Outcomes of Curable Cancers in Vulnerable Populations

描述(申请人提供)：一些癌症，包括睾丸癌；霍奇金和非霍奇金淋巴瘤；早期乳腺癌、结直肠癌、肺癌和膀胱癌；早期黑色素瘤；以及成人的儿科恶性肿瘤被认为是“可治愈的”，我们定义为5年无复发的生存。虽然在整个人群中都有高治愈率的报道，但人们对这些比率在人口亚群中的比较是否一致，以及如果是这样，哪些因素导致治愈率较低知之甚少。在拟议的研究中，重点关注20-50岁的成年人，我们的目标是评估俄亥俄州总体人口，特别是医疗补助人口中这些癌症的存活率。医疗补助受益人是人口中的一个弱势群体。这是因为，除了社会经济脆弱性外，成年受益人还患有致残的身体和/或精神疾病。低收入育龄妇女是一个例外，她们寻求为产妇护理提供医疗补助。在俄亥俄州所有人口的研究中，我们将检查人口属性、医疗补助状况、其他社会经济指标和居住县对存活率的影响。当关注医疗补助受益人，并考虑到该人群的索赔数据可用时，我们将检查在存在或不存在精神和/或身体共病的情况下治愈的可能性。拟议的研究将使用一个独特的基于人口的数据库，我们将通过将俄亥俄州癌症发病率监测系统(OCISS)的记录与州医疗补助登记和索赔文件以及美国人口普查的数据联系起来来开发该数据库。与死亡相关的变量来自国家死亡指数，可通过OCISS文件获得。通过确定不同人群之间存活率和治愈率的差异，这些研究将为未来旨在确定造成这种差异的具体因素的研究努力提供基础。此外，由于很少在保健服务和与差异有关的研究中对这些癌症进行审查，拟议的研究将提供一个机会，以评估在更大规模和其他环境中开展可比研究的方法问题和潜在困难。项目简介：一些癌症，包括睾丸癌；霍奇金淋巴瘤和非霍奇金淋巴瘤；早期乳腺癌、结直肠癌、肺癌和膀胱癌；早期黑色素瘤；以及成人的儿科恶性肿瘤被认为是“可治愈的”，我们定义为5年无复发生存。拟议的研究旨在确定在俄亥俄州的人口亚群中，是否一致地观察到可治愈癌症的有利结果。我们将根据医疗补助状况检查生存结果；在医疗补助受益人中，将在存在或不存在精神和/或身体并存的情况下评估存活率和治愈率。

DESCRIPTION (provided by applicant): A number of cancers, including cancer of the testis; Hodgkins and non-Hodgkins lymphoma; early- stage breast, colorectal, lung, and urinary bladder cancer; early-stage melanoma; and pediatric malignancies in adults are considered "curable", which we define as 5-year survival without relapse. While high rates of cure have been reported in the population at large, little is known about whether these rates compare uniformly across subgroups of the population; and if so, which factors contribute to lower cure rates. In the proposed studies, which focus on adults 20-50 years of age, we aim to assess survival from these cancers in the population of Ohio overall, and in the Medicaid population in particular. Medicaid beneficiaries constitute a disadvantaged subgroup of the population. This is because in addition to socioeconomic vulnerabilities, adult beneficiaries suffer from disabling physical and/or mental ailments. An exception to this is low-income women of childbearing age seeking Medicaid coverage for maternity care. In studies accounting for the entire population in the state of Ohio, we will examine variations in survival by demographic attributes, as well as Medicaid status, additional socioeconomic indicators, and county of residence. When focusing on Medicaid beneficiaries, and given the availability of claims data for that population, we will examine the likelihood of cure in the presence or absence of mental and/or physical comorbid conditions. The proposed studies will use a unique population-based database, which we will develop by linking records from the Ohio Cancer Incidence Surveillance System (OCISS), with the state Medicaid enrollment and claims files, and data from the U.S. Census. Death-related variables, available through the OCISS files, originate from the National Death Index. By identifying differentials in survival and cure rates across subgroups of the population, these studies will provide a foundation for future research endeavors aimed at identifying the specific factors contributing to such disparities. In addition, because these cancers have been rarely examined in the context of health services and disparities-related research, the proposed studies will provide an opportunity to assess methodological issues and potential difficulties in carrying out comparable studies at a larger scale and in other settings. Project Narrative: A number of cancers, including cancer of the testis; Hodgkins and non-Hodgkins lymphoma; early- stage breast, colorectal, lung, and urinary bladder cancer; early-stage melanoma; and pediatric malignancies in adults are considered "curable", which we define as 5-year survival without relapse. The proposed studies aim to determine whether favorable outcomes of curable cancers are observed uniformly across subgroups of the population in Ohio. We will examine survival outcomes by Medicaid status; and among Medicaid beneficiaries, survival and cure rates will be evaluated in the presence or absence of mental and/or physical comorbid conditions.