Racial Disparity in Diagnostic Evaluation of Uterine Cancer

子宫癌诊断评估中的种族差异

• 批准号: 10276384
• 负责人: Jason Wright
• 金额: $ 65.5万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-27 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10276384
• 关键词: Accounting; Address; Affect; African American; Area; Awareness; Behavior; Behavioral; Belief; Cancer Death Rates; Cancer Patient; Cancerous; Caring; Characteristics; Clinical; Clinical Data; Clinical Pathology; Data; Data Mart; Databases; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic tests; Early Diagnosis; Effectiveness; Ethnic Origin; Evaluation; Exhibits; Future; Guidelines; Health Care Seeking Behavior; Health Services Accessibility; Healthcare; Healthcare Systems; Histologic; Incidence; Infrastructure; Intervention; Knowledge; Lead; Link; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Medicaid; Medicare; Newly Diagnosed; Obesity; Outcome; Pathway interactions; Patients; Prevalence; Process; Prognosis; Prognostic Factor; Provider; Race; Reporting; Research; Risk Factors; Role; SEER Program; Sampling; Secondary Prevention; Socioeconomic Factors; Socioeconomic Status; Stage at Diagnosis; Surveys; Symptoms; Technology; Testing; Time; Uterine Cancer; Uterine hemorrhage; Woman; behavioral health; beneficiary; black women; black/white disparity; cancer diagnosis; cancer type; caucasian American; data registry; design; disparity reduction; evidence base; experience; follow-up; health inequalities; high risk; improved; mortality disparity; mortality risk; neglect; neoplasm registry; novel; patient population; population based; racial disparity; social culture; socioeconomics; tumor

Uterine cancer is the most common gynecologic malignancy in the U.S., with a two-fold higher risk of mortality for black women than white women. Early diagnosis is vital for patients’ prognosis as it greatly improves the effectiveness of subsequent treatment. Evidence has shown a significant black-white difference in uterine cancer stage at diagnosis (53% of black women versus 69% of white women are diagnosed at early stage), which explains more of the racial gap in mortality risk than any other factor. However, there has been little research elucidating barriers in the diagnostic pathway that lead to this disparity in early diagnosis, and reasons for the more advanced-stage uterine cancer in black women remain largely unclear, hindering our ability to address this important health inequity. Since many factors in the diagnostic pathway may be modifiable and amenable to interventions, this reflects a lost opportunity of secondary prevention (i.e., early detection and control of the cancerous process). The overarching objective of this project is to reduce racial disparity in the early diagnosis of uterine cancer by systematically examining patients’ diagnostic pathway and identifying barriers to early diagnosis in black women. We will achieve this objective via the following specific aims: 1) to examine racial disparity between black and white women with uterine cancer in the quality of diagnostic evaluation they receive; 2) to compare symptoms and diagnostic evaluation of women who have early versus advanced stage uterine cancer and examine their role in influencing racial disparity in stage at diagnosis; and 3) to conduct a population-based patient experience survey and link to cancer registry data to examine how sociocultural, behavioral and access barriers affect disparity in uterine cancer diagnosis. Aims 1- 2 will draw on three unique large healthcare databases that have patient-level indicators of race/ethnicity and socioeconomic status, contain a complete record of patients’ diagnostic pathway starting from the time when symptoms are reported to a provider, and cover a diverse patient population encompassing the commercially insured, Medicaid enrollees, and Medicare beneficiaries. These databases include the Optum Clinformatics Data Mart, the MarketScan Multi-State Medicaid Database, and the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Aim 3 will exploit the infrastructure of statewide cancer registries and the latest technology of rapid case ascertainment to survey a population-based sample of women newly diagnosed with uterine cancer about their experience. By further linking patient reported survey data to pathology/clinical data in cancer registry, we can uniquely examine how sociocultural, behavior, and patient-perceived barriers affect uterine cancer stage at diagnosis and the potential interplay between tumor characteristics (e.g., histologic type) and patient experience. Findings from this study will provide an essential evidence base about causes of racial disparity in uterine cancer diagnosis. Such information can guide meaningful design of targeted interventions to promote early diagnosis in black women and reduce disparity.

子宫癌是美国最常见的妇科恶性肿瘤，死亡率的风险更高2倍 对于黑人妇女而不是白人妇女。早期诊断对于患者的预后至关重要，因为它大大改善了 随后治疗的有效性。证据表明子宫有明显的黑白差异 诊断时的癌症阶段（黑人女性中有53％与69％的白人妇女在早期被诊断出）， 这比其他任何因素都更大的死亡风险中的种族差距。但是，几乎没有 研究在诊断途径中阐明障碍，导致早期诊断的差异 黑人妇女中更先进的子宫癌的原因在很大程度上不清楚，阻碍了我们 解决这一重要健康不平等的能力。由于诊断途径中的许多因素可能是 可以修改并适合干预措施，这反映了次要预防的失去机会（即早期 检测和控制取消过程）。该项目的总体目标是减少种族 通过系统地检查患者的诊断途径和 确定黑人妇女早期诊断的障碍。我们将通过以下特定来实现这一目标 目的：1）检查子宫癌的黑人和白人妇女之间的种族差异 他们接受的诊断评估； 2）比较拥有的妇女的符号和诊断评估 早期与高级阶段子宫癌，并检查其作用影响阶段的种族差异 诊断; 3）进行基于人群的患者经验调查并链接到癌症注册表数据 检查社会文化，行为和获取障碍如何影响子宫癌诊断的差异。目标1- 2将利用三个独特的大型医疗保健数据库，这些数据库具有患者级的种族/民族指标和 社会经济地位，包含患者诊断途径的完整记录 症状被报告给提供者，并覆盖涵盖商业上的潜水员患者 保险人，医疗补助招募和医疗保险受益人。这些数据库包括optum临床技术 数据集市，MarketScan多国家医疗补助数据库以及监视，流行病学和结束 结果（SEER）-Medicare数据库。 AIM 3将利用全州癌症注册机构的基础设施和 快速案例确定的最新技术来调查新诊断的基于人群的妇女样本 与子宫癌的经历有关。通过进一步联系患者报告的调查数据与病理/临床 癌症注册表中的数据，我们可以独特地研究社会文化，行为和患者感知的障碍 在诊断时影响子宫癌阶段以及肿瘤特征之间的潜在相互作用（例如， 组织学类型）和患者经验。这项研究的发现将提供有关的基本证据基础 子宫癌诊断中种族差异的原因。这样的信息可以指导有意义的设计 采取针对性的干预措施，以促进黑人妇女的早期诊断并减少差异。