Studying Socioeconomic Disparities in Cancer Survival with Tapered Matching

通过锥形匹配研究癌症生存的社会经济差异

• 批准号: 8772925
• 负责人: JEFFREY H SILBER
• 金额: $ 43.27万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-03 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8772925
• 关键词: Accounting; Asians; Breast Cancer Treatment; Cancer Patient; Characteristics; Chronic Disease; Colon Carcinoma; Data; Databases; Diagnosis; Education; Elderly; Eligibility Determination; Future; Goals; Hispanics; Income; Low income; Malignant Neoplasms; Medicare; Methodology; Methods; Minority; Minority Groups; Modeling; Neighborhoods; Not Hispanic or Latino; Observational Study; Patients; Population; Population Characteristics; Poverty; Race; Research; Research Design; Series; Socioeconomic Status; Study models; System; Testing; Time; Treatment Factor; Treatment outcome; Update; Widespread Disease; Work; aged; design; improved; low socioeconomic status; malignant breast neoplasm; public health relevance; socioeconomics

DESCRIPTION (provided by applicant): There has been extensive research examining the influence of race and socioeconomic status (SES) on disparities in cancer survival. The problem with most studies that model this question is that (1) race and SES are closely entwined, so coefficients on race and income are difficult to interpret; (2) model coefficients on covariates ar dominated by the majority population; and (3) the determinants of disparities are not transparent using standard regression models since formal testing of race coefficient differences across models lacks clear interpretation when models are composed of different covariates. Recently we introduced the concept of Tapered Multivariate Matching (TMM) and applied this methodology to the study of racial disparities in breast cancer treatment and survival. By using a focal group (the minority population) and a series of "tapered" matches to the focal group, forcing the majority population to more closely resemble the minority population in sequential matches, the method allows one to (1) observe and formally compare majority to minority patient covariates, treatments, and outcomes inside and across each match and (2) observe and formally compare the changing majority population characteristics across each match, thereby uncovering potential causes for observed disparities. In the present study we propose to reorient and update the TMM study design specifically to examine SES across and within racial strata. The overall goal of the study is to better understand why breast and colon cancer patients with lower SES in the Medicare system have worse survival and to suggest potential remedies to improve these disparities. This is a retrospective observational study that utilizes secondary data in the SEER-Medicare database for over 250,000 elderly breast and colon cancer patients diagnosed between 1991 and 2009. The study has three aims. AIM 1: To determine the overall SES-associated disparity in presentation and treatment factors and survival between patients defined as having lower income and education through a number of alternative definitions of SES using patient level information (Medicare Dual Eligibility) and neighborhood level information on income, education, and poverty (from the patient's neighborhood level data), accounting for race. AIM 2: To determine whether disparities in presentation factors, treatment, and survival have changed over time (over the last two decades). AIM 3: To understand why survival disparities exist through use of Tapered Multivariate Matching. This study builds on our previous work but requires a modified matching design and completely new matches. Results from this study should aid in understanding why disparities in cancer survival persist by race and SES and should help in reducing such disparities in the future.

描述（由申请人提供）：已经进行了广泛的研究，研究了种族和社会经济地位（SES）对癌症生存差异的影响。大多数研究这个问题的研究的问题是（1）种族和SES紧密纠缠，因此种族和收入的系数很难解释； （2）在大多数人群中占主导地位的协变量的模型系数； （3）使用标准回归模型的差异决定因素不是透明的，因为当模型由不同的协变量组成时，模型的种族系数差异的正式测试缺乏明确的解释。最近，我们介绍了锥形多元匹配（TMM）的概念，并将这种方法应用于乳腺癌治疗和生存中种族差异的研究。通过使用焦点群（少数族裔人口）和一系列与焦点群体的“锥形”匹配，迫使大多数人群在顺序匹配中更与少数群体更相似地类似于少数族裔，该方法允许（1）观察并正式观察到多数派与少数族裔患者的竞争和形式的群体和形式的群体相比，与少数群体的治疗范围相比，与之相比，与之相比（2）的范围是互相匹配的（2），与之相比（2）群体的范围（2）与之相比，（2）与（2）相比（2）群体的范围（2）与（2）相比（2）的范围（2）群体的范围（2）群体的范围（2）群体构成了群体的范围。观察到的差异的原因。在本研究中，我们建议重新调整和更新TMM研究设计，以检查种族层面和内部的SES。该研究的总体目的是更好地理解Medicare系统中SES较低的乳腺癌和结肠癌患者的生存率较差，并提出潜在的补救措施以改善这些差异。这是一项回顾性观察性研究，用于在1991年至2009年间被诊断出的25万名老年乳腺癌和结肠癌患者中使用SEER-MEDICARE数据库中的二级数据。该研究具有三个目标。目标1：确定通过患者级别的信息（Medicare Dual Dual Dual Ciquibility（Medicare Dual Dual Ciquibility）以及有关收入，教育和贫困的邻里水平的信息（从患者的邻里水平数据），通过患者级别的信息（来自患者的邻里数据），通过许多SES的替代定义来确定被定义为具有较低收入和教育的患者之间的总体差异，并确定被定义为较低收入和教育的患者。目标2：确定表现因素，治疗和生存的差异是否随着时间的流逝而变化（在过去的二十年中）。目标3：了解为什么使用锥形多元匹配存在生存差异。这项研究以我们以前的工作为基础，但需要修改的匹配设计和全新的比赛。这项研究的结果应有助于理解为什么癌症生存的差异被种族和SES持续存在，并应有助于减少未来的差异。