Does Violence Against Women result in disparities in cancer care for women with b

针对女性的暴力行为是否会导致女性癌症护理方面的差异

基本信息

批准号：
8460774
负责人：
Ann L Coker
金额：
$ 34.36万
依托单位：
UNIVERSITY OF KENTUCKY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-25 至 2015-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8460774
关键词：
Adult Affect Appalachian Region Breast Breast Cancer Treatment Cancer Burden Cancer Control Cancer Patient Caring Censuses Cervical Child Choices and Control Clinic Colonoscopy Colorectal Colorectal Cancer Consent Cox Proportional Hazards Models Data Data Analyses Data Set Diagnosis Diagnostic Neoplasm Staging Divorce Education Ensure Epidemiologic Studies Equation Ethnic Origin Event Exposure to Family member Fecal occult blood Frequencies Funding Gender Geographic state Grant Health Health Insurance Healthcare Human Papillomavirus Incidence Individual Insurance Coverage Intervention Interview Kentucky Life Life Cycle Stages Link Literature Logistic Regressions Low income Malignant Neoplasms Malignant neoplasm of cervix uteri Malignant neoplasm of lung Mammography Measures Mediating Medical Medical Surveillance Medicare Medicare claim Medicare/Medicaid Mental Health Methods Minority Modeling Neighborhoods Occult blood screen Outcome Outcomes Research Palliative Care Pap smear Parents Pathway interactions Patient Self-Report Patients Pattern Physicians Positioning Attribute Poverty Poverty Areas Prevalence Public Health Race Recruitment Activity Registries Research Research Personnel Risk Role Rural Schools Screening for cancer Services Severities Smoke Smoking Status Socioeconomic Factors Socioeconomic Status Solutions Source Stage at Diagnosis Staging Supportive care Surveys Survivors Telephone Telephone Interviews Texas Time Tumor stage Unemployment Uninsured United Nations United States Centers for Medicare and Medicaid Services Violence Woman Women&apos s Health Work base cancer care cancer diagnosis cancer health disparity cancer prevention cancer therapy care seeking cohort emotional abuse experience health disparity improved low socioeconomic status malignant breast neoplasm men mortality neoplasm registry physical conditioning population based programs prospective psychologic residence rural area screening social socioeconomics survivorship tool violence against women

项目摘要

Background: Violence against women (VAW) is defined by the United Nations as "any act of gender based violence that results in physical, sexual, or psychological harm or suffering to women." In Kentucky almost 40% of women had experienced some form of VAW in their lifetime. The frequency of VAW poses a serious public health challenge not only due to the prevalence but also the long term impact on women's health, documented in an impressive body of literature. However, very little research has explored the effect of lifetime VAW on cancer prevention and control. Kentucky has a high cancer burden with the highest cancer mortality rate of all US states. Incidence rates of cancer and the proportion of women diagnosed at a later stage are higher in the Appalachian region of Kentucky. VAW frequently co-occurs with social factors leading to health disparities including unemployment, less education and minority race. Overall objectives of this project are to determine the extent to which VAW may explain noted disparities in cancer care based on women's race/ethnicity, socioeconomic status, access to health insurance, or residence in high poverty and rural areas of Kentucky. Specific aims: To determine whether VAW is associated with disparities in breast cancer (aim 1), colorectal cancer (aim 2) and cervical cancer (aim 3) care outcomes to include not receiving cancer screening at recommended intervals, being diagnosed with cancer at a later stage, not receiving recommended cancer treatment including supportive/palliative care, and poorer cancer specific survival among women diagnosed with these cancers in Kentucky and adjusting for relevant confounders including race, socioeconomic status, having health insurance, rural residence, and specific regions of high poverty (e.g., living in the Appalachian region of eastern Kentucky or the Delta region of western Kentucky). Methods: We propose a prospective cohort using the Kentucky Cancer Registry (KCR) as the source of 3150 breast cancer cases, 1575 colorectal cancer cases and 525 cervical cancer cases. These 5250 women will be interviewed by phone to determine their lifetime exposure to VAW and comorbid conditions. These data will be linked with state level Medicare claims data for women completing phone surveys who are 65 or older. The Medicare claims data, administered by the Center for Medicare and Medicaid Services, include comprehensive coverage of medical services regardless of where the patients seek care in the nation, which would allow the detailed examination of the proposed cancer care continuum: cancer screening, stage at diagnosis, treatment, supportive or palliative care and survivorship. Both logistic regression and Cox proportional hazards modeling will be used to determine the role of VAW (by frequency, duration, severity, recency and type) and socioeconomic attributes influencing disparities in cancer care. These associations will be investigated for each of the hypothesized five cancer care outcomes and by specific cancer. The mediating or moderating role of socioeconomic factors will also be explored using structural equation modeling. Relevance: This will be the first population-based cohort of the influence of VAW on the life course of cancer care in a state with high cancer burden and regions of extreme poverty. Findings will have significant public health impact in reducing disparities and improving cancer prevention and control in women.

背景：对妇女的暴力行为（VAW）由联合国定义为“任何基于性别的暴力行为导致身体，性或心理伤害或妇女的痛苦。”在肯塔基州，几乎40％一生中经历了某种形式的VAW。 VAW的频率不仅构成了严重的公共卫生挑战由于普遍存在，但也对妇女健康的长期影响，记录在令人印象深刻的文献中。但是，很少的研究探讨了终生VAW对预防癌症和控制的影响。肯塔基有一个癌症负担高，美国所有州的癌症死亡率最高。癌症的发生率和比例在肯塔基州阿巴拉契亚地区，在后期被诊断出的妇女更高。 VAW经常与导致健康差异的社会因素，包括失业，较少的教育和少数民族种族。总体目标该项目的内容是确定VAW可以根据妇女的癌症护理中概述的差异的程度种族/民族，社会经济地位，获得健康保险或肯塔基州农村地区的住所。具体目的：确定VAW是否与乳腺癌的差异有关（AIM 1），结直肠癌（AIM 2）和宫颈癌（AIM 3）护理结果包括不以建议的间隔进行癌症筛查，在以后的阶段被诊断出患有癌症，未接受建议的癌症治疗，包括支持/姑息治疗，以及在肯塔基州被诊断出患有这些癌症的妇女的癌症特异性生存率较差，并调整了相关的混淆者在内贫困（例如，居住在肯塔基州东部的阿巴拉契亚地区或肯塔基州西部的三角洲地区）。方法：我们建议使用肯塔基州癌症注册中心（KCR）作为3150例乳腺癌病例的来源， 1575例结直肠癌病例和525例宫颈癌病例。这5250名妇女将通过电话采访以确定他们一生暴露于VAW和合并状况。这些数据将与州级Medicare索赔数据链接对于完成65岁或65岁以上的电话调查的妇女。 Medicare索赔数据，由中心管理 Medicare和Medicaid服务，包括对医疗服务的全面覆盖范围在美国寻求护理，这将允许对拟议的癌症护理连续体进行详细检查：癌症筛查，诊断，治疗，支持或姑息治疗和生存。逻辑回归和考克斯比例危害建模将用于确定VAW的作用（按频率，持续时间，严重程度，重新度和类型）和社会经济属性影响癌症护理差异的影响。这些关联将针对每个协会进行调查在假设的五个癌症护理结果和特定癌症中。社会经济的调解或调节作用还将使用结构方程建模探索因素。相关性：这将是第一个基于人群的队列 VAW对癌症负担很高的州和极端地区的状态下VAW对癌症护理的影响贫困。调查结果将对降低差异和改善癌症预防和改善癌症和女性控制。