Understanding Reversed Race/Ethnic Associations with Cancer Screening Tests

了解种族/民族与癌症筛查测试的反向关联

• 批准号: 7404442
• 负责人: WILLIAM RAKOWSKI
• 金额: $ 19.18万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-12 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7404442
• 关键词: Address; Adoption; Age; Attention; Behavioral Risk Factor Surveillance System; Breast; Clinical; Colorectal; Data; Data Set; Databases; Decision Making; Diffusion; Disease regression; Ethnic Origin; Ethnic group; Factor Analysis; Future; Generic Drugs; Health Information National Trends Survey; Individual; Insurance Coverage; Intervention; Logistic Regressions; Malignant Neoplasms; Mammography; Medical Surveillance; Morbidity - disease rate; Multivariate Analysis; National Health Interview Survey; Not Hispanic or Latino; Numbers; Pap smear; Persons; Play; Population; Population Group; Procedures; Process; Prostate; Purpose; Race; Rate; Recommendation; Recording of previous events; Relative (related person); Research; Research Project Grants; Resource Allocation; Risk; Role; Screening for cancer; Screening procedure; Statistically Significant; Surveys; Testing; Time; Translating; Weight; Woman; base; cancer prevention; male; men; mortality; racial and ethnic; trend; Address; Adoption; Age; Attention; Behavioral Risk Factor Surveillance System; Breast; Clinical; Colorectal; Data; Data Set; Databases; Decision Making; Diffusion; Disease regression; Ethnic Origin; Ethnic group; Factor Analysis; Future; Generic Drugs; Health Information National Trends Survey; Individual; Insurance Coverage; Intervention; Logistic Regressions; Malignant Neoplasms; Mammography; Medical Surveillance; Morbidity - disease rate; Multivariate Analysis; National Health Interview Survey; Not Hispanic or Latino; Numbers; Pap smear; Persons; Play; Population; Population Group; Procedures; Process; Prostate; Purpose; Race; Rate; Recommendation; Recording of previous events; Relative (related person); Research; Research Project Grants; Resource Allocation; Risk; Role; Screening for cancer; Screening procedure; Statistically Significant; Surveys; Testing; Time; Translating; Weight; Woman; base; cancer prevention; male; men; mortality; racial and ethnic; trend

DESCRIPTION (provided by applicant): Evidence for disparities in the utilization of screening tests plays a central role in the nation's efforts at cancer prevention and control. Persons in traditionally underserved racial and ethnic groups have had lower screening rates relative to non-Hispanic Whites. In addition, they often have disproportionately higher morbidity and mortality. The process of making decisions about groups in the population who are "at-risk" of lower screening test utilization typically starts with bivariate analyses of the associations between a set of potential covariates and use of a screening test. The next step is to conduct multivariable analysis most often using logistic regression, to identify the final set of variables that achieve statistical significance. This final set of statistically significant variables is then translated into population groups who need targeted interventions to reduce disparities. This proposed research addresses a situation we, and others, have observed in several analyses of cancer screening in population-based data sets. That is, analyses done with different survey databases have found several instances where bivariate associations between race/ethnicity and cancer screening have been "reversed" in multivariable analyses. That is, a group with lower screening in bivariate ("crude rate") analysis shows higher screening based on the "adjusted" results from the multivariable analysis. These reversals may have implications not only for intervention planning, but also for the way that analyses are conducted to identify correlates of a screening procedure. The Specific Aims of this proposed research are: 1.) To investigate the extent of reversals of associations from bivariate to multivariable analyses of the correlates of cancer screening, by examining results several population-level surveys, by using multiple years of each survey, and by expanding the scope of screening tests to include both women and men. 2.) To investigate variables that may explain reversals of association when comparing the results of bivariate and multivariate analyses of factors associated with cancer screening tests. This two-year project will conduct secondary analyses with multiple years of data from three national- level surveys: The National Health Interview Survey, The Behavioral Risk Factor Surveillance System, and the Health Information National Trends Survey. Five screening tests will be examined: mammography, clinical breast exam, Pap testing, prostate exam, and colorectal examination. This research will extend research to date in several ways. First, it greatly expands the number of survey databases being examined. Second, it expands the number of screening tests being reviewed, and gives added attention to male screening. Third, it uses definitions of screening that are as consistent as possible across the individual surveys. Fourth, it uses a consistent set of independent variables across the surveys. Fifth, it will be possible to look for trends over time in the presence of reversals of association for repeat screening.

描述（由申请人提供）：筛查测试利用中差异的证据在国家预防和控制癌症的努力中起着核心作用。相对于非西班牙裔白人，传统上服务不足的种族和族裔的人的筛查率较低。此外，它们的发病率和死亡率通常不成比例。较低筛查测试利用的“处于危险中”的人群中的群体的决策通常始于对一组潜在协变量和使用筛查测试之间关联的双变量分析。下一步是最常使用逻辑回归进行多变量分析，以确定获得统计显着性的最终变量集。然后将最终的一组统计学意义变量转化为需要有针对性干预措施以减少差异的人群群体。这项拟议的研究解决了我们和其他人在基于人群数据集中的癌症筛查分析中观察到的情况。也就是说，使用不同的调查数据库进行的分析发现了几个实例，在多变量分析中，种族/民族和癌症筛查之间的双变量关联已被“逆转”。也就是说，在双变量（“粗率”）分析中进行较低筛选的组显示了基于多变量分析的“调整后”结果的较高筛选。这些逆转可能不仅对干预计划有影响，而且对进行分析以识别筛查程序的相关性的方式。这项拟议的研究的具体目的是：1。）通过使用每种调查的多年种群级调查来研究结果的几个人群级调查，并通过使用每种调查的多年来研究癌症筛查相关性的相关性的逆转程度，并通过扩大筛查测试的范围，以包括男性和男性。 2.）研究变量可以解释与癌症筛查测试相关的因素的双变量和多变量分析的结果时可以解释关联的逆转。这个为期两年的项目将通过三个国家级调查的多年数据进行次要分析：国家健康访谈调查，行为风险因素监视系统和《健康信息国家趋势调查》。将检查五次筛查测试：乳房X线摄影，临床乳房检查，子宫颈抹片检查，前列腺检查和结直肠检查。这项研究将以几种方式扩展研究。首先，它大大扩大了正在检查的调查数据库数量。其次，它扩大了正在审查的筛查测试的数量，并更加关注男性筛查。第三，它使用在整个调查中尽可能一致的筛选定义。第四，它在整个调查中使用一组一致的自变量。第五，在存在关联逆转以进行重复筛选的情况下，随着时间的流逝，可以寻找趋势。