Social and built environment and race/ethnic variations in cancer outcomes

描述（由申请人提供）：癌症在诊断、治疗和生存阶段在种族/民族群体中有很大差异，但这些差异的原因尚不完全清楚，并且仅通过基于人口普查的社会经济措施部分表征。癌症监测数据可以成为检查癌症结果中种族/民族差异的强大而有效的资源，并且通过添加更充分地表征种族/民族和社会经济地位的数据，可以大大改善在这方面的利用。我们建议使用这些数据来检查以前未探索的因素（社区社会和建筑环境以及个人移民经历）对结直肠癌，前列腺癌和乳腺癌后结果的影响，这些因素跨越几个种族/族裔群体。我们将使用来自公开可用的人口普查、商业、失业和医疗设施数据库的地理数据来创建社会和建筑环境的测量方法，并将这些测量方法与来自基于人口的加州癌症登记数据库的地理编码癌症发病率和死亡率数据合并到GIS中。利用这一数据资源，我们的目标是：1)确定按个人水平和社区社会人口统计学划分的更有可能被诊断为晚期或晚期疾病的患者亚组；2)确定卫生保健提供者的距离和密度对所选治疗模式的影响；3)评估社区社会经济和建筑环境对癌症生存的影响。我们关注的是社会和建筑环境结构（社区社会经济地位和物质匮乏、失业、医疗保健、可步行性/扩张以及获得体育活动设施和社区服务的机会），这些与我们感兴趣的结果有合理的关联。分析将包括33.3万例乳腺癌、31.8万例前列腺癌和23万例结直肠癌病例，这些病例在1988-2003年期间被诊断并居住在加州，他们是非西班牙裔白人、黑人、西班牙裔、中国人、日本人、菲律宾人、韩国人、越南人、夏威夷人/太平洋岛民或南亚人。本研究的目的是了解个人和社区层面的因素对跨种族/民族群体和内部结果测量的贡献。长期目标是为更有针对性的研究提供必要的背景信息，以解决社区建设和社会环境对幸存者体验的互动作用。从个体影响中辨别出环境社区影响与公共卫生直接相关，因为其结果将有助于规划者将干预措施的重点放在改善个人或社区层面或两者的生存体验上。通过二次数据分析来解决幸存者的经历与癌症流行病学项目公告中的小额赠款是一致的，确定癌症健康差异的潜在原因的目标直接响应了NCI的使命。

DESCRIPTION (provided by applicant): Cancer stage at diagnosis, treatment, and survival vary substantially across racial/ethnic groups, but the reasons for these disparities are incompletely understood and only partly characterized by Census-based socioeconomic measures. Cancer surveillance data can be a powerful and efficient resource for examining racial/ethnic disparities in cancer outcomes, and their utilization in this regard can be greatly improved by the addition of data that more fully characterize race/ethnicity and socioeconomic status. We propose to use these data to examine the effects on outcomes after colorectal, prostate, and breast cancers of previously unexplored factors (the neighborhood social and built environment and personal immigration experience), across several racial/ethnic groups. We will create measures of social and built environments using geodata from publicly-available Census, business, unemployment, and medical facility databases and incorporate these measures into a GIS with geocoded cancer incidence and mortality data from the population-based California Cancer Registry database. Using this data resource, we aim to: 1) identify patient subgroups delineated by individual-level and neighborhood sociodemographics who are more likely to be diagnosed with late or advanced disease; 2) determine the effect of proximity to and density of health care providers on selected treatment patterns; and 3) assess the effects of neighborhood socioeconomics and built environment on cancer survival. We are focusing on social and built environment constructs (neighborhood socioeconomic status and material deprivation, unemployment, medical care, walkability/sprawl and opportunities to access physical activity facilities, and neighborhood services) that have plausible associations with our outcomes of interest. The analyses will include 333,000 breast, 318,000 prostate, and 230,000 colorectal cancer cases who were diagnosed and resided in California during 1988-2003, and were non-Hispanic White, Black, Hispanic, Chinese, Japanese, Filipino, Korean, Vietnamese, Hawaiian/Pacific Islander, or South Asian. This study's objective is to understand the contributions of individual- and community-level factors to outcome measures across and within racial/ethnic groups. The long-term goal is to provide the necessary background information for more targeted studies that address the interactive roles of the neighborhood built and social environment on the survivorship experience. Discerning the contextual neighborhood effects from the individual effects is directly relevant to public health, as the results will help planners to focus interventions towards improving the survivorship experience on the individual or community level, or both. Addressing the survivorship experience via secondary data analysis is consistent with the Small Grants in Cancer Epidemiology Program Announcement, and the goal of determining the underlying causes of cancer health disparities is directly responsive to the mission of the NCI.