Differential Delivery of Follow-up Care and Survivorship Among Latinos Using Medi

描述（由申请人提供）：使用医疗保险的拉丁美洲人之间的后续护理和生存率的差异交付本申请涉及广泛的挑战领域（05）比较有效性研究和特定的挑战主题，05-AA-101现有临床数据集的创新分析。研究表明，平等获得癌症治疗和支持性护理可以消除结果上的差异。拉丁裔在美国占4550万人。尽管许多报告表明，与非西班牙裔相比，拉丁美洲人患某些疾病和死亡的风险较低，甚至有更好的健康行为，尽管有与健康状况不佳相关的传统风险因素，如低收入和教育水平。与此同时，患有某些癌症的拉丁美洲人比非拉丁美洲人更有可能死得更早。例如，一名被诊断患有乳腺癌的拉丁裔妇女在诊断后的5年内死于乳腺癌的可能性比同年龄、同疾病阶段的非拉丁裔白色妇女高22%。这一现象急需调查。拉丁裔社区生存率较低的原因尚不清楚，但可能反映了获得及时，高质量治疗的机会较少。科学家们还没有研究患有乳腺癌、前列腺癌和胃癌的拉丁美洲人接受癌症和预防性护理的及时性是否会影响他们的生存率。本研究将重点关注监测、流行病学和最终结果（SEER）癌症监测数据与医疗保险的联系。首先，这项研究将评估与其他种族群体相比，拉丁美洲人在诊断后多久接受乳腺癌，前列腺癌和胃癌的标准治疗。然后，这项研究将确定癌症护理或一般预防性医疗保健的延迟是否取决于拉丁美洲人居住的地方（即贫穷的社区，没有很多医生或大多数居民只说西班牙语）。最后，这项研究将评估治疗和护理的延迟是否与拉丁美洲人比其他种族群体更早死亡有关。在为期2年的研究期结束时，这项研究将培养研究生在卫生服务研究提供基础设施，以解决最具挑战性的问题，在医疗保健服务。社会将了解阻碍拉丁美洲癌症幸存者获得及时和高质量护理的障碍。这项研究将帮助政策制定者，研究界和卫生保健系统在整个人口中平等地应用当前关于成功治疗的知识，最终减少种族和种族群体之间的差异，并制定有效的有针对性的干预措施和政策，以避免一刀切的政策，使癌症生存率的差异永久化。 公共卫生相关性：该项目将提供有关后续护理的差异化交付及其对拉丁美洲人口生存率的影响的知识。政策制定者、研究界和卫生服务提供者将利用这些知识，为整个人口提供平等的循证护理服务。该项目为研究生和差异研究人员提供工作，并提供基础设施，以减少受经济衰退不利影响的族裔群体的差异。

DESCRIPTION (provided by applicant): Differential Delivery of Follow-up Care and Survivorship Among Latinos Using Medicare This application addresses broad Challenge Area (05) Comparative Effectiveness Research and specific Challenge Topic, 05-AA-101 Innovative Analyses of Existing Clinical Datasets. Research shows equal access to cancer treatment and supportive care eliminates disparities in outcomes. Latinos comprise 45.5 million people in the US. Although many reports demonstrate Latinos, compared to non-Hispanics, have lower risks of some diseases and death and even have better health behaviors despite having traditional risk factors associated with poor health such as low income and education levels. Paradoxally, Latinos with some cancers are more likely to die sooner than non-Latinos. For example, a Latina woman diagnosed with breast cancer is 22% more likely to die of breast cancer during the 5 years after diagnosis than a non- Latina white woman of the same age with the same stage of disease. This phenomena needs urgent investigation. The reasons for poorer survival in the Latino community are unclear but may reflect poorer access to timely, high quality treatment. Scientists have not studied if the timeliness of cancer and preventative care that Latinos with breast, prostate and stomach cancers receive impacts their survivorship. This study will focus on the Surveillance, Epidemiology, and End Results (SEER) cancer surveillance data linkage to Medicare. First, this study will assess how soon after a diagnosis Latinos receive standard care for breast, prostate and stomach cancers compared to other ethnic groups. Then this study will determine if delays in either cancer care or general preventative health care depends on where Latinos live (i.e. neighborhoods that are poor, without many doctors or where most residents speak only Spanish). Finally, this study will assess if the delays in treatment and care are associated with earlier death in Latinos compared to other ethnic groups. By the end of the 2-year study period, this study will have trained graduate students in health services research providing infrastructure to address the most challenging questions in health care delivery. Society will know barriers that stand in the way of timely and high-quality care for Latino cancer survivors. This research will assist policy makers, the research community and the health care system apply current knowledge about successful treatments equally throughout the population and ultimately reduce disparities between ethnic and racial groups and develop effective targeted interventions and policies to avoid one-size-fits-all policies that perpetuate disparities in cancer survival. PUBLIC HEALTH RELEVANCE: This project will provide knowledge about the differential delivery of follow-up care and its impact on survivorship in the Latino population. Policy makers, the research community, and health providers will use this knowledge to provide evidence based delivery of care equally throughout the population. This project provides graduate students and disparities researchers' jobs and provides the infrastructure to reduce disparities in ethnic groups adversely impacted by the recession.