Healthcare Access Dimensions and Racial Disparities in Lung Cancer

肺癌的医疗保健获取维度和种族差异

• 批准号: 10622329
• 负责人: Min Lian
• 金额: $ 30.24万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-02 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10622329
• 关键词: Address; Affect; African American; African American population; American; Cancer Burden; Cancer Etiology; Cancer Patient; Cessation of life; Characteristics; Classification; Continuity of Patient Care; Data; Databases; Diagnosis; Dimensions; Disease; Disparity; Disparity population; Early Diagnosis; Education; Ethnic Population; European; Guidelines; Health Insurance; Healthcare Systems; Hospitals; Incidence; Inferior; Insurance Coverage; Intervention; Malignant neoplasm of lung; Measures; Mediastinal; Medicare; Modality; Modeling; Neighborhoods; Non-Small-Cell Lung Carcinoma; Not Hispanic or Latino; Operative Surgical Procedures; Outcome; Palliative Care; Patients; Population Study; Provider; Radiation therapy; Risk; Role; SEER Program; Sampling; Services; Stage at Diagnosis; Staging; Statistical Models; Surveys; System; Testing; United States; Vulnerable Populations; beneficiary; cancer care; cancer health disparity; cancer therapy; chemotherapy; cohort; density; differences in access; disparity reduction; effective intervention; experience; genetic testing; geographic barrier; health care availability; improved; insight; long-standing disparities; longitudinal database; lung cancer screening; mortality; multimodality; novel; outcome disparities; patient expectation; population based; population survey; racial difference; racial disparity; racial population; rural dwellers; screening; service organization; social disparities; sociodemographics; surveillance data; targeted treatment; treatment and outcome; treatment disparity

PROJECT SUMMARY/ABSTRACT Lung cancer is the leading cause of cancer death in the United States. Advances in lung cancer treatment have substantially improved survival. However, the benefit has not reached all racial/ethnic groups of patients equally. Compared with non-Hispanic European Americans (EA), non-Hispanic African Americans (AA) are disproportionately affected by lung cancer with higher incidence and inferior survival. Their poorer outcomes are largely driven by more advanced stages at diagnosis and underutilization of stage-appropriate treatment. Importantly, AA and EA patients with lung cancer can achieve comparable outcomes under similar treatment modalities. This strongly suggests that barriers to cancer care are central to outcome disparities, and strategies targeting specific barriers will be critical to reduce long-standing disparities. However, studies addressing the underlying mechanisms of lung cancer treatment disparities have focused on non-modifiable and much less modifiable factors. There is an urgent need to elucidate modifiable factors influencing lung cancer treatment in AA patients. As Penchansky proposed, healthcare access consists of five distinct dimensions, including affordability, accommodation, acceptability, availability, and accessibility. However, most of previous studies assessed access to lung cancer care based on insurance coverage and availability of providers, and other dimensions of access remain critically understudied. We found that insurance coverage and availability of cancer care collectively explained <50% of the excess risk of underutilization of guideline-concordant treatment in AA vs EA lung cancer patients. Thus, we hypothesize that excess risks of underutilization of guideline- concordant lung cancer care and mortality in AA vs EA patients are attributable to access barriers AA patients disproportionately experience. To test this novel hypothesis, we will develop an integrated database with AA and EA patients diagnosed with non-small cell lung cancer, primarily including data from the longitudinal SEER-Medicare database, national annual surveys of population-based samples of Medicare enrollees, a nationwide database of providers, and neighborhood contextual measures. Using advanced spatial statistical modeling to account for clustering within providers and neighborhoods, we will simultaneously assess five access dimensions in association with lung cancer care and outcomes (Aim 1), examine racial differences in access dimensions overall and by indicators of social disadvantage (Aim 2), and further quantify the independent and collective contributions of access dimensions to racial disparities in lung cancer care and outcomes (Aim 3). This will be the first population-based study to comprehensively assess the impacts of all five access dimensions on lung cancer treatment and their contributions to lung cancer disparities. The results will provide novel insights into which specific components of access are most important and potentially modifiable in explaining lung cancer disparities, as well as where in the lung cancer care continuum they may be most amenable to intervention to improve lung cancer care for AAs and reduce disparities.

项目概要/摘要 肺癌是美国癌症死亡的主要原因。肺癌治疗的进展 显着提高了生存率。然而，这种益处并未惠及所有种族/族裔群体的患者 平等地。与非西班牙裔欧洲裔美国人 (EA) 相比，非西班牙裔非洲裔美国人 (AA) 肺癌的发病率较高，生存率较低。他们的结果较差 很大程度上是由于诊断阶段较晚以及未充分利用适合阶段的治疗。 重要的是，AA 和 EA 肺癌患者在相似的治疗下可以获得相似的结果 方式。这强烈表明癌症治疗的障碍是结果差异的核心，而策略 针对具体障碍对于减少长期存在的差距至关重要。然而，研究针对 肺癌治疗差异的根本机制集中在不可改变的方面，更不用说 可修改的因素。迫切需要阐明影响肺癌治疗的可改变因素 AA患者。正如 Penchansky 提出的，医疗保健服务由五个不同的维度组成，包括 负担能力、住宿、可接受性、可用性和可达性。然而，之前的大部分研究 根据保险范围和提供者的可用性以及其他因素评估获得肺癌护理的机会 访问的维度仍然没有得到充分研究。我们发现保险范围和可用性 癌症护理共同解释了指南一致治疗未充分利用的超额风险<50% AA 与 EA 肺癌患者。因此，我们假设指南未充分利用的过度风险 AA 与 EA 患者的肺癌护理和死亡率一致可归因于 AA 患者的准入障碍 经验不成比例。为了检验这个新假设，我们将与 AA 开发一个集成数据库 和诊断为非小细胞肺癌的 EA 患者，主要包括纵向数据 SEER-Medicare 数据库，对 Medicare 参保者人口样本进行的全国年度调查， 全国范围内的提供者数据库和社区环境措施。使用先进的空间统计 建模以考虑提供者和社区内的集群，我们将同时评估五个 与肺癌护理和结果相关的获取维度（目标 1），检查以下方面的种族差异： 整体的准入维度和社会弱势指标（目标 2），并进一步量化 获取维度对肺癌护理和种族差异的独立和集体贡献 结果（目标 3）。这将是第一项以人口为基础的研究，全面评估所有因素的影响 关于肺癌治疗及其对肺癌差异的贡献的五个可及性维度。结果 将提供新颖的见解，了解访问的哪些特定组成部分是最重要和潜在的 可以修改解释肺癌差异，以及它们在肺癌治疗连续体中的位置 最容易接受干预措施，以改善 AA 的肺癌护理并减少差异。