Understanding cancer and comorbidities among American Indian and Alaska Native people

了解美洲印第安人和阿拉斯加原住民的癌症和合并症

• 批准号: 10722119
• 负责人: Sarah Nash
• 金额: $ 22.68万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-23 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722119
• 关键词: Address; Age; Alaska Native; American Indians; Cancer Burden; Cancer Patient; Cancer Survivor; Caring; Cause of Death; Characteristics; Chronic; Chronic Obstructive Pulmonary Disease; Clinical; Clinical Management; Colorectal; Communities; Congestive Heart Failure; Coronary Arteriosclerosis; Data; Data Analyses; Data Set; Databases; Diabetes Mellitus; Diagnosis; Diagnostic; Dose; Female breast; Future; Geography; Goals; Guidelines; Health Services Research; Health system; Healthcare; Hyperlipidemia; Hypertension; Incidence; Individual; Interruption; Intervention; Kidney; Knowledge; Link; Lung; Malignant Neoplasms; Medicare; Minority Groups; Modeling; National Comprehensive Cancer Network; National Health Services; Native-Born; Neighborhoods; Outcome; Outcomes Research; Patients; Play; Population; Prevalence; Provider; Quality of life; Reporting; Research; Research Support; Role; Secondary to; Services; Site; Socioeconomic Status; Staging; System; Time; United States Indian Health Service; Urban Health; Work; aged; cancer care; cancer diagnosis; cancer health disparity; cancer site; cancer survival; cancer therapy; care delivery; community engagement; comorbidity; comorbidity Index; data warehouse; evidence base; experience; flexibility; information gathering; innovation; mortality; non-Native; population based; response; rurality; sex; treatment and outcome; treatment services; tribal health; underserved minority

ABSTRACT Almost nothing is known about the prevalence of comorbidities among American Indian and Alaska Native (AIAN) cancer survivors, and how comorbidities impact cancer treatment and survival in this population. Yet, AIAN people have higher incidence of several potential comorbid conditions, relative to their non-Native counterparts. Comorbidities impact the clinical management of cancer, including which cancer treatments a patient receives and when they receive that treatment. As a result, cancer patients with comorbidities are more likely to have poorer survival and quality of life than their comorbidity-free counterparts. There is a critical need to understand prevalence and impact of comorbidities on cancer treatment and outcomes among AIAN people; without this information, our ability to address known cancer disparities in this underserved minority population will remain limited. The objective of this research is to understand the landscape of comorbidities among AIAN cancer patients, and how they influence cancer treatment and survival. The central hypothesis is that comorbidities play a central role in the undue burden of cancer among AIAN people. The rationale for this study is that understanding the prevalence of comorbidities among AIAN cancer patients, and how they impact cancer treatment delivery and outcomes, will provide critical opportunities for multi-level intervention targeting health systems, providers, and/or patients. This research supports a long-term goal to reduce the burden of cancer among AIAN people by reducing the impact of comorbidities on treatment and survival. To address this objective, this research will pursue three specific aims, and one exploratory aim. The specific aims will use the SEER-Medicare linked database to 1) Determine the prevalence of comorbidities among AIAN people aged over 65y; 2) Determine impact of comorbidities on receipt of timely and evidence- based services during diagnosis, staging and first-line treatment among AIAN people aged over 65y; and, 3) Evaluate impact of comorbidities on cancer survival among AIAN people aged over 65y. An exploratory aim will determine the feasibility of reproducing these analyses in the Indian Health Service (IHS) National Patient Information Reporting System (NPIRS) data warehouse. This research is innovative because it uses underutilized datasets to explore questions about which nothing is known for AIAN people. Further, we propose a community engaged approach to this secondary data analysis that will inform this and future work. Upon the successful completion of this research, the role that presence and number of comorbidities plays in cancer diagnosis, treatment, and survival among AIAN people will be known. This information will provide critical information to understand causes of AIAN cancer disparities that will be used to drive future healthcare-based structural and programmatic interventions.

抽象的 关于美洲印第安人和阿拉斯加原住民中合并症的患病率几乎一无所知 (AIAN) 癌症幸存者，以及合并症如何影响该人群的癌症治疗和生存。然而， 与非本地人相比，AIAN 人几种潜在合并症的发生率更高 同行。合并症影响癌症的临床管理，包括哪些癌症治疗 患者接受治疗以及何时接受治疗。因此，患有合并症的癌症患者更多 与无合并症的人相比，他们的生存率和生活质量可能较差。有一个迫切的需求 了解 AIAN 人群中合并症的患病率及其对癌症治疗和结果的影响； 如果没有这些信息，我们就无法解决这个服务不足的少数群体中已知的癌症差异 仍将受到限制。 本研究的目的是了解 AIAN 癌症的合并症情况 患者，以及他们如何影响癌症治疗和生存。中心假设是合并症 在 AIAN 人民过度的癌症负担中发挥着核心作用。这项研究的理由是 了解 AIAN 癌症患者合并症的患病率及其对癌症的影响 治疗的实施和结果，将为针对健康的多层次干预提供重要机会 系统、提供者和/或患者。这项研究支持减轻癌症负担的长期目标 通过减少合并症对治疗和生存的影响来改善 AIAN 人群的健康状况。 为了实现这一目标，本研究将追求三个具体目标和一个探索性目标。这 具体目标将使用 SEER-Medicare 链接数据库来 1) 确定合并症的患病率 65岁以上的AIAN人群； 2) 确定合并症对及时收到证据的影响- 为 65 岁以上的 AIAN 人群提供诊断、分期和一线治疗的基础服务；以及，3) 评估合并症对 65 岁以上 AIAN 人群癌症生存的影响。探索性目标 将确定在印度卫生服务 (IHS) 全国患者中重复这些分析的可行性 信息报告系统 (NPIRS) 数据仓库。这项研究具有创新性，因为它使用了 未充分利用的数据集来探索 AIAN 人一无所知的问题。此外，我们 提出一种社区参与的二次数据分析方法，为当前和未来的工作提供信息。 成功完成这项研究后，合并症的存在和数量的作用 在 AIAN 人的癌症诊断、治疗和生存中所发挥的作用将会为人所知。该信息将 提供关键信息以了解 AIAN 癌症差异的原因，这些差异将用于推动未来发展 基于医疗保健的结构性和规划性干预措施。