In-Depth Examination of Disparities in Cancer Outcomes

描述（由申请人提供）：这项拟议的研究使用1996年至2000年密歇根居民的医疗保险和医疗补助资格和索赔文件，这些文件与密歇根癌症和死亡证明登记处相关联，以创建新诊断的癌症患者的初始队列。该队列将根据医疗补助资格状况（双重资格与仅医疗保险资格）进行识别。我们建议检查乳腺癌、结直肠癌、肺癌和前列腺癌发病率的差异，这些疾病在诊断时的阶段，给予患者的治疗和相关的护理费用，以及诊断后的生存时间。本研究旨在扩大有关社会、个人、种族和卫生系统变量之间复杂相互作用的知识，这些变量在癌症轨迹上产生和影响差异。我们测试了一组系统衍生的假设，并试图确定在轨迹早期确定的差异如何影响轨迹后期点的差异。例如，较晚的诊断阶段是否会导致较不适当的护理，从而导致更高的费用和更短的生存期？对癌症检测和/或治疗差异对生存的影响的研究是本研究对科学现状的重要补充之一。我们有四个简单陈述的目标，分析起来非常复杂。我们的目标是针对两种人群——有资格获得医疗保险和全额医疗补助福利的人，以及有资格获得医疗保险而没有医疗补助的人（在本申请中，称为“仅医疗保险”）。这些目标是：1)测量双重资格和医疗保险受益人的癌症发病率；2)比较双重资格和仅医疗保险受益人的诊断阶段；3)比较两组的治疗交付情况，估算护理成本；4)衡量双重资格和医疗保险受益人的生存率。

DESCRIPTION (provided by applicant): This proposed research uses 1996 through 2000 Medicare and Medicaid eligibility and claim files for Michigan residents linked with the Michigan Cancer and Death Certificate Registries to create an inception cohort of newly diagnosed cancer patients. This cohort will be identified by Medicaid eligibility status (dually eligible versus Medicare only). We propose to examine disparities in the incidence of breast, colorectal, lung, and prostate cancer, the stage of these diseases at diagnosis, treatment afforded to patients and associated costs of care, and the survival time following diagnosis. This research seeks to expand knowledge regarding the complex interactions among the social, personal, racial, and health system variables that create and influence disparities along the cancer trajectory. We test a systematically derived set of hypotheses and seek to determine how disparities identified early in the trajectory influence disparities at later points in the trajectory. For example, does later stage at diagnosis lead to less appropriate care that leads to higher costs and shorter survival? An examination of the impact of disparities in cancer detection and/or treatment on survival is one of the significant additions of this research to the state of the science. We have four simply stated aims that are analytically highly complex. Our aims are targeted at two populations of interest--persons dually eligible for Medicare and full Medicaid benefits and persons eligible for Medicare without Medicaid (for the purposes of this application, referred to as "Medicare only.") These aims are: 1) Measure the cancer incidence rates in dually eligible and Medicare only beneficiaries; 2) Compare stage of diagnosis for dually eligible and Medicare only beneficiaries; 3) Compare treatment delivery between the two groups and estimate the cost of care; and 4) Measure survival rates for dually eligible and Medicare only beneficiaries.