Building multi-level models to examine the relationship between obesity and pros

项目总结(见说明)： 前列腺癌是一种常见的、复杂的疾病，具有强烈的种族差异，只有少数已证实的和不可改变的危险因素。非洲裔美国人患前列腺癌的风险最高，而且往往患有晚期疾病。肥胖是一种潜在的可改变的危险因素，已被证明会增加 在诊断和治疗(生化)失败时出现晚期疾病的风险。肥胖在非裔美国人中也是最普遍的。然而，关于肥胖在前列腺癌进展中的作用一直存在争议，因为所有研究都没有显示出相关性。虽然与肥胖和晚期癌症有关，但患者和邻居层面的因素尚未被作为前列腺癌患者肥胖影响的修饰性因素进行研究。该项目的目标是检查前列腺癌的差异，并建立肥胖和前列腺癌结果的多水平模型。我们的一般假设是，患者和邻居层面的因素往往因种族/民族而不同，它们会改变肥胖对前列腺癌预后的影响。我们提出了以下具体目标：目标1：确定种族差距之间的联系(以差距的相对衡量标准衡量)。不平等的斜率指数和不平等的相对指数均值和比率)前列腺癌严重程度(卡坦评分、肿瘤特征和确诊年龄)和人口/行为修正因素(体重指数、背包年限、受教育年限和年龄)；目标2：通过社区特征(社会经济地位、压力、人口组成和建成环境)确定肥胖和前列腺癌结果之间的关系。我们将使用前瞻性的纵向病例研究设计来检验患者和邻居水平的特征与前列腺癌严重程度差异之间的关系。这些结果包括病理因素、确诊时的年龄、确诊时的肿瘤分期、确诊时的PSA和治疗失败的风险。差异的测量将被用来确定种族差异如何随着肥胖、吸烟、教育和年龄的变化而变化。多变量模型将被用来检验肥胖对前列腺癌预后的影响，确定患者和邻近因素的影响。我们将能够将肥胖的影响与其他患者水平的变量区分开来，并在社区环境中检查这些影响。确定患者和邻居变量的显著改变可能为前列腺癌进展提供新的途径，识别预后不良的高风险患者组，并提供有效干预的策略以减少差异。

PROJECT SUMMARY (See instructions): Prostate cancer is a common, complex disease with strong ethnic disparities and only a few confirmed and non-modifiable risk factors. African-Americans are at highest risk for developing prostate cancer and often present with advanced disease. Obesity, a potentially modifiable risk factor, has been shown to increase the risk of advanced disease at diagnosis and treatment (biochemical) failure. Obesity is also most prevalent in African-American populations. However, there has been controversy regarding obesity's role in prostate cancer progression, as all studies have not shown associations. Although linked to obesity and advanced cancer, patient- and neighborhood-level factors have not been studied as modifiers of obesity effects in prostate cancer patients. The goal of this project is to examine prostate cancer disparities and to build multilevel models of obesity and prostate cancer outcomes. Our general hypothesis is that patient- and neighborhood-level factors that often differ by race/ethnicity modify the effects of obesity on prostate cancer outcomes. We propose the following specific aims: Aim 1: To determine associations between racial disparities (measured by the relative measure of disparity. Slope Index of Inequality, and the Relative Index of Inequality mean and ratio) in prostate cancer severity (Kattan Scores, tumor characteristics, and age at diagnosis) and demographic/behavioral modifiers (body mass index (BMI), pack years, years of education, and age); Aim 2: To determine the relationship between obesity and prostate cancer outcomes by neighborhood characteristics (socioeconomic status, stress, demographic composition, and built environment). We will use a prospective, longitudinal case-case study design to examine the relationship between patient- and neighborhood-level characteristics and disparities in prostate cancer severity. These outcomes include pathological factors, age at diagnosis, tumor stage at diagnosis, PSA at diagnosis, and risk of treatment failure. Measures of disparity will be used to determine how racial disparities vary with obesity, smoking, education and age. Multivariate models will be used to examine the effects of obesity on prostate cancer outcomes, determining the influence of patient and neighborhood factors. We will be able to distinguish the effects of obesity from other patient-level variables and to examine such effects in neighborhood context. Determining significant modification by patient and neighborhood variables may suggest novel pathways for prostate cancer progression, identify groups of patients at highest risk for poor outcomes, and provide strategies for effective intervention to decrease disparities.