Examining the Relationship between Residential History at Midlife and Prostate Cancer Outcomes

摘要 前列腺癌(PCA)是少数几种癌症之一，其死亡率是黑人男性的两倍以上，这使得 癌症中最大的种族差异之一。尽管在PCa的发病率上有记录上的差异 和死亡率与人们居住的地方有关，目前尚不清楚患者的居住史对他们的 PCA结果。居住环境因种族和社会经济(SES)而有很大差异。我们仍然知之甚少 关于社区风险因素和结构性种族主义的纵向暴露是如何在几年前捕获的 癌症诊断和存活率有助于癌症护理连续统一体上的PCA差异。 此外，PCa的疾病结局和差异受患者年龄的影响。住宅史 中年时期是可能影响前列腺癌发病率、进展、死亡率和整体护理的因素之一。 生还者。我们提出了一种创新的将PA癌症登记数据与来自 PA医疗成本控制委员会和~30年LexisNexis地址数据提供特征 病人居住的人口普查区域。我们将使用宾夕法尼亚州(PA)癌症登记数据(N~20,000名患者 在宾夕法尼亚州东南部)以确定纵向邻里特征(贫困)之间的关系 轨迹、历史红线、贷款偏见和士绅化)和沿线关键点的PCA结果 在一个多元化和历史性的地区，癌症护理是一个连续的整体。这些不同的特征将用于确定 在PCA结果的风险建模中检查居住历史的最佳实践。我们要过一种新奇的生活 解决住宅历史在以下方面的作用的课程方法 主成分分析的差异。我们还假设累积风险敞口 在年内关键时期暴露于邻里风险因素 PCA护理轨迹在以下方面影响疾病特征 诊断和PCA-死亡率。多水平回归模型将是 进行多层次的独立关联评估 影响PCA结果的因素。我们还将通过以下方式检查修改 年龄。我们从这项研究中学到的信息将帮助我们 了解将居住史整合到癌症研究中的方法 并制定有效干预措施以促进前列腺癌 高危成人人群的健康状况 我们建议进行一项纵向的双向研究，以解决 以下目标：目标1：检查主成分分析之间的关系 诊断时的差异和居住特征；目标2：我们将在这方面采用生命过程框架 检查PCA差异和累积癌症差异研究之间的关系(基于Ory等人。 住宅历史；目标3：检查住宅暴露于2014年的情况(AJPM)。差异发生在一个 特别是在中年期间积累的是与PCA环境相关的。研究重点放在 差距；目标4：在特定生命阶段进行社区需求评估，提供独特的机会 与专业临床医生和社区规划利益相关者建立伙伴关系，为政策、实践和社区规划的健康提供信息 改善PCA的服务范围和关爱社区。

ABSTRACT Prostate cancer (PCa) is one of a few cancers with more than double the mortality for black men, making this one of the greatest racial disparities in cancer. Although there are documented disparities in PCa incidence and mortality related to where people live, it is unclear how residential histories of patients contribute to their PCa outcomes. Residential environments vary greatly by race and socioeconomics (SES). Still little is known about how longitudinal exposures to neighborhood risk factors and structural racism captured years before a cancer diagnosis and into survivorship contribute to PCa disparities along the cancer care continuum. Additionally, disease outcomes and disparities in PCa are moderated by patient age. Residential history during midlife is one of the factors that likely influences PCa incidence, progression, mortality, and overall care of survivors. We propose an innovative linkage of PA cancer registry data to hospital billing records from the PA Healthcare Cost Containment Council and ~30 years of LexisNexis address data to provide characteristics of census tracts where patients live. We will use Pennsylvania (PA) Cancer Registry data (N~20,000 patients in Southeastern PA) to determine the relationship between longitudinal neighborhood characteristics (poverty trajectories, historical redlining, lending bias, and gentrification) and PCa outcomes at critical points along the cancer care continuum in a diverse and historic region. These various characteristics will be used to determine best practices to examine residential histories in risk modeling for PCa outcomes. We will take a novel life course approach to addressing the role of residential history on PCa disparities. We hypothesize that cumulative exposures as well as exposures to neighborhood risk factors during critical periods in the PCa care trajectory influence disease characteristics at diagnosis and PCa-mortality. Multilevel regression models will be conducted to evaluate independent associations of multi-level factors with PCa outcomes. We will also examine modification by age. The information that we learn from this study will help us to understand ways to integrate residential history in cancer research and strategize about effective interventions to promote prostate health among high-risk adult populations We propose a longitudinal, ambidirectional study to address the following aims: Aim 1: To examine the relationships between PCa disparities and residential characteristics at diagnosis; Aim 2: To We will employ a life-course framework in this examine relationships between PCa disparities and accumulated cancer disparities research (based on Ory, et al. residential history; Aim 3: To examine how residential exposures 2014, AJPM). Disparities occur within an accumulated specifically during midlife are associated with PCa environmental context. Research focused on disparities; Aim 4: Conduct a community needs assessment in particular life stages provide unique opportunities partnership with expert clinician and community planning stakeholders to inform policy, practice, and the health of the to improve PCa outreach and care community.