The role of Federal legislation on breast cancer disparities

联邦立法对乳腺癌差异的作用

• 批准号: 8374988
• 负责人: ROBERT A LEVINE
• 金额: $ 16.53万
• 依托单位: MEHARRY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-12-14 至 2013-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8374988
• 关键词: Accounting; Address; Adverse effects; African American; Age; Area; Behavioral; Biological; Caring; Centers of Research Excellence; Cessation of life; Characteristics; Comorbidity; Data; Developed Countries; Diagnosis; Disease; Drug Prescriptions; Elderly; Elderly woman; Epidemiology; Ethnic Origin; HIV; Health; Health Insurance; Healthcare; Highly Active Antiretroviral Therapy; Individual; Intervention; Laws; Licensing; Life; Life Expectancy; Link; Logistic Regressions; Mammography; Measures; Medical; Medical Assistance; Medicare; Medicare claim; Modeling; Modification; National Cancer Institute; National Center on Minority Health and Health Disparities; Nature; Patients; Persons; Policies; Policy Maker; Positioning Attribute; Provider; Race; Relative (related person); Research Personnel; Resources; Respiratory distress; Role; Safety; Sampling; Screening procedure; Services; Socioeconomic Status; Solutions; Source; Statutes and Laws; Testing; Time; Translating; United States Centers for Medicare and Medicaid Services; United States Food and Drug Administration; Woman; abstracting; base; cancer health disparity; cancer information system; drug market; falls; hazard; health disparity; human very old age (85+); innovation; low socioeconomic status; malignant breast neoplasm; mortality; older women; premature; programs; psychologic; social; socioeconomics; success; surfactant

4.2.12. Levine Abstract. The role of federal legislation on breast cancer disparities After the Medicare program began to reimburse providers for screening mammography, mortality from breast cancer among US elderly began to fall. However, rates fell more rapidly among whites, and racial disparities widened. Interestingly, disparities did not widen uniformly across the US. We hypothesize that Medicare law inadvertently favors acquisition of screening mammography services by whites since it defines medical assistance as a cash benefit to pay providers regardless of the extent to which cash is the primary barrier to service acquisition. We propose to use the observed geographic variability in mortality disparities to address this hypothesis. We shall obtain large national samples of Medicare data and SEER-linked Medicare claims data to test the following sub-hypotheses: H-l: Regional and state level characteristics will have a significant effect on mammography utilization after adjusting for individual factors. H-2: The effect of regional and state level characteristics on mammography utilization will be different for African American and White women. H-3: The region having the greatest equitability for screening mammography utilization will be more likely to have programs in place aiming to increase mammography utilization and reduce disparities. H-4: Relative to places with moderate to high levels of success, failing places will be more likely to have low survival from breast cancer, and greater percentage increase in racial disparity in survival over time. H-5: Relative to places that are failing or have moderate to high screening mammography utilization, exceptionally successful places will be more likely to have high survival from breast cancer, and to have greater percentage reduction in racial disparity in survival over time. We believe there are compelling reasons to address the proposed hypotheses using alternative means as soon as possible: (a) thousands of deaths from breast cancer among the elderly may have already occurred or will occur because of unintended, adverse effects traceable to Medicare's definition of medical assistance as cash to pay providers; (b) breast cancer may be the tip of the iceberg, particularly with the advent of new programs to provide cash for prescription drugs as part of Medicare; and (c) there may be wider implications as regards the observed declines[2] in US position relative to other industrialized nations for life expectancy and other key measures. The project also proposes reasonable means for obtaining preliminary answers that will be useful for policy makers.

4.2.12。莱文摘要。 Medicare计划开始向提供者筛查乳房X线摄影，美国老年人的乳腺癌死亡率开始偿还乳腺癌差异的作用。但是，白人之间的速度更快，种族差异扩大。有趣的是，在整个美国，差异并没有统一扩大。我们假设Medicare法律无意中利用白人筛查乳房X线摄影服务的获取，因为它将医疗援助定义为现金收益，以支付提供者，无论现金在多大程度上是服务获取服务的主要障碍。我们建议使用观察到的死亡率差异的地理变异性来解决这一假设。 我们将获得大量的国家医疗保险数据样本和与SEER相关的Medicare索赔数据，以测试以下子集体：H-L：调整个体因素后，区域和州水平特征将对乳房X线照相利用产生重大影响。 H-2：非裔美国人和白人妇女的区域和州一级特征对乳房X线摄影利用的影响将有所不同。 H-3：具有筛查乳房X线摄影利用率最大的区域将更有可能制定旨在增加乳房X线摄影利用并降低差异的计划。 H-4：相对于成功至高水平的地方，乳腺癌的生存率更低，并且随着时间的流逝，种族差异的百分比更高。 H-5：相对于失败或中等筛查乳房X线摄影的地方 利用，出色的地方将更有可能患有乳腺癌的生存率很高，并且随着时间的流逝，种族差异的百分比降低了。我们认为，有令人信服的理由可以尽快使用替代手段解决拟议的假设：（a）老年人中成千上万的乳腺癌死亡可能已有 已经发生或将发生，因为意外，不利影响可追溯到Medicare将医疗援助定义为现金来支付提供者的现金； （b）乳腺癌可能是冰山一角，特别是随着新计划的出现，作为医疗保险的一部分提供处方药的现金； （c）相对于其他工业化国家的预期寿命和其他关键措施，观察到的美国位置下的下降[2]可能存在更广泛的含义。 该项目还提出了合理的手段，以获得对决策者有用的初步答案。