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: 8820828
• 负责人: CHARNITA M. ZEIGLER-JOHNSON
• 金额: $ 32.14万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-01 至 2016-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8820828
• 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; 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; built environment; 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; racial disparity; screening; socioeconomic disparity; 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（参见说明）： 前列腺癌是一种常见、复杂的疾病，具有强烈的种族差异，并且只有少数已证实且不可改变的危险因素。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。肥胖是一种潜在的可改变的风险因素，已被证明会增加 诊断和治疗（生化）失败时出现晚期疾病的风险。肥胖在非裔美国人中也最为普遍。然而，关于肥胖在前列腺癌进展中的作用一直存在争议，因为所有研究均未显示出相关性。尽管与肥胖和晚期癌症有关，但患者和社区层面的因素尚未被研究作为前列腺癌患者肥胖影响的调节因素。该项目的目标是检查前列腺癌的差异并建立肥胖和前列腺癌结果的多层次模型。我们的一般假设是，患者和社区层面的因素通常因种族/民族的不同而不同，这些因素会改变肥胖对前列腺癌结果的影响。我们提出以下具体目标： 目标 1：确定种族差异（通过差异的相对测量、不平等斜率指数以及不平等相对指数平均值和比率来衡量）与前列腺癌严重程度（Kattan 评分、肿瘤特征）之间的关联，和诊断时的年龄）和人口/行为修饰因素（体重指数（BMI），包装年数，受教育年限和年龄）；目标 2：通过社区特征（社会经济地位、压力、人口构成和建筑环境）确定肥胖与前列腺癌结果之间的关系。我们将使用前瞻性、纵向案例研究设计来检查患者和社区层面的特征与前列腺癌严重程度差异之间的关系。这些结果包括病理因素、诊断时的年龄、诊断时的肿瘤分期、诊断时的 PSA 以及治疗失败的风险。差异衡量标准将用于确定种族差异如何随肥胖、吸烟、教育和年龄的变化而变化。多变量模型将用于检查肥胖对前列腺癌结果的影响，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层面的变量区分开来，并在邻近环境中检查此类影响。确定患者和邻里变量的显着改变可能会提出前列腺癌进展的新途径，识别出不良结果风险最高的患者群体，并提供有效干预策略以减少差异。