Identifying predictors of racial disparity in treatment and mortality among patients diagnosed with breast cancer in South Carolina and geospatial investigation of breast cancer patient navigation

尽管黑人女性的死亡率较低，但治疗开始时间的延迟导致了较高的死亡率 黑人女性和白人女性中的乳腺癌(BRCA)。生存研究表明，推迟两个月 在BRCA病例中，几个月的时间与不太有利的生存有关。佐剂激素的使用 治疗(AHT)已被证明可以改善激素受体的短期和长期存活率。 全球范围内的(HR+)BRCA阳性患者，因为它降低了BRCA的死亡率和复发。的优势 尽管有AHT，但符合条件的BRCA患者中有10%-30%从未开始接受AHT治疗，许多人开始接受治疗 AHT从未完成治疗，导致复发和死亡率增加。这种缺乏最初的理解 与白人相比，黑人对AHT的依从性更差。有效缩小贫富差距 少数族裔中的治疗延误和死亡率将需要通过以下方式确定机制： 哪些差距特别出现，研究已被证明影响 黑人女性接受BRCA治疗的几率。对于这个应用程序，我建议评估种族 南卡罗来纳州(SC)BRCA治疗和死亡率的差异 来自SC中央癌症登记中心的女性BRCA病例超过8年，与行政医疗有关 以及公共保险和私人保险的BRCA患者的药房索赔数据。我将评估 1)地理因素、2)种族差异、3)地理信息系统之间的复杂相互作用 (地理信息系统)映射，4)生存方法和5)多水平模型，以确定治疗延迟和 可以干预的死亡。地理信息系统的方法还没有被用来具体识别个人- 以及社区层面的特征，这些特征可能会导致背景下黑人的BRCA死亡率 多水平生存模型；这有可能允许应用基于证据的方法 以缩小差距。该项目有3个目标：1)评估治疗延误和 AHT在乳腺癌诊断患者中的应用(博士前和完成)；2)确定 南卡罗来纳州黑人女性中不同健康地区乳腺癌相关生存率差异的预测因素 利用多层次生存模型和地理信息系统方法(博士前和尚未完成)；3) 评估邻里水平因素是否改变了患者导航对初始推荐摄取的影响 在少数民族人群中提供乳腺癌护理和诊断解决的时间(博士后方向)。这个 F99期奖学金将提供必要的培训和指导，以加深我的知识 以及1)差异、2)生存、3)多层次、4)地理信息系统和5)地理空间分析方面的技能。K00阶段将 让我了解1)癌症患者导航等干预性分析，2)随机对照试验 和3)在这次奖学金期间提高我的学术生产力和专业发展，包括 准备和提交赠款和出版物。

Delay in treatment initiation contributes to higher mortality among Black women despite lower incidence of breast cancer (BrCa) among Black compared to White women. Survival studies show that a delay of two months has been linked with a less favorable survival among BrCa cases. The use of Adjuvant Hormonal Therapy (AHT) has been shown to improve both short- and long-term survival among Hormone Receptor Positive (HR+) BrCa patients worldwide as it reduces BrCa mortality and reoccurrence. The advantages of AHT notwithstanding, 10-30% of eligible BrCa patients never start treatment with AHT and many who start AHT never complete the treatment leading to reoccurrence and increased mortality. This lack of initial uptake and adherence to AHT is worse among Blacks compared to Whites. Effective reduction of disparities in treatment delays and mortality among racial minorities will require the identification of the mechanisms by which disparities occur particularly, studying neighborhood-level factors that have been shown to affect the odds of receipt of BrCa treatments among Black women. For this application, I propose to assess racial disparities in BrCa treatment and mortality in South Carolina (SC) utilizing data that was derived from all female BrCa cases over eight years from the SC Central Cancer Registry linked with administrative medical and pharmacy claims data for both publicly insured and privately insured BrCa patients. I will assess the complex interplay between 1) geographic factors, 2) racial disparities 3) Geographical Information System (GIS) mapping, 4) survival methods and 5) multi-level models to identify predictors of treatment delays and mortality that can be intervened upon. GIS methods have not been utilized to specifically identify individual- and neighborhood-level characteristics that may contribute to BrCa mortality among blacks within the context of multilevel survival modelling; this has the potential to allow for the application of evidence-based approaches to reduce disparities. This project has 3 aims: 1) to assess racial disparities in treatment delays and the utilization of AHT among patients diagnosed with breast cancer (Pre-Doctoral and completed); 2) to identify predictors of dissimilarity in breast cancer related survival by health regions among Black women in SC utilizing multilevel survival models and GIS methodologies (Pre-Doctoral and yet to be completed); 3) to assess if neighborhood-level factors modify the effect of patient navigation on uptake of initial recommended breast cancer care and time to diagnostic resolution among minority populations (Post-Doctoral direction). The F99 phase of this fellowship award will provide the necessary training and mentoring to further my knowledge and skill in 1) disparities, 2) survival, 3) multi-level, 4) GIS, and 5) geospatial analyses. The K00 phase will expose me to 1) interventional analyses such as cancer patient navigation, 2) Randomized Controlled Trials and 3) enhance my scholarly productivity and professional development during this fellowship, including preparation and submission of grants and publications.