A Study of Cancer Diagnosis as a Risk Factor for Personal Bankruptcy

癌症诊断作为个人破产风险因素的研究

• 批准号: 7938057
• 负责人: SCOTT D. RAMSEY
• 金额: $ 26.4万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-24 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7938057
• 关键词: Acute; Address; Adult; Adverse effects; Adverse event; Affect; Age; American; Area; Bankruptcy; Biological; Body mass index; Cancer Burden; Cancer Patient; Caring; Censuses; Characteristics; Clinical; Code; Data; Databases; Deductibles; Diagnosis; Disease; Economics; Elderly; Ethnic Origin; Expenditure; Face; Goals; Growth; Health; Health Insurance; Health Personnel; Health Policy; Height; Home environment; Household; Incidence; Income; Individual; Injury; Insurance; Lawyers; Licensing; Link; Malignant Neoplasms; Medical; Medical Surveillance; National Cancer Institute; Neighborhoods; Outcome; Ownership; Patient Self-Report; Patients; Persons; Population; Population Control; Prevention; Race; Records; Relative (related person); Relative Risks; Reporting; Research; Research Design; Research Personnel; Risk; Risk Factors; Running; Services; Societies; Socioeconomic Status; Source; Stage at Diagnosis; Supportive care; Surveys; Translating; Washington; Weight; cancer care; cancer diagnosis; cancer health disparity; cancer therapy; cancer type; cohort; cost; court; design; experience; falls; health disparity; high risk; innovation; neoplasm registry; novel; payment; policy implication; residence; sex; socioeconomics; treatment planning; trend

DESCRIPTION (provided by applicant): This application, "A Study of Cancer Diagnosis as a Risk Factor for Personal Bankruptcy," addresses broad Challenge Area (09) Health Disparities, and Challenge Topic 09-MD-102: Trans-disciplinary Research to Integrate the Biological and Non-biological Determinants of Health to Address Health Disparities. Bankruptcy may represent a unique and heretofore unstudied determinant of health disparity. In 2008, there were more than 1 million personal bankruptcy filings, equivalent to 1 in 120 American households. Moreover, corresponding with the recent economic downturn, bankruptcy filings are increasing at an alarming rate, more than doubling since 2006. Persons entering bankruptcy following a severe illness may experience difficulties obtaining health insurance or accessing health care providers, and may not be able to complete acute treatment for the disease or obtain care for related long-run adverse effects. In a recent survey, 28% of individuals filing for bankruptcy indicated that illness or injury was a primary cause. However, because surveys of illness and bankruptcy have largely relied on self report, the true relationship remains controversial. Bankruptcy may be a particular concern for persons who are diagnosed with cancer. Media reports have highlighted cases where cancer has caused financial hardship, including bankruptcy. Among the 1.4 million persons diagnosed with cancer each year, the number filing for bankruptcy is unknown. The overall goal of this project is to determine the impact of a diagnosis of cancer on individuals' risk of incurring personal bankruptcy. To accomplish this goal, study investigators have obtained special dispensation from the Chief Judge of the U.S. Bankruptcy Court-Western District of Washington to link person-level bankruptcy records with Western Washington Surveillance Epidemiology and End Results (SEER) cancer registry records and Washington State driver's license records. This innovative study represents the first use of these databases to study cancer-related bankruptcy. The study design does not rely on self-reported data, thereby overcoming inherent weaknesses in previous research. Using a retrospective cohort design, we will estimate the relative risk of bankruptcy for adults diagnosed with cancer between 1995 and 2008 compared to adults without cancer. We will match cancer cases identified from Washington SEER records to age- and sex-matched individuals without cancer from driver's license records. Using the linked database, we will evaluate the impact of age, sex, race and ethnicity, and the patient's cancer (including cancer type, stage at diagnosis, year at diagnosis, and initial treatment) on bankruptcy risk. In separate analyses, we will link neighborhood-level Census Bureau records to evaluate the influence of socioeconomic variables (e.g., average income, percentage of home ownership). We will also examine the impact of regional factors such as the Washington State bankruptcy exemption level, lawyers per capita, and state income growth. Finally, we will examine the impact of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 on bankruptcy filings among cancer patients, both in general and compared to persons without cancer. Our study will provide rigorous scientific evidence characterizing the relationship between cancer and personal bankruptcy. We expect these results to inform health care policy discussions. Bankruptcy may represent a unique and heretofore unstudied potential source of health disparity. In this study, we have formed a novel partnership with the Federal Bankruptcy Court and the National Cancer Institute's SEER cancer registry to link bankruptcy records for cancer patients and a matched control population without cancer. If we find that cancer patients experience excess rates of bankruptcy compared to persons without cancer, our results will have important implications for those researching the causes of cancer disparity, and for policymakers seeking to mitigate the economic as well as clinical burden of persons with cancer.

