Comparative Modeling to Inform Cervical Cancer Control Policies: METRICS PROSPR Supplement Phase 2

项目摘要/摘要 了解结构性种族主义和歧视（SRD）对宫颈癌护理服务的影响 筛选过程以及如何为少数群体产生不同的结果是一个挑战 有很多原因我们用来为医疗保健决策提供信息的许多证据缺乏多样性， 从患者群体和医疗保健环境的角度来看，研究人员现在 认识到SRD不仅造成健康差距，而且也造成证据基础不足。 CISNET-PROSPR度量工作组在我们的阶段合作解决这些问题 我补充说，我们概念化的结构和体制因素如何导致获得差异 关心，识别建模的机会（和复杂性），以探索 不同宫颈癌结局亚组之间筛查实践的差异。在第二阶段，我们 建议定量分析反映METRICS网站结构政策的多层次数据， 子宫颈检查过程的措施和结果，并使用模型来预测健康的影响， 不同的子宫颈癌筛查做法对缓解（或加剧）子宫颈癌患者健康差距的作用 癌症发病率和死亡率。 承认将SRD和中等社会暴露直接联系起来的经验证据有限 子宫颈癌筛查实践和结果，METRICS和CISNET-Cervical研究人员 建议继续合作，以（1）测试和解释选定的SRD措施对两个 筛查结果;（2）预测宫颈癌不同模式的影响和贡献 筛查，诊断和治疗黑人与所有女性之间不同的宫颈癌结果， 美国;以及（3）将来自METRICS的SRD或ISE关联的测量整合到CISNET-Cervical中 模型来探索对观察到的宫颈癌结局差异的影响。 这项工作将有助于补充关于如何衡量SRD和ISEs并建立模型的有限文献， 促进宫颈癌筛查的公平性。

Project Abstract/Summary Understanding the impact of structural racism and discrimination (SRD) on care delivery in the cervical cancer screening processes and how it may produce disparate outcomes for minoritized communities is challenging for many reasons. Much of the evidence that we use to inform health care decisions lacks diverse representation from both a patient population and a healthcare setting perspective. Researchers now recognize that SRD, not only contribute to health disparities, but also to an inadequate evidence base. The CISNET-PROSPR METRICS Working Group has collaborated to address these issues during our Phase I supplement where we conceptualized how structural and institutional factors can lead to differences in access to care, identifying opportunities (and complexities) for modeling to explore the relative contributions of differences in screening practice among subgroups on disparate cervical cancer outcomes. In Phase II, we propose to quantitatively analyze multi-level data that reflect structural policies from the METRICS sites on cervical screening process measures and outcomes, and use the models to project the health impact of differential cervical cancer screening practices on alleviation (or exacerbation) of health disparities in cervical cancer incidence and mortality. Acknowledging the limited empirical evidence directly associating SRD and intermediate social exposures (ISEs) to cervical cancer screening practice and outcomes, the METRICS and CISNET-Cervical investigators propose to continue their collaboration to (1) test and interpret the influence of selected SRD measures on two screening outcomes; (2) project the impact and contributions of differential patterns of cervical cancer screening, diagnosis, and treatment on disparate cervical cancer outcomes among Black versus all women in the U.S.; and (3) integrate measures of association of SRD or ISEs from METRICS into the CISNET-Cervical models to explore the impacts on observed disparities in cervical cancer outcomes. This work would contribute to the limited existing literature on how to measure and model SRD and ISEs to promote equity in cervical cancer screening.