能，并在与癌症预防和控制相关的医疗保健政策背景下分析调查结果。 研究，培训和教育计划是专为推进候选人的职业生涯，其主要目标是成为一个独立的研究者专门从事癌症差异和医疗保健政策和融资的融合领域。 本署致力研究癌症相关的成果，并为获指定为导师、共同导师及顾问的杰出人士提供导师服务，以及本建议书所概述的培训计划，将为候选人提供最佳资源，以达致其职业目标。

DESCRIPTION (provided by applicant): Although cancer is the second leading cause of death in the elderly population, there is evidence that older Americans are less likely to be diagnosed at early stages of cancer, or to receive potentially curative treatment for early stages of cancer. The disparities are especially pronounced for members of lower socioeconomic groups. Despite the nearly universal Medicare coverage, the out-of-pocket expenses may present significant financial burden to elderly individuals with limited resources, which implies a greater likelihood to delay or not to seek preventive, routine, or screening services. With respect to cancer-related outcomes, this translates into advanced stages of cancer upon diagnosis, and sub-optimal treatment and follow-up care, therefore poor prognosis. The proposed studies will compare cancer-related outcomes (stage at diagnosis, treatment, and follow-up care) among individuals >= 65 years of age diagnosed with breast, prostate, or colon cancer during the study period, 1998-2002. Comparisons will be aimed at identifying disparities by age, race, comorbidities, socioeconomic status, and Medicaid status. The study will link the Ohio Cancer Incidence Surveillance System (OCISS) with Medicare and Medicaid files, in order to identify Medicare-only, and dually eligible Medicare-Medicaid eligible individuals. Data from the U.S. Census will be used to derive measures of socioeconomic status in the Medicare-only population. The research plan outlined in this proposal will be complemented by a detailed training plan to enhance the Candidate's skills in relation to measuring cancer disparities, and in analyzing the findings in the context of health care policy relevant to cancer prevention and control. The research, training, and education plan is uniquely designed to advance the Candidate's career, the principal goal of which is to become an independent investigator specializing in the converging areas of cancer disparities and health care policy and financing. The commitment of the Department to study cancer-related outcomes; the mentorship to be received by the outstanding individuals designated as Mentor, Co-Mentors and Consultants; as well as the training plan outlined in this proposal, will provide the optimal resources for the Candidate to achieve her career goals.