Understanding rural mortality disparities in cancer: a multi-level approach

了解农村癌症死亡率差异：多层次方法

• 批准号: 10340241
• 负责人: KELLY KENZIK
• 金额: $ 27.18万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10340241
• 关键词: Address; Area; Behavioral Risk Factor Surveillance System; Black Populations; Black race; Budgets; Cancer Patient; Caring; Censuses; Characteristics; Clinical Trials; Code; Commuting; Complex; County; Data; Data Set; Databases; Diagnosis; Emergency department visit; Evaluation; Excess Mortality; Fibrinogen; Future; Geographic Factor; Geographic Locations; Geography; Health; Health Information National Trends Survey; Health Insurance; Health Services Accessibility; Health behavior; Healthcare; Hospitalization; Individual; Inferior; Insurance; Intervention; Link; Malignant Neoplasms; Maps; Mediating; Mediation; Methodology; Modeling; Nature; Office Management; Outcome; Participant; Play; Policies; Policy Developments; Policy Maker; Population; Poverty; Poverty Areas; Quality of Care; Race; Reasons for Geographic And Racial Differences in Stroke; Reporting; Research Personnel; Role; Rural; Rural Population; SEER Program; Sampling; Social support; Socioeconomic Status; Specialist; Stroke Belt; System; Transportation; Work; cancer health disparity; cohort; comorbidity; contextual factors; data registry; deprivation; evidence base; experience; health literacy; indexing; malignant breast neoplasm; mortality; mortality disparity; multilevel analysis; neoplasm registry; primary outcome; rural area; rural disparities; rural patients; rural poverty; rural residence; rurality; social vulnerability; sociodemographics; statistics; therapy development; urban area; urban disparity; urban residence; virtual

Abstract Cancer mortality rates in the US declined by 26% between 1991 and 2015, but the decline has not been equal across all populations. Approximately 19% of the US population resides in rural areas; for over three decades, this population has experienced increasingly inferior outcomes when compared with their urban counterparts. The underlying cause(s) of the widening rural/urban gap in cancer outcomes is hypothesized to be multifactorial, with socioeconomic status (SES) both at the individual-level and geographic area-level likely playing a significant role. Gaps in evidence include the use of multiple “rural” definitions, a lack of evidence on associated geographic factors, and limited evidence based on multi-level approaches to understand the complex nature of rural disparities. Therefore, the overall objective of this study is to conduct a comprehensive examination of the underlying causes of rural/urban disparities in mortality among individuals diagnosed with cancer. In the first aim, the Surveillance, Epidemiology, and End Results (SEER) population-level data will be used to examine mortality among individuals diagnosed with cancer across three definitions of rurality, providing researchers and policy makers with the magnitude of differences by each definition. In the second aim, SEER will be linked via county- indicators to 16 databases (US Census Bureau, Area Deprivation Index, Bureau of Labor Statistics, County Health Rankings and Roadmaps, AMA Healthcare Workforce Mapper, BRFSS, Social Vulnerability Index, Health Information National Trends Survey, etc.). These linkages will allow us to estimate the contribution of specific area- level factors (e.g., area-level SES, access to high-quality care) on rural/urban mortality differences using effect decomposition methodology. In the third aim, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort (U01 NS041588) will be linked to state level cancer registry data using the Virtual Pooled Registry Cancer Linkage System (VPR-CLS). REGARDS includes longitudinally collected data for 30,239 participants (44% blacks), oversampled from stroke belt/buckle states (56% of participants from NC, SC, GA, TN, AL, MS, AK, LA) with large rural populations experiencing the highest mortality. REGARDS collects information at the individual level on sociodemographics, health literacy, and distance to healthcare, transportation, and risky health behaviors. Multi-level modeling and mediation modeling approaches will allow for the examination of the contribution of individual-level characteristics and the area-level characteristics simultaneously. Results will provide estimates of how much of the mortality disparity is explained by differences in urban and rural geographic characteristics overall as well estimates that describe the potential impact of hypothetical interventions on specific mediating factors. Findings will provide the critical evidence needed to inform policy and intervention development aimed at addressing the systemic disparities in mortality experienced by rural patients with cancer.

抽象的 1991 年至 2015 年间，美国癌症死亡率下降了 26%，但下降幅度并不相同 大约 19% 的美国人口居住在农村地区超过 30 年； 与城市邻居相比，这些人的生活质量越来越差。 癌症结果城乡差距扩大的根本原因是多因素的， 个人层面和地理区域层面的社会经济地位（SES）可能发挥着重要作用 证据方面的差距包括使用多种“农村”定义，缺乏相关地理的证据。 因素和基于多层次方法的有限证据来了解农村的复杂性 因此，本研究的总体目标是对差异进行全面考察。 癌症诊断患者死亡率差异的根本原因 第一个目标是： 监测、流行病学和最终结果 (SEER) 人口水平数据将用于检查死亡率 在三种农村定义中被诊断患有癌症的个体中，为研究人员和政策提供了帮助 在第二个目标中，SEER 将通过县级联系起来。 16 个数据库的指标（美国人口普查局、地区剥夺指数、劳工统计局、县 健康排名和路线图、AMA 医疗保健劳动力地图、BRFSS、社会脆弱性指数、健康 信息国家趋势调查等）。这些联系将使我们能够估计特定领域的贡献。 使用效果来确定农村/城市死亡率差异的水平因素（例如，地区级社会经济地位、获得高质量护理的机会） 第三个目标是中风的地理和种族差异的原因。 （问候）队列（U01 NS041588）将使用虚拟汇总与州级癌症登记数据相关联 登记癌症关联系统 (VPR-CLS) 包括纵向收集的 30,239 例数据。 参与者（44% 黑人），从中风带/带扣州进行过采样（56% 的参与者来自北卡罗来纳州、南卡罗来纳州、佐治亚州、 田纳西州、阿拉巴马州、密西西比州、阿拉巴马州、路易斯安那州）的农村人口死亡率最高。 个人层面的社会人口统计、健康素养和医疗距离方面的信息， 运输和危险的健康行为将允许多层次建模和中介建模方法。 同时考察个体层面特征和地区层面特征的贡献。 结果将估计死亡率差异有多少是由城市和地区的差异解释的。 农村地理特征的总体情况以及描述假设的潜在影响的估计 对特定中介因素的干预措施将为政策和决策提供所需的关键证据。 制定干预措施，旨在解决农村患者死亡率的系统性差异 患有癌症。