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.

项目概要/摘要 尽管宫颈癌是一种可预防的疾病，但美洲印第安人/阿拉斯加原住民 (AI/AN) 女性的宫颈癌筛查率明显较低，但不成比例地较高 宫颈癌发病率；并且更常在疾病的较远阶段被诊断出来 比他们的非本地同行。尽管在降低宫颈癌总体发病率方面取得了进展 在美国，AI/AN 女性的发病率较高（且不断增加），并且 诊断时局部疾病与晚期疾病的不利特征表明，持续的 需要积极、全面的筛查，并对异常结果及时随访。在 这是有效且众所周知的宫颈癌控制干预措施（例如巴氏涂片检查）的时代 人乳头瘤病毒 (HPV) 筛查、检测以及 HPV 疫苗接种已广泛普及， 宫颈癌整个过程中的这些明显差异令 AI/AN 女性感到震惊， 反映了重大的公共卫生问题。本研究旨在填补这些关键空白 利用 IHS 中 AI/AN 女性的关联数据进行知识、理解和翻译 Epi 数据集市与高度独特的新墨西哥州 HPV 巴氏涂片登记 (NMHPVPR) 中的女性合作， 描述宫颈癌筛查覆盖率、率和强度、宫颈癌筛查失败的特征 筛查、诊断和治疗，以及宫颈筛查与 HPV 疫苗接种的相关性 AI/AN 女性中。我们的目标是使用链接的数据集来：a）减少任何种族 NMHPVPR 中 AI/AN 女性的错误分类以及宫颈癌筛查的特征 覆盖率、强度、间隔时间和年度筛查率，并确定筛查方面的差异 在新墨西哥州 IHS/部落/城市 (I/T/U) 医疗保健机构登记的 AI/AN 妇女； b) 评估异常巴氏涂片/HPV 检测的后续失败以及诊断后的治疗 新墨西哥 AI/AN 妇女中宫颈癌前期的发病率，并进行地理空间分析 未能指导在最需要的领域采取有针对性的干预措施； c) 估计 HPV 疫苗接种覆盖率、疫苗剂量输送以及按 HPV 疫苗接种状况启动筛查 参加 I/T/U 设施的 AI/AN 女性。这项研究的总体前提是 全面阐明AI/AN故障发生的具体途径 整个宫颈癌连续过程中的女性将提供成本效益和数据驱动的信息 可以减轻不同人群之间普遍存在的健康差距的干预策略 这些服务不足的人群。研究结果将被转化为若干经过同行评审的 手稿并将被翻译成报告和演示文稿，以告知部落领导层和 I/T/U 管理员/提供商了解关键的改进机会。