Outcomes of Curable Cancers in Vulnerable Populations

描述（由申请人提供）：许多癌症，包括睾丸癌;霍奇金斯和非霍奇金斯淋巴瘤;早期乳腺癌、结肠直肠癌、肺癌和膀胱癌;早期黑色素瘤;以及成人的儿科恶性肿瘤，被认为是“可治愈的”，我们将其定义为5年无复发生存.虽然在总体人群中报告了高治愈率，但人们对这些比率在人群的亚组中是否一致知之甚少;如果是这样，哪些因素导致治愈率较低。在拟议的研究中，重点是20-50岁的成年人，我们的目标是评估这些癌症在俄亥俄州人口中的生存率，特别是在医疗补助人口中。医疗补助受益人是人口中的弱势群体。这是因为除了社会经济脆弱性之外，成年受益人还患有致残性身体和/或精神疾病。这方面的一个例外是低收入育龄妇女寻求医疗补助覆盖产妇护理。在对俄亥俄州全部人口的研究中，我们将通过人口统计学属性以及医疗补助状态、其他社会经济指标和居住县来检查生存率的变化。当关注医疗补助受益人时，并考虑到该人群的索赔数据的可用性，我们将研究在存在或不存在精神和/或身体共病情况下治愈的可能性。拟议的研究将使用一个独特的基于人群的数据库，我们将通过将俄亥俄州癌症发病率监测系统（OCISS）的记录与州医疗补助登记和索赔文件以及美国人口普查的数据相关联来开发该数据库。通过OCISS档案提供的与死亡有关的变量来自国家死亡指数。通过确定不同亚组人群的生存率和治愈率的差异，这些研究将为未来的研究工作提供基础，旨在确定导致这种差异的具体因素。此外，由于这些癌症很少在保健服务和与癌症有关的研究中得到检查，拟议的研究将提供一个机会，以评估在更大规模和其他环境中进行可比研究的方法问题和潜在困难。项目叙述：许多癌症，包括睾丸癌;霍奇金斯和非霍奇金斯淋巴瘤;早期乳腺癌、结肠直肠癌、肺癌和膀胱癌;早期黑素瘤;以及成人的儿科恶性肿瘤，被认为是“可治愈的”，我们将其定义为5年无复发的生存期.拟议的研究旨在确定可治愈癌症的有利结果是否在俄亥俄州人群的亚组中均匀观察到。我们将通过医疗补助状态检查生存结果;在医疗补助受益人中，将在存在或不存在精神和/或身体共病情况下评估生存率和治愈率。

DESCRIPTION (provided by applicant): A number of cancers, including cancer of the testis; Hodgkins and non-Hodgkins lymphoma; early- stage breast, colorectal, lung, and urinary bladder cancer; early-stage melanoma; and pediatric malignancies in adults are considered "curable", which we define as 5-year survival without relapse. While high rates of cure have been reported in the population at large, little is known about whether these rates compare uniformly across subgroups of the population; and if so, which factors contribute to lower cure rates. In the proposed studies, which focus on adults 20-50 years of age, we aim to assess survival from these cancers in the population of Ohio overall, and in the Medicaid population in particular. Medicaid beneficiaries constitute a disadvantaged subgroup of the population. This is because in addition to socioeconomic vulnerabilities, adult beneficiaries suffer from disabling physical and/or mental ailments. An exception to this is low-income women of childbearing age seeking Medicaid coverage for maternity care. In studies accounting for the entire population in the state of Ohio, we will examine variations in survival by demographic attributes, as well as Medicaid status, additional socioeconomic indicators, and county of residence. When focusing on Medicaid beneficiaries, and given the availability of claims data for that population, we will examine the likelihood of cure in the presence or absence of mental and/or physical comorbid conditions. The proposed studies will use a unique population-based database, which we will develop by linking records from the Ohio Cancer Incidence Surveillance System (OCISS), with the state Medicaid enrollment and claims files, and data from the U.S. Census. Death-related variables, available through the OCISS files, originate from the National Death Index. By identifying differentials in survival and cure rates across subgroups of the population, these studies will provide a foundation for future research endeavors aimed at identifying the specific factors contributing to such disparities. In addition, because these cancers have been rarely examined in the context of health services and disparities-related research, the proposed studies will provide an opportunity to assess methodological issues and potential difficulties in carrying out comparable studies at a larger scale and in other settings. Project Narrative: A number of cancers, including cancer of the testis; Hodgkins and non-Hodgkins lymphoma; early- stage breast, colorectal, lung, and urinary bladder cancer; early-stage melanoma; and pediatric malignancies in adults are considered "curable", which we define as 5-year survival without relapse. The proposed studies aim to determine whether favorable outcomes of curable cancers are observed uniformly across subgroups of the population in Ohio. We will examine survival outcomes by Medicaid status; and among Medicaid beneficiaries, survival and cure rates will be evaluated in the presence or absence of mental and/or physical comorbid conditions.