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Grant Details

Grant Number: 5R01CA137750-04 Interpret this number
Primary Investigator: Schootman, Mario
Organization: Washington University
Project Title: Geographic Disparities in Colorectal Cancer Survival
Fiscal Year: 2012
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Abstract

ABSTRACT Colorectal cancer (CRC) is the fourth most common cancer in the United States and the second leading cause of cancer deaths. Despite declines in CRC incidence rates, survival following diagnosis has improved only modestly over the past few decades. Even though environmental contexts play an important role in health, disease, and behavior, most studies about CRC survival have largely ignored the geographic variation and importance of area-level socioeconomic conditions that have been associated with CRC screening, CRC stage at diagnosis, and with the survival of many other cancers. CRC patients who live in areas with worse socioeconomic conditions have decreased survival than those who live under more affluent conditions; however, the mechanisms by which these area-level factors exert their influence on CRC survival remain unclear. This amended application of the proposed population-based, prospective study has three specific aims. Aim 1) Determine the extent of the geographic variation of CRC survival across the United States based on small geographic areas at the sub-county (census-tract) level using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data for over 100,000 men and women aged 66 or older diagnosed with CRC. Aim 2) Determine the extent to which lower CRC survival can be explained by higher area socioeconomic deprivation among persons age 66 and older. Aim 3) Identify potential mediating pathways by which higher area socioeconomic deprivation is associated with lower CRC survival among persons age 66 and older, namely a) patient characteristics, b) physician and hospital characteristics, c) tumor characteristics, d) type of treatment received, and e) surveillance for CRC after diagnosis to detect recurrence and metastases. A multilevel spatial model will be developed to address the specific aims of the proposed study. We will use the following existing data sources: 1) 1992-2005 data from NCI's SEER program (survival, patient characteristics, type of treatment, tumor characteristics); 2) 1991-2005 Medicare data (patient characteristics, type of treatment, surveillance after diagnosis) which is linked to the SEER data; 3) 1991-2005 data from the Provider of Services File (hospital and physician characteristics), 4) 1990-2005 census data (area deprivation measures), and 5) Medicare Current Beneficiary Survey data. Advanced Bayesian spatial analyses of CRC survival will be performed and a geographic information system will be used to display the results. Our study will increase understanding of and identify important mechanisms of the role of area-level socioeconomic deprivation on CRC survival. In addition, this study will help provide opportunities for targeting specific geographic areas to allocate resources and interventions locally to improve CRC survival using evidence- based approaches, thereby reducing health disparities associated with living in socioeconomically deprived areas.

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Publications

Hospital and Geographic Variability in Thirty-Day All-Cause Mortality Following Colorectal Cancer Surgery.
Authors: Schootman M, Lian M, Pruitt SL, Deshpande AD, Hendren S, Mutch M, Jeffe DB, Davidson N
Source: Health Serv Res, 2014 Mar 27;null, p. null.
EPub date: 2014 Mar 27.
PMID: 24673560
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Patient, hospital, and geographic disparities associated with comanagement during hospitalization for colorectal cancer surgery.
Authors: de Vries S, Jeffe DB, Pruitt SL, Davidson NO, Schootman M
Source: J Hosp Med, 2014 Apr;9(4), p. 226-31.
EPub date: 2014 Feb 3.
PMID: 24493477
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The health and welfare of rural and urban cancer survivors in Missouri.
Authors: Schootman M, Homan S, Weaver KE, Jeffe DB, Yun S
Source: Prev Chronic Dis, 2013 Sep 12;10, p. E152.
EPub date: 2013 Sep 12.
PMID: 24028832
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Do diagnostic and treatment delays for colorectal cancer increase risk of death?
Authors: Pruitt