The Social Environment and Colorectal Cancer in the United States

项目总结/摘要 该提案的首要目标是评估社会环境与健康之间的关系 美国结直肠癌（CRC）的差异，并确定公共卫生政策在 减少他们。CRC是美国女性和男性中第三常见的癌症，也是第二常见的癌症。 是癌症死亡率的主要原因，估计2020年共有53，200人死亡。虽然改进 在筛查摄取方面，治疗的进步和危险行为的减少导致了CRC的降低 近年来的发病率和死亡率，低社会经济地位（SES），种族/少数民族， 那些没有健康保险的人仍然有更大的CRC负担。由于所有这些因素的相互作用， 由于社会经济地位的特殊性，要解开社会经济地位作为CRC健康差异驱动因素的作用是具有挑战性的。最近 癌症研究的发展强调了评估社区水平和其他社会因素的必要性。 除了个人特征外，还应考虑到水平因素，因为这些因素反映了获得资源的情况， 是癌症风险的关键因素，如：交通，娱乐场所，健康食品，医疗保健服务 教育和就业机会。极端浓度指数（ICE）允许 衡量空间和社会两极分化的不同方面，包括种族/族裔、经济和 种族化的经济居住隔离，并提供一个全面的社会评估， 个人的环境。 2014年，根据《患者保护和平价医疗法案》（Patient Protection and Affordable Care Act (ACA)，使低收入者能够获得医疗保险，预计将减少CRC 健康差距。先前评估ACA早期的研究显示， 覆盖率，但研究评估其对CRC筛查，发病率和诊断阶段的影响， 结果不一致，在种族/族裔群体中没有得到很好的理解。因此，本研究将使用数据 从2010 - 2018年全国健康访谈调查中具有全国代表性的成年人样本中， 和2009 - 2017年美国癌症统计数据库，其中包括2009年至2017年的所有癌症病例。 国家，采用多层次建模和计量经济学方法，这些具体目标：1）确定 在CRC筛查、发病率和诊断阶段存在健康差异，2）阐明 医疗补助计划的扩大，以减少这些健康差距。这项研究的结果将有价值的通知 卫生政策的影响，以及哪些群体最需要CRC干预措施来促进NCI 使命是"帮助所有人活得更长、更健康"。跨学科培训环境和 专家指导团队将为申请人提供一个极好的培训机会， 方法和内容的专业知识，为未来的职业生涯作为癌症流行病学和健康的差距 研究员

Project Summary/Abstract The overarching goal of this proposal is to evaluate the relationship between the social environment and health disparities in colorectal cancer (CRC) in the United States, and determine the role of public health policy in reducing them. CRC is the third most common cancer in women and men in the US, and it is the second leading overall cause of cancer mortality, with a total of 53,200 deaths estimated for 2020. While improvements in screening uptake, advances in treatment and reduction of risky behaviors have resulted in lowering CRC incidence and mortality in recent years, people of low socioeconomic status (SES), racial/ethnic minorities, and those without health insurance still have a greater burden of CRC. Due to the interplay of all these characteristics, it is challenging to unpack the role of SES as a driver of CRC health disparities. Recent developments in cancer research have highlighted the need for evaluating neighborhood-level and other social level factors, in addition to individual characteristics as they capture information on access to resources that are key elements of cancer risk, such as: transportation, recreational places, healthy food, healthcare services and education and employment opportunities. The Index of Concentration at the Extremes (ICE) permits the measurement of different aspects of spatial and social polarization, including racial/ethnic, economic and racialized economic residential segregation, and provide a comprehensive assessment of the social environment of individuals. In 2014, the implementation of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), made health insurance coverage accessible to people of low income, and was expected to reduce CRC health disparities. Prior research evaluating the early years of ACA has shown an increase in insurance coverage, but studies evaluating its effect on CRC screening, incidence and stage at diagnosis have had inconsistent results, and it is not well-understood within racial/ethnic groups. Therefore, this study will use data from a nationally representative sample of adults in the National Health Interview Survey for years 2010-2018, and the United States Cancer Statistics database for 2009-2017, which includes all incident cancer cases in the country, to employ multilevel modeling and econometric methods with these specific aims: 1) determine the presence of health disparities in CRC screening, incidence and stage at diagnosis and 2) elucidate the role of Medicaid expansion in reducing these health disparities. Results from this study will be valuable in informing the effect of health policy and for which groups CRC interventions are most needed to contribute to the NCI mission of “helping all people live longer, healthier lives”. The interdisciplinary training environment and the expert mentorship team for this proposal will provide the applicant an excellent training opportunity to develop methodological and content expertise for a future career as cancer epidemiologist and health disparities researcher.