描述（由申请人提供）：本申请“癌症诊断作为个人破产风险因素的研究”解决了广泛的挑战领域 (09) 健康差异和挑战主题 09-MD-102：跨学科研究整合健康的生物和非生物决定因素，以解决健康差异。破产可能是健康差异的一个独特且迄今为止未经研究的决定因素。 2008年，有超过100万个人申请破产，相当于每120个美国家庭中就有1个申请破产。此外，与最近的经济衰退相对应，破产申请正以惊人的速度增加，自 2006 年以来增加了一倍多。因重病而破产的人可能会在获得健康保险或寻求医疗保健提供者方面遇到困难，并且可能无法完成对疾病进行紧急治疗或就相关的长期不良反应进行护理。在最近的一项调查中，28% 申请破产的个人表示疾病或受伤是主要原因。然而，由于对疾病和破产的调查很大程度上依赖于自我报告，因此真实的关系仍然存在争议。对于被诊断患有癌症的人来说，破产可能是一个特别令人担忧的问题。媒体报道强调了癌症导致经济困难（包括破产）的案例。每年有 140 万人被诊断患有癌症，其中申请破产的人数未知。该项目的总体目标是确定癌症诊断对个人破产风险的影响。为了实现这一目标，研究调查人员获得了华盛顿西区美国破产法院首席法官的特别许可，将个人破产记录与西华盛顿州流行病学和最终结果监测 (SEER) 癌症登记记录以及华盛顿州司机的记录联系起来许可证记录。这项创新研究首次使用这些数据库来研究与癌症相关的破产。该研究设计不依赖于自我报告的数据，从而克服了先前研究的固有弱点。通过回顾性队列设计，我们将估计 1995 年至 2008 年间被诊断患有癌症的成年人与未患癌症的成年人相比破产的相对风险。我们将从华盛顿 SEER 记录中识别出的癌症病例与驾驶执照记录中年龄和性别匹配的无癌症个体进行匹配。使用链接的数据库，我们将评估年龄、性别、种族和民族以及患者的癌症（包括癌症类型、诊断分期、诊断年份和初始治疗）对破产风险的影响。在单独的分析中，我们将链接社区级人口普查局的记录，以评估社会经济变量（例如平均收入、住房拥有率百分比）的影响。我们还将研究华盛顿州破产豁免水平、人均律师人数和州收入增长等区域因素的影响。最后，我们将研究 2005 年《破产滥用预防和消费者保护法》对癌症患者破产申请的影响，无论是一般情况还是与非癌症患者相比。我们的研究将提供严格的科学证据来描述癌症与个人破产之间的关系。我们希望这些结果能为医疗保健政策讨论提供信息。破产可能是健康差异的一个独特且迄今为止未经研究的潜在根源。在这项研究中，我们与联邦破产法院和国家癌症研究所的 SEER 癌症登记处建立了一种新颖的合作伙伴关系，将癌症患者的破产记录与匹配的无癌症对照人群联系起来。如果我们发现癌症患者的破产率高于未患癌症的人，那么我们的结果将对那些研究癌症差异原因的人以及寻求减轻癌症患者的经济和临床负担的政策制定者产生重要影响。