Spatiotemporal Analysis of Disparities in Ovarian Cancer Treatment and Survival

卵巢癌治疗和生存差异的时空分析

• 批准号: 9105267
• 负责人: Robert Edward Bristow
• 金额: $ 38.63万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-12 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9105267
• 关键词: Accounting; Address; Adherence; Affect; Affordable Care Act; Breast; California; Cancer Etiology; Caring; Case Mixes; Case Study; Cessation of life; Characteristics; Classification; Cohort Studies; Collaborations; Colorectal; Cox Proportional Hazards Models; Data; Disease; Educational Status; Ensure; Epithelial ovarian cancer; Geographic Locations; Geography; Goals; Guideline Adherence; Guidelines; Health; Health Services Accessibility; Health system; Healthcare Systems; Hospitals; Inequality; Inferior; Intervention; Link; Liquid substance; Literature; Locales; Logistic Regressions; Lung; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Malignant neoplasm of ovary; Measures; Methodology; Modeling; National Comprehensive Cancer Network; Operative Surgical Procedures; Outcome; Patients; Population; Populations at Risk; Probability; Process; Quality of Care; Race; Research; Risk Factors; Series; Services; Socioeconomic Status; Statutes and Laws; Subgroup; System; Target Populations; Third-Party Payer; Time; Transplantation; Underserved Population; United States; Vulnerable Populations; Woman; bariatric surgery; base; cancer care; cancer health disparity; cancer survival; cancer therapy; defined contribution; disadvantaged population; ethnic disadvantage; ethnic minority population; geographic risk; health care delivery; health equity; indexing; low socioeconomic status; neoplasm registry; novel; novel strategies; population based; prognostic; programs; public health relevance; racial and ethnic; racial and ethnic disparities; racial minority; socioeconomic disparity; spatiotemporal; standard care; standard of care; survival outcome; treatment disparity; treatment planning; trend

 DESCRIPTION (provided by applicant): Disparities in ovarian cancer care are emblematic of the double standard of care still present in the United States affecting racial/ethnic minorities and disadvantaged populations. Recent data suggest that geographic location contributes to inequalities in access to appropriate care, which leads to worse survival outcomes in populations with more limited access to care. The literature examining geography as a contributing factor to disparities in ovarian cancer treatment and survival is limited in both breadth and depth. Hypothesis: Racial/ethnic and socioeconomic status (SES) disparities in ovarian cancer survival largely reflect disproportionate access to and receipt of high quality care that are associated with geographic location as well as other patient-related and health care system factors. Approach: The current proposal applies established methodologies (spatial and spatiotemporal analyses) in a novel approach to a series of retrospective population-based cohort studies of invasive epithelial ovarian cancer. The spatial analysis will employ the framework of generalized additive models (GAMs) in logistic regression and Cox proportional hazard models, with simultaneous smoothing and adjustment for confounders, to study the impact of geographic location on racial/ethnic and SES disparities in adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines (Aim 1) and disease-specific survival (Aim 2) in an estimated 29,970 cases reported to the California Cancer Registry (CCR) between 1996- 2013. The temporal and spatiotemporal analyses (Aim 3) will the expand the GAM models to include a trivariate smooth of longitude, latitude, and time to study trends in racial/ethnic and SES disparities in treatment and survival among an estimated 34,965 cases reported to the CCR between 1996-2016. The impact of the introduction of the Affordable Care Act legislation in 2014 on adherence to NCCN treatment guidelines and survival among vulnerable populations will be investigated and compared to temporal trajectories in access to care and survival for the preceding time period. The current proposal also will develop a novel metric (the Observed-to-Expected adherence to treatment guidelines ratio) that combines both structural (case volume) and process (rate of guideline adherence) measures of ovarian cancer care quality that will be integrated as a predictor variable into the analyses of geographic barriers to appropriate care, racial and SES disparities in geographic barriers, geographic predictors of ovarian cancer survival, and temporal/spatiotemporal trends analyses of adherence to treatment guidelines and survival. Expected Outcomes: Collectively, Aims 1, 2 and 3 will provide the necessary framework for intervention strategies targeting underserved populations disproportionately affected by geographic risk factors for inferior ovarian cancer survival. Furthermore, these data will serve as a platform for partnership with the California Department of Health, Office of Health Equity to develop a centralization of ovarian cancer care paradigm that will define quality metrics and criteria for regional referral centers, address disparities in access to appropriate care resulting from geographic location, and be implemented and studied prospectively through collaboration with third party payers.

 描述（由适用提供）：卵巢癌护理中的差异象征着美国仍存在的双重护理标准，影响了种族/族裔少数民族和处境不利的人群。最近的数据表明，地理位置会导致获得适当护理的不平等现象，从而导致人口中的生存率较差，而获得护理的机会更有限。将地理学作为导致卵巢癌治疗和生存差异的因素的文献受到限制。假设：种族/种族和社会经济地位（SES）卵巢癌的差异在很大程度上反映了对高质量护理的不成比例的机会 方法：当前的提案应用了一种新的方法（空间和空间时间分析），用于一种新的方法，用于一系列基于人群的回顾性侵入性上皮卵巢癌的研究。空间分析将在逻辑回归和COX比例危险模型中采用广义添加剂模型（GAM）的框架，并对混杂因素进行平滑和调整，以研究地理位置/种族和SES分布对种族/种族和SES分布的影响，对种族/种族分布的影响，遵守国家综合癌症（NCCN）卵巢癌症（NCCN）的卵巢癌症（AIS 1）（AIL AIL AIN）（AIL AIL AIN）（AIL AIL SECECOVIVER（AIL）（AIL AIN）（AIL AIN）（AIL）（AIL AIM）（AIL AIL AIN）（AIL AIM）（AIL AIL AIN）（AIL AIM）（AIL AIM）（AIL AIM）（AIL AIL）（目标）在1996年至2013年之间，向加利福尼亚癌症登记处（CCR）报告了临时和空间临时分析（AIM 3），将扩展GAM模型，包括经度的平稳，纬度和时间来研究种族/族裔和SES分布的趋势在治疗和生存中的34,965案例中，估计了34,965例CCR之间。 2014年引入《平价医疗法案》立法对遵守NCCN治疗指南的影响以及弱势群体之间的生存的影响将进行研究，并将其与前一个时期获得护理和生存的临时轨迹进行比较。 The current proposal also will develop a novel metric (the Observed-to-Expected Adherence to Treatment Guidelines Ratio) that combines both structural (case volume) and process (rate of guideline adherence) measures of ovarian cancer care quality that will be integrated as a predictor variable into the analyses of geographic barriers to appropriate care, racial and SES disparities in geographic barriers, geographic predictors of ovarian cancer survival, and遵守治疗指南和生存的临时/时空趋势分析。预期的结果：统一，目标1、2和3将为靶向不足的人群的干预策略提供必要的框架，该策略受卵巢癌次生癌症生存的地理风险因素不成比例的影响。此外，这些数据将成为与加利福尼亚卫生部卫生公平办公室合作的平台，以开发卵巢癌护理范式集中化，该范围将定义区域参考中心的质量指标和标准，解决通过与第三方付款人合作实施和研究前瞻性的访问适当护理的分布，以获取适当的护理。