Improving our understanding of breast cancer mortality disparities through recurrence: a multi-level approach among women in Georgia

通过复发提高我们对乳腺癌死亡率差异的理解：格鲁吉亚妇女的多层次方法

• 批准号: 10573305
• 负责人: Lauren E McCullough
• 金额: $ 56.68万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-04 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10573305
• 关键词: Accounting; Adopted; Affect; Area; Black Populations; Black race; Breast Cancer Patient; Breast Cancer survivor; Cancer Prognosis; Caring; Cells; Censuses; Characteristics; Clinical; Clinical Data; Clinical Research; Communities; Data; Diagnosis; Disease; Disparate; Disparity; Distal; Distant; Early Diagnosis; Epidemiologic Methods; Ethnic Origin; Event; Funding Opportunities; Guidelines; Hospitals; Individual; Inequity; Institution; Intervention; Investigation; Low income; Mediating; Mediator; Minority; Nonmetastatic; Not Hispanic or Latino; Outcome; Outcomes Research; Pathway interactions; Pattern; Policies; Population; Population Heterogeneity; Population-Based Registry; Positioning Attribute; Prevalence; Prognosis; Public Health; Race; Recurrence; Recurrent Malignant Neoplasm; Research; Risk Estimate; Role; Rural; Social Environment; Societies; Source; Statistical Methods; Survivors; Time; Tumor Biology; United States; Woman; Work; breast cancer diagnosis; cancer health disparity; cancer recurrence; cancer survival; data registry; data streams; demographic disparity; demographics; disparity reduction; economic disparity; ethnic disparity; evidence base; experience; high risk; improved; innovation; intersectionality; lifetime risk; low socioeconomic status; malignant breast neoplasm; mortality; mortality disparity; multidisciplinary; multilevel analysis; neoplasm registry; outcome disparities; population based; racial determinant; racial disparity; rural disparities; rural residence; social epidemiology; survival disparity

PROJECT SUMMARY/ABSTRACT Significance. Although national and philanthropic efforts have sought to reduce and eliminate breast cancer (BC) mortality disparities over the past few decades, they have not only persisted—but widened. Additionally, due to incomplete capture of recurrence data, no previous investigation has identified drivers of disparities in BC recurrence following a diagnosis of early-stage (I–IIIA) disease. In Georgia, where economic and racial/ethnic disparities are among the greatest in the United States, the sources of BC outcome disparities are unresolved, and likely arise from the interplay of causal and contributing factors at multiple levels—from cell to society. Approximately 40% of all BC survivors will suffer a recurrence during their lifetime, and clinical data suggest a higher risk of recurrence in minority and low-income women. Given the high lifetime risk of recurrence, posited race/ethnic disparities in recurrent BC, and documented mortality disparities across demographic domains, now is the pivotal time to characterize underlying pathways contributing to inequities in BC prognosis. Innovation. Our proposal is innovative in that it will be the first to estimate risks and rates of BC recurrence by demographic characteristics, consider intersectionality in BC outcome disparities, and use a multilevel decomposition approach to identify potential targets for intervention. Approach. Integrating multiple data streams (e.g., discharge, administrative claims, hospital, and census data) with cancer registry data from a large, diverse population, we will identify proximal, intermediate, and distal determinants of race/ethnic, SES, and urban/rural disparities in both recurrence and BC-specific mortality, as well as examine recurrence and its treatments as mediators of disparities in mortality rates by race, SES, and urban/rural characteristics. Data will be from approximately 30,000 women diagnosed with a first primary stage I–IIIA BC in Georgia (2013–2017) and followed for up to 12 years. Impact. Previous research in this area has had consistent shortcomings including (1) insufficient ascertainment of recurrence at the population level; (2) examining one or few factors without accounting for shared contributions across multiple levels; and (3) inadequate power to explore intersections of identity. Our study, for the first time, will examine multi-level contributors to race/ethnic, SES, and urban/rural disparities in both BC recurrence and mortality among women with early-stage disease. Our innovative multi- level decomposition approach will move us beyond merely documenting disparities, to identifying modifiable targets within the social contexts of affected communities, facilitating prioritization of interventions.

项目摘要/摘要 尽管国家和慈善事业一直在寻求减少和消除乳腺癌 （BC）在过去几十年中的死亡率差异，它们不仅持续存在，而且扩大了。此外， 由于不完全捕获复发数据，以前没有研究确定卑诗省分布的驱动因素 诊断出早期疾病（I-IIIA）疾病后的复发。在佐治亚州，经济和种族/种族 差异是美国最大的差异之一，卑诗省结果差异的来源尚未解决， 并且可能是由于因果关系的相互作用和多个级别的因素的相互作用（从细胞到社会）。 大约40％的卑诗省幸存者将在其一生中遭受复发，临床数据表明 少数民族和低收入妇女复发的风险更高。鉴于终身复发风险很高，已列出 复发性不列颠哥伦比亚省的种族/种族差异，并记录了人口统计领域的死亡率差异，现在 是表征有助于卑诗省预后不平等的基本途径的关键时期。创新。 我们的建议具有创新性，因为它将是第一个通过人群估算BC复发率的风险和率 特征，考虑BC结果差异中的交叉性，并使用多级分解 确定干预措施的潜在目标的方法。方法。集成多个数据流（例如， 带有癌症注册表的数据 人口，我们将确定种族/种族，SES和城市/农村的近端，中间和独特的决定者 复发和特异性死亡率的差异，以及检查复发及其治疗 划分种族，SES和城市/农村特征的死亡率差异差异的调解人。数据将来自 大约有30,000名妇女被诊断为乔治亚州IIIA第一阶段的第一阶段（2013- 2017年），随后 长达12年。影响。该领域的先前研究具有一致的缺点，包括（1） 在人口水平上的复发不足； （2）检查一个或几个没有 考虑到多个级别的共同贡献； （3）探索交叉点的功率不足 身份。我们的研究首次将研究种族/种族，SES和城市/农村的多层次贡献者 早期疾病女性的卑诗省复发和死亡率的差异。我们的创新性多 水平分解方法将使我们不仅可以记录差距，而要确定可修改 在受影响社区的社会环境中的目标，支持干预措施的优先级。