Does Violence Against Women result in disparities in cancer care for women with b

背景：联合国对暴力侵害妇女行为的定义是“任何基于性别的暴力行为， 导致对女性的身体、性或心理伤害或痛苦。 在他们一生中经历了某种形式的VAW。VAW的频率不仅对公共卫生构成了严重的挑战 由于这种情况的流行，而且对妇女健康的长期影响，有令人印象深刻的文献记载。 然而，很少有研究探讨终生VAW对癌症预防和控制的影响。肯塔基州有一个 癌症负担很高，癌症死亡率是美国各州中最高的。癌症的发病率和 在肯塔基州的阿巴拉契亚地区，确诊时间较晚的女性发病率更高。VAW经常与 导致健康差距的社会因素包括失业、教育程度低和少数族裔。总体目标 该项目的目的是确定VAW可以在多大程度上解释基于女性的癌症护理方面的明显差异 种族/族裔、社会经济地位、获得医疗保险的机会或肯塔基州高度贫困和农村地区的居住权。 具体目标：确定VAW是否与乳腺癌(AIM 1)、结直肠癌(AIM)的差异有关 2)和宫颈癌(目标3)的护理结果包括不按建议的间隔接受癌症筛查，即 在后期被诊断为癌症，没有接受推荐的癌症治疗，包括支持性/姑息治疗， 在肯塔基州，被诊断患有这些癌症的女性的癌症特异性存活率较低，并调整了相关因素 混杂因素包括种族、社会经济地位、是否有医疗保险、农村居住地和特定的高收入地区 贫困(例如，居住在肯塔基州东部的阿巴拉契亚地区或肯塔基州西部的三角洲地区)。方法： 我们提出了一个使用肯塔基州癌症登记中心(KCR)作为3150例乳腺癌病例来源的前瞻性队列， 结直肠癌1575例，宫颈癌525例。这5250名女性将通过电话接受采访，以确定 他们终生暴露在VAW和共病条件下。这些数据将与州一级的联邦医疗保险索赔数据相关联 适用于65岁或以上完成电话调查的女性。联邦医疗保险索赔数据，由医疗保险中心管理 医疗保险和医疗补助服务，包括全面的医疗服务，无论患者在哪里 在全国范围内寻求治疗，这将允许详细检查拟议的癌症护理连续体：癌症 筛查、诊断、治疗、支持性或姑息治疗和生存阶段。Logistic回归与COX 将使用比例风险建模来确定VAW的作用(按频率、持续时间、严重程度、近期和 类型)和影响癌症治疗差异的社会经济属性。这些关联将被调查为每个 在假设的五种癌症护理结果中，并按具体癌症分类。社会经济的调节或调节作用 还将使用结构方程建模来探索影响因素。相关性：这将是第一个基于人群的队列 在癌症负担高和极端地区，VAW对癌症护理生命过程的影响 贫穷。研究结果将对缩小差距、改善癌症预防和预防产生重大的公共卫生影响 对女性的控制。

Background: Violence against women (VAW) is defined by the United Nations as "any act of gender based violence that results in physical, sexual, or psychological harm or suffering to women." In Kentucky almost 40% of women had experienced some form of VAW in their lifetime. The frequency of VAW poses a serious public health challenge not only due to the prevalence but also the long term impact on women's health, documented in an impressive body of literature. However, very little research has explored the effect of lifetime VAW on cancer prevention and control. Kentucky has a high cancer burden with the highest cancer mortality rate of all US states. Incidence rates of cancer and the proportion of women diagnosed at a later stage are higher in the Appalachian region of Kentucky. VAW frequently co-occurs with social factors leading to health disparities including unemployment, less education and minority race. Overall objectives of this project are to determine the extent to which VAW may explain noted disparities in cancer care based on women's race/ethnicity, socioeconomic status, access to health insurance, or residence in high poverty and rural areas of Kentucky. Specific aims: To determine whether VAW is associated with disparities in breast cancer (aim 1), colorectal cancer (aim 2) and cervical cancer (aim 3) care outcomes to include not receiving cancer screening at recommended intervals, being diagnosed with cancer at a later stage, not receiving recommended cancer treatment including supportive/palliative care, and poorer cancer specific survival among women diagnosed with these cancers in Kentucky and adjusting for relevant confounders including race, socioeconomic status, having health insurance, rural residence, and specific regions of high poverty (e.g., living in the Appalachian region of eastern Kentucky or the Delta region of western Kentucky). Methods: We propose a prospective cohort using the Kentucky Cancer Registry (KCR) as the source of 3150 breast cancer cases, 1575 colorectal cancer cases and 525 cervical cancer cases. These 5250 women will be interviewed by phone to determine their lifetime exposure to VAW and comorbid conditions. These data will be linked with state level Medicare claims data for women completing phone surveys who are 65 or older. The Medicare claims data, administered by the Center for Medicare and Medicaid Services, include comprehensive coverage of medical services regardless of where the patients seek care in the nation, which would allow the detailed examination of the proposed cancer care continuum: cancer screening, stage at diagnosis, treatment, supportive or palliative care and survivorship. Both logistic regression and Cox proportional hazards modeling will be used to determine the role of VAW (by frequency, duration, severity, recency and type) and socioeconomic attributes influencing disparities in cancer care. These associations will be investigated for each of the hypothesized five cancer care outcomes and by specific cancer. The mediating or moderating role of socioeconomic factors will also be explored using structural equation modeling. Relevance: This will be the first population-based cohort of the influence of VAW on the life course of cancer care in a state with high cancer burden and regions of extreme poverty. Findings will have significant public health impact in reducing disparities and improving cancer prevention and control in women.