Characterizing Disparities and Elucidating Opportunities Across the Cervical Cancer Continuum among Native American Women

描述美国原住民妇女宫颈癌连续体的差异并阐明机会

• 批准号: 10020805
• 负责人: Kevin Charles English
• 金额: $ 17.31万
• 依托单位: ALBUQUERQUE AREA INDIAN HEALTH BOARD
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-18 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10020805
• 关键词: Administrator; Advisory Committees; Age; Alaska Native; American Indians; Area; Back; Behavior; Biopsy; Cancer Control; Cancer Detection; Caring; Cervical; Cervical Cancer Screening; Cervical Intraepithelial Neoplasia; Cluster Analysis; Colposcopy; Cytology; Data; Data Linkages; Data Mart; Data Set; Data Sources; Databases; Detection; Diagnosis; Diagnostic; Disease; Distant; Dose; Epidemiology; Event; Excision; Failure; Funding Mechanisms; Goals; Health care facility; Hispanics; Human Papilloma Virus Vaccination; Human Papillomavirus; Incidence; Insurance Coverage; Intervention; Knowledge; Leadership; Link; Malignant neoplasm of cervix uteri; Manuscripts; Mexican Americans; Multivariate Analysis; National Health Services; Native Americans; New Mexico; Not Hispanic or Latino; Pap smear; Pathology; Pathway interactions; Patients; Pattern; Peer Review; Population; Pregnancy; Prevention Measures; Preventive service; Primary Prevention; Procedures; Provider; Public Health; Registries; Reporting; Research; Secondary Prevention; Testing; Time; Translating; Translations; Underserved Population; United States Indian Health Service; Urban Health; Vaccinated; Vaccination; Vaccines; Vagina; Vulva; Woman; cancer health disparity; cancer prevention; cancer therapy; cervical cancer prevention; clinical database; clinical practice; comorbidity; cost effective; data warehouse; follow-up; health disparity; innovation; insight; longitudinal design; non-Native; population based; repository; routine screening; screening; screening guidelines; trend; tv watching; uptake

PROJECT SUMMARY/ABSTRACT Although cervical cancer is a preventable disease, American Indian/Alaska Native (AI/AN) women suffer from substantially lower cervical cancer screening rates, disproportionately higher cervical cancer incidence rates; and are more often diagnosed at distant stages of the disease than their non-Native counterparts. Despite progress in reducing the overall cervical cancer rate in the U.S., the higher (and increasing) incidence rate among AI/AN women, and the unfavorable profile of local versus advanced stage of disease at diagnosis, indicate a continued need for aggressive and comprehensive screening and timely follow-up of abnormal results. At a time when efficacious and well-known cervical cancer control interventions such as Pap screening, testing for human papillomavirus (HPV), and HPV vaccinations are widely available, these stark disparities across the cervical cancer continuum are alarming for AI/AN women and reflect a significant public health problem. This study will aim to fill in these critical gaps in knowledge, understanding, and translation by utilizing linked data for AI/AN women in the IHS Epi Data Mart with women in the highly unique New Mexico HPV Pap Registry (NMHPVPR) to characterize cervical cancer screening coverage, rates and intensity, failures in cervical cancer screening, diagnosis and treatment, and correlates of cervical screening with HPV vaccination among AI/AN women. Our aims are to use the linked dataset to: a) reduce any racial misclassification of AI/AN women in the NMHPVPR and characterize cervical cancer screening coverage, intensity, intervals, and annual screening rates and to identify disparities in screening among AI/AN women registered at IHS/Tribal/Urban (I/T/U) health care facilities in New Mexico; b) assess failures in follow-up to abnormal Pap/HPV tests, and treatment following a diagnosis of cervical precancer among New Mexican AI/AN women and to geospatially analyze the failures so as to guide targeted interventions in the areas of most need; and c) to estimate HPV vaccination coverage, vaccine dose delivery, and screening initiation by HPV vaccination status in AI/AN women attending I/T/U facilities. The overarching premise of this study is that comprehensive elucidation of the specific pathways through which failures occur among AI/AN women across the cervical cancer continuum will inform cost-effective and data-driven strategies for intervention that can mitigate the pervasive health disparities witnessed among this underserved population. Study findings will be translated into several peer-reviewed manuscripts and will be translated into reports and presentations to inform tribal leadership and I/T/U administrators/providers about key opportunities for improvement.

项目摘要/摘要 尽管宫颈癌是一种可预防的疾病，但美洲印第安人/阿拉斯加人（AI/AN） 妇女患宫颈癌筛查率较低，较高的症 宫颈癌的发病率；并且经常在疾病的遥远阶段被诊断出 比他们的非本地同行。尽管在降低总体宫颈癌率方面取得了进展 在美国，AI/A/A妇女的发病率较高（且增加） 诊断时局部疾病与晚期阶段的不利形象，表明持续 需要进行积极而全面的筛查以及及时的异常结果随访。在 有效且知名的宫颈癌控制干预措施（例如PAP） 筛查，人乳头瘤病毒（HPV）的测试以及HPV疫苗接种，广泛可用， 宫颈癌连续体中的这些鲜明的差异令人震惊 反映出一个重大的公共卫生问题。这项研究的目的是填补这些关键空白 通过利用IHS中的AI/A妇女的链接数据，知识，理解和翻译 在高度独特的新墨西哥州HPV PAP注册表（NMHPVPR）中与女性的Epi Data Mart 宫颈癌的宫颈癌筛查覆盖率，速率和强度，宫颈癌的失败 与HPV疫苗接种的筛查，诊断和治疗以及宫颈筛查的相关性 在ai/a妇女中。我们的目的是将链接数据集使用：a）减少任何种族 在NMHPVPR中对AI/A AI/A的妇女的分类错误，并表征了宫颈癌筛查 覆盖范围，强度，间隔和年度筛查率，并确定筛查的差异 在新墨西哥州的IHS/部落/Urban（I/T/U）医疗机构的AI/A/A妇女中； b）评估对异常PAP/HPV测试的随访中的失败，并在诊断后进行治疗 新墨西哥州/妇女中的宫颈预科剂，并进行地理空间分析 失败以指导最需要领域的有针对性干预措施； c）估计HPV 疫苗接种覆盖范围，疫苗剂量输送和通过HPV疫苗接种状态筛查开始 在参加I/T/U设施的AI/A妇女中。这项研究的总体前提是 全面阐明AI/AN之间发生故障的特定途径 宫颈癌连续体中的妇女将为具有成本效益和数据驱动 干预策略可以减轻见证的普遍健康差异 这个服务不足的人口。研究结果将被翻译成几个同行评审 手稿，将转化为报告和演讲，以告知部落领导和 I/T/U管理员/提供商有关改进的关键机会。