Building multi-level models to examine the relationship between obesity and pros

建立多层次模型来研究肥胖与职业之间的关系

• 批准号: 8624549
• 负责人: CHARNITA M. ZEIGLER-JOHNSON
• 金额: $ 17.15万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8624549
• 关键词: Address; Advanced Malignant Neoplasm; African American; Aftercare; Age; Age Factors; American; Area; Behavioral; Biochemical; Body Weight; Body mass index; Cancer Intervention; Cancer Patient; Cancer Prognosis; Case Study; Characteristics; Complex; Demographic Factors; Diagnosis; Diagnostic Neoplasm Staging; Disease; Disease Progression; Education; Environment; Ethnic Origin; Ethnic group; Etiology; European; Failure; Family; Goals; Health system; Inequality; Instruction; Intervention; Link; Malignant neoplasm of prostate; Measures; Modeling; Modification; Neighborhoods; Non obese; Obesity; Outcome; Pathway interactions; Patients; Pattern; Pennsylvania; Philadelphia; Physical activity; Population; Prevalence; Public Health; Race; Recording of previous events; Relative (related person); Research; Research Design; Research Infrastructure; Resources; Risk; Risk Factors; Role; Severities; Smoking; Smoking Status; Socioeconomic Status; Stage at Diagnosis; Stress; Treatment Failure; Tumor stage; Universities; Weight maintenance regimen; advanced disease; cancer diagnosis; cancer health disparity; cancer risk; cancer therapy; cohort; deprivation; effective intervention; health disparity; high risk; indexing; men; metropolitan; modifiable risk; mortality; multilevel analysis; novel; novel strategies; primary outcome; prospective; screening; socioeconomics; tumor; tumor progression

PROJECT SUMMARY (See instructions): Prostate cancer is a common, complex disease with strong ethnic disparities and only a few confirmed and non-modifiable risk factors. African-Americans are at highest risk for developing prostate cancer and often present with advanced disease. Obesity, a potentially modifiable risk factor, has been shown to increase the risk of advanced disease at diagnosis and treatment (biochemical) failure. Obesity is also most prevalent in African-American populations. However, there has been controversy regarding obesity's role in prostate cancer progression, as all studies have not shown associations. Although linked to obesity and advanced cancer, patient- and neighborhood-level factors have not been studied as modifiers of obesity effects in prostate cancer patients. The goal of this project is to examine prostate cancer disparities and to build multilevel models of obesity and prostate cancer outcomes. Our general hypothesis is that patient- and neighborhood-level factors that often differ by race/ethnicity modify the effects of obesity on prostate cancer outcomes. We propose the following specific aims: Aim 1: To determine associations between racial disparities (measured by the relative measure of disparity. Slope Index of Inequality, and the Relative Index of Inequality mean and ratio) in prostate cancer severity (Kattan Scores, tumor characteristics, and age at diagnosis) and demographic/behavioral modifiers (body mass index (BMI), pack years, years of education, and age); Aim 2: To determine the relationship between obesity and prostate cancer outcomes by neighborhood characteristics (socioeconomic status, stress, demographic composition, and built environment). We will use a prospective, longitudinal case-case study design to examine the relationship between patient- and neighborhood-level characteristics and disparities in prostate cancer severity. These outcomes include pathological factors, age at diagnosis, tumor stage at diagnosis, PSA at diagnosis, and risk of treatment failure. Measures of disparity will be used to determine how racial disparities vary with obesity, smoking, education and age. Multivariate models will be used to examine the effects of obesity on prostate cancer outcomes, determining the influence of patient and neighborhood factors. We will be able to distinguish the effects of obesity from other patient-level variables and to examine such effects in neighborhood context. Determining significant modification by patient and neighborhood variables may suggest novel pathways for prostate cancer progression, identify groups of patients at highest risk for poor outcomes, and provide strategies for effective intervention to decrease disparities.

项目摘要（请参阅说明）： 前列腺癌是一种常见的，复杂的疾病，具有较强的种族差异，只有少数确认且不可修道的危险因素。非裔美国人患前列腺癌的风险最高，并且经常出现晚期疾病。肥胖症是一种潜在可修改的危险因素，已被证明增加了 诊断和治疗时晚期疾病的风险（生化）衰竭。肥胖症在非裔美国人人口中也最普遍。然而，关于肥胖症在前列腺癌进展中的作用一直存在争议，因为所有研究都没有显示关联。尽管与肥胖症和晚期癌症有关，但尚未将患者和邻居水平的因素作为前列腺癌患者的肥胖作用的修饰剂研究。该项目的目的是检查前列腺癌差异，并建立肥胖和前列腺癌预后的多级模型。我们的总体假设是，通常因种族/种族而差异的患者和邻里水平因素改变了肥胖对前列腺癌预后的影响。我们提出以下具体目的：目的1：确定种族差异之间的关联（通过差异相对度量衡量，不平等的斜率指数，不等式均等和比率的相对指数）在前列腺癌的严重程度中的相对指数（kattan得分，肿瘤的分数，肿瘤，诊断和人性化的年龄）以及年龄的教育（Bommi and Temagraphicing and tem and Bodys and tocifiers and Bodys and Bodys and tocife and Bodys and tocife）（BMI）（BMI），BMI（BMI），BMI，BMI（BMI），BMI，BMI，BMI，BMI，BMI，BMI;目标2：确定肥胖与前列腺癌结果之间的关系，通过邻里特征（社会经济地位，压力，人口统计组成和建筑环境）。我们将使用前瞻性的纵向病例研究设计来检查患者和邻居水平的特征与前列腺癌严重程度的差异之间的关系。这些结果包括病理因素，诊断年龄，诊断时的肿瘤阶段，诊断时PSA和治疗失败的风险。差异措施将用于确定种族差异如何随肥胖，吸烟，教育和年龄变化。多元模型将用于检查肥胖对前列腺癌预后的影响，从而确定患者和邻里因素的影响。我们将能够将肥胖的影响与其他患者级变量区分开，并在邻里环境中检查这种影响。确定患者和邻里变量的重大修饰可能表明前列腺癌进展的新途径，确定结果最高风险的患者组，并提供有效干预措施降低差异的策略。