Disparities in Cancer Outcomes from the COVID-19 Pandemic

COVID-19 大流行导致癌症结果存在差异

• 批准号: 10726225
• 负责人: Brian Robert Englum
• 金额: $ 23.18万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-18 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10726225
• 关键词: Address; Affect; Age; Black race; Businesses; COVID-19; COVID-19 disparity; COVID-19 pandemic; COVID-19 pandemic effects; Cancer Patient; Caring; Cessation of life; Characteristics; China; Clinical Services; Colonoscopy; Computerized Medical Record; Country; Cox Proportional Hazards Models; Data; Data Set; Databases; Detection; Diagnosis; Diagnostic; Diagnostic Procedure; Disease; Disparate; Disparity; Disparity population; Drops; Early Diagnosis; Early identification; Education; Ethnic Origin; Evaluation; Female; Fright; Future; Geographic Locations; Geography; Health system; Healthcare; Healthcare Activity; Healthcare Systems; Hospitals; Individual; Informatics; Infrastructure; Inpatients; Intervention; Intervention Studies; Italy; Latino; Location; Malignant Neoplasms; Medical; Methodology; Modeling; Newly Diagnosed; Outcome; Outpatients; Patient risk; Patients; Policy Maker; Population; Populations at Risk; Procedures; Race; Recurrent Malignant Neoplasm; Research; Resources; Risk Factors; Rural; SARS-CoV-2 B.1.1.529; SARS-CoV-2 B.1.617.2; SARS-CoV-2 transmission; Screening for cancer; Screening procedure; Subgroup; System; Testing; Time; United States; United States Department of Veterans Affairs; Vaccination; Veterans; Vulnerable Populations; access disparities; cancer care; cancer diagnosis; cancer health disparity; cancer recurrence; cancer type; coronavirus disease; curative treatments; data infrastructure; design; experience; future outbreak; health care availability; low socioeconomic status; mortality; news; operation; outcome disparities; pandemic disease; pandemic impact; patient subsets; preservation; programs; repository; routine screening; rural area; screening; sex; simulation; transmission process

PROJECT SUMMARY Background: A nationwide moratorium was instituted on all elective clinical services in March 2020 to slow the transmission of COVID-19, safeguard patients, and preserve healthcare resources. This led to a major disruption in cancer screening and diagnostic procedures. Among Veterans nationwide, we found a significant and persistent decrease in the detection of new cancers. Without routine screening and easy access to medical care, cancer patients may go undetected, only presenting when the cancer is beyond curative therapy. The unprecedented COVID-related disruptions may also have exacerbated preexisting disparities in cancer outcomes among disadvantaged populations. Significance: With no information on the impact of the COVID-19 pandemic on cancer outcomes or changes in outcome disparities, health systems cannot identify populations at risk or implement programs to mitigate current deficits. We need a comprehensive evaluation of how pandemic disruptions to cancer care are affecting cancer outcomes. In addition, we need a surveillance system to assess changes in cancer outcomes over time, as the impacts of the pandemic evolve and mitigation efforts are implemented. We hypothesize that cancer outcomes in the COVID era will worsen, with higher rates of 1) mortality, 2) cancer recurrence, and 3) metastatic disease at presentation. Additionally, disparities in the above outcomes will be exacerbated in the COVID era among patients in the following vulnerable subgroups: female, age > 60 years, Black, Latino, rural, or in zip codes with lower SES. We will evaluate these hypotheses through the following Specific Aims: 1) Identify differences in cancer outcomes between the COVID and pre-COVID eras by cancer type. 2) Identify disparities in cancer outcomes among disadvantaged populations in the COVID era. Methodology: Using detailed, nationwide, patient-level data from the Veterans Administration Informatics and Computing Infrastructure (VINCI), we will evaluate changes cancer outcomes from the pre-COVID (March 1, 2018 through February 29, 2020) to COVID (March 1, 2020 to February 28, 2025) era. Poisson and Cox Proportional Hazards models will be used to analyse the change from the pre-COVID to COVID era by cancer type and among vulnerable subgroups. Next Steps/Implementation: The VINCI dataset offers a unique opportunity to provide near real-time assessment of the impacts of ongoing disruptions in new cancer identification on cancer outcomes and the exacerbation of existing disparities in a healthcare crisis. This project will allow us to develop actionable data and a system of surveillance to guide interventions that address the identified disparities. Using the validated system developed in this project, we will expand to populations outside of the VA and initiate interventional studies to mitigate or eliminate the identified disparities.

项目摘要 背景：2020年3月，在所有选修临床服务上建立了全国暂停措施，以减慢 COVID-19的传播，保障患者并保存医疗保健资源。这导致了一个专业 癌症筛查和诊断程序的破坏。在全国退伍军人中，我们发现了一个重要的 并持续减少新癌症的检测。没有常规筛选，便于访问 医疗保健，癌症患者可能会未被发现，只有在癌症超出治疗疗法的情况下才会出现。 前所未有的共价相关干扰可能也会加剧癌症的前提差异 处境不利的人群的结果。 意义：没有关于199大流行对癌症结果或变化的影响的信息 在结果差异中，卫生系统无法识别有风险的人群或实施计划以减轻 当前缺陷。我们需要对癌症护理大流行如何的全面评估 影响癌症的结果。此外，我们需要一个监视系统来评估癌症结果的变化 随着时间的流逝，随着大流行发展和缓解工作的影响。我们假设这一点 癌症时代的癌症结局会恶化，较高的发生率为1）死亡率，2）癌症复发和3） 介绍时转移性疾病。此外，上述结果的差异将在 以下脆弱亚组中，患者中的互联时代：女性，年龄> 60岁，黑人，拉丁裔，农村，农村， 或在SES较低的邮政编码中。我们将通过以下特定目的评估这些假设：1） 确定通过癌症类型的癌症和前卵形时代之间癌症结局的差异。 2）识别 在共同时代，处境不利人群的癌症结果差异。 方法论：使用退伍军人管理信息学和 计算基础架构（VINCI），我们将评估前旋转的癌症结果的变化（3月1日， 2018年至2020年2月29日至2月29日）至Covid（2020年3月1日至2025年2月28日）。泊松和考克斯 比例危害模型将用于分析癌症从前旋转到共同时代的变化 类型和脆弱的亚组。 下一步/实施：VINCI数据集提供了一个独特的机会，可以提供近实时的实时 评估新癌症鉴定对癌症结局的持续中断的影响和 加剧医疗危机中现有差异。该项目将使我们能够开发可行的数据 以及一种监视系统，以指导解决确定差异的干预措施。使用已验证的 在该项目中开发的系统，我们将扩展到VA之外的人群，并开始介入 减轻或消除已确定差异的研究。