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

描述(由申请人提供)：癌症在诊断、治疗和存活阶段在种族/民族群体中差异很大，但这些差异的原因尚不完全了解，仅有基于人口普查的社会经济措施的部分特征。癌症监测数据可以成为检查癌症结果中种族/族裔差异的强大而有效的资源，通过增加更全面地描述种族/族裔和社会经济地位的数据，可以极大地改善这方面的利用。我们建议使用这些数据来检查几个种族/民族中以前未被探索的因素(社区社会和建筑环境以及个人移民经历)对结直肠癌、前列腺癌和乳腺癌患者预后的影响。我们将使用公开可用的人口普查、商业、失业和医疗设施数据库中的地理数据来创建社会和建筑环境的测量，并将这些测量合并到具有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的地理信息系统中。利用这一数据资源，我们的目标是：1)确定由个人和社区社会人口学描述的患者亚群，他们更有可能被诊断为晚期或晚期疾病；2)确定距离和卫生保健提供者的密度对所选治疗模式的影响；以及3)评估社区社会经济和建筑环境对癌症生存的影响。我们专注于与我们感兴趣的结果有合理关联的社会和建筑环境建设(社区社会经济状况和物质匮乏、失业、医疗保健、步行/蔓延、获得体育活动设施的机会和社区服务)。这些分析将包括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利福尼亚州，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/太平洋岛民或南亚人。这项研究的目的是了解个人和社区层面的因素对种族/民族群体之间和内部的结果衡量的贡献。长期目标是为更有针对性的研究提供必要的背景信息，这些研究旨在解决社区建设和社会环境对生存体验的互动作用。区分背景影响和个人影响与公共健康直接相关，因为结果将帮助规划者将干预重点放在改善个人或社区层面的生存体验上，或者两者兼而有之。通过二次数据分析解决生存经验与癌症流行病学小额拨款计划的宣布是一致的，确定癌症健康差异的根本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.