Multilevel Determinants of Socioeconomic Disparities in Geographic Late Stage Hepatocellular Carcinoma Hotspots

晚期肝细胞癌热点地区社会经济差异的多层次决定因素

• 批准号: 10671068
• 负责人: Kali Zhou
• 金额: $ 16.58万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-25 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10671068
• 关键词: Acculturation; Address; Adult; Affect; American; Area; Cancer Control; Cancer Control Research; Cancer Etiology; Caring; Censuses; Cessation of life; Characteristics; Cirrhosis; Clinic; Clinical; Clinical Data; Communities; Complex; County; Data; Data Linkages; Data Reporting; Data Set; Detection; Development; Diagnosis; Disadvantaged; Disease Management; Disparity; Early Diagnosis; Equity; Ethnic Origin; Etiology; Failure; Fostering; Foundations; Frequencies; Future; Geography; Goals; Growth; Health; Image; Immigrant; Incidence; Individual; Intervention; Intervention Trial; Interview; Knowledge; Language; Liver diseases; Location; Los Angeles; Low Income Population; Low income; Maintenance; Malignant Neoplasms; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of liver; Maps; Mediating; Medical Records; Mentors; Mentorship; Methodology; Mission; Modeling; National Institute on Minority Health and Health Disparities; Neighborhoods; Newly Diagnosed; Outcome; Pathway interactions; Patient Self-Report; Patients; Persons; Population; Predisposing Factor; Primary carcinoma of the liver cells; Process; Prognosis; Prognostic Factor; Provider; Public Health; Qualitative Methods; Questionnaires; Randomized; Registries; Reporting; Research; Research Personnel; Research Proposals; Resource-limited setting; Resources; Risk; Role; Science; Screening for Hepatocellular Cancer; Selection Bias; Services; Severities; Socioeconomic Status; Stage at Diagnosis; Strategic Planning; Structure; Surveys; System; Techniques; Technology; Testing; Training; Tumor Biology; Underserved Population; United States; Update; Urban Population; Work; cancer diagnosis; cancer health disparity; career development; cohort; contextual factors; data registry; density; deprivation; design; disparity reduction; effective intervention; environmental enrichment for laboratory animals; epidemiology study; ethnic minority; evidence base; experience; health care service utilization; imaging facilities; improved; improved outcome; innovation; intervention delivery; low socioeconomic status; multilevel analysis; neoplasm registry; patient engagement; population based; primary outcome; prospective; racial minority; recruit; residence; safety net; secondary outcome; social; social determinants; social health determinants; sociodemographics; socioeconomic disadvantage; socioeconomic disparity; socioeconomics; stakeholder perspectives; theories; therapy design; transportation access; urban area

PROJECT SUMMARY/ABSTRACT Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer-related deaths in the United States (US), with rising incidence among low-income individuals. Due to importance of cancer stage at diagnosis to survival, we applied small area estimation to the population-based cancer registry in urban Los Angeles County (LAC) to identify areas of highest late stage HCC burden for intervention. These geographic late stage HCC “hotspots” were disproportionately concentrated in areas of lowest socioeconomic status (SES). Few strategies to promote the early detection of HCC have been studied and most are not tailored to the low SES populations that experience the greatest disparity. The scientific objective of this proposal is to address this need by characterizing the individual-, organizational-, and community-level determinants of the geographic aggregation of late stage HCC in low SES communities. Specifically, we propose to use geospatial techniques to refine our population-based late stage hotspots and perform sensitivity analyses around spatial, clinical, and temporal inputs (Aim 1). We will analyze a multilevel dataset built from prospective survey, medical record, and geospatial linkage of 700 incident HCC registry cases to identify the root determinants of SES disparities (Aim 2). Last, semi-structured interviews will be conducted at multiple levels (e.g., patients, providers, and community leaders) to explore barriers to completion of the early detection pathway for HCC in low SES populations (Aim 3). Study constructs are conceptually grounded in the National Institute on Minority Health and Health Disparities Framework, with interviews guided by the Multi-Level Health Outcomes Framework. Together, our rich theory-driven data will directly inform the strategic plan for a multilevel early detection pilot intervention targeting late stage HCC hotspots in a future R34, followed by a cluster randomized controlled intervention trial in a R01. The training objectives in this proposal will foster Dr. Zhou’s growth as a cancer disparities researcher focused on geospatial innovation in early detection strategies to mitigate disparities and improve outcomes among underserved populations with HCC. The four core components of Dr. Zhou’s training plan combine advanced didactics with applied experience: (1) proficiency in spatial methodology and geovisualization; (2) foundation in multilevel modeling and qualitative methods to support effective disparities research; (3) introduction to multilevel intervention design and delivery; and (4) professional development in cancer disparities. Dr. Zhou has access to an academic research environment enriched for cancer disparities and cancer control research, a socioeconomically diverse urban population in LAC, and a strong transdisciplinary mentorship team, comprised of primary mentor Dr. Cockburn (spatial sciences and cancer control) and co-mentors Dr. Mack (multilevel modeling), Dr. Bastani (multilevel interventions), and Dr. Terrault (career development). In summary, this proposal embeds detailed training goals within a practical sequence of research aims to provide Dr. Zhou with a clear path to investigator independence.

项目摘要/摘要 肝细胞癌（HCC）是美国与癌症相关死亡的增长最快的原因 （美国），低收入个人之间发生了不断增长的事件。由于诊断时癌症阶段的重要性 生存，我们将小面积估计应用于洛杉矶城市的基于人群的癌症注册表 县（LAC）确定最高后期HCC燃烧的区域进行干预。这些地理后期 HCC“热点”不成比例地集中在最低的社会经济地位（SES）领域。很少 促进早期发现HCC的策略已经研究了，并且大多数不是针对低SES量身定制的 经历最大差距的人群。该提议的科学目标是解决这个问题 通过表征地理的个人，组织和社区级别的决定者的需求 低SES社区中晚期HCC的聚合。具体来说，我们建议使用地理空间技术 为了完善我们基于人群的晚期热点，并在空间，临床和 临时输入（AIM 1）。我们将分析由预期调查，病历和 700个事件HCC注册案件的地理空间连接以识别SES差异的根决定者（AIM 2）。最后，半结构化访谈将以多个层次进行（例如，患者，提供者和 社区领导者）探索在低SES中完成HCC早期检测途径的障碍 种群（目标3）。研究结构在概念上以少数民族健康研究所为基础 和健康差异框架，采访以多层次的健康成果框架为指导。 我们丰富的理论驱动的数据将直接为多级早期检测飞行员的战略计划提供信息 靶向后期HCC热点的干预措施在未来的R34中，然后是一个随机控制的簇 R01中的干预试验。该提案中的培训目标将促进周博士作为癌症的成长 研究人员的差异专注于早期检测策略中的地理空间创新，以减轻分布和 HCC服务不足的人群的结果改善。周博士培训的四个核心组成部分 计划合并的高级教学学具有应用经验：（1）熟练掌握空间方法论和 地理化； （2）以多级建模和定性方法的基础来支持有效分布 研究; （3）多层干预设计和交付简介； （4）专业发展 癌症分布。 Zhou博士可以使用丰富的癌症分布的学术研究环境 和癌症控制研究，LAC中的社会经济多样化的城市人口，也有很强的 跨学科指导团队完成了小学指导博士科克本博士（空间科学与癌症 Control）和Co-Mack博士（多层次建模），Bastani博士（多级干预措施）和Terrault博士 （职业发展）。总而言之，该建议将详细的培训目标嵌入 研究旨在为周博士提供一条清晰的研究者独立性的途径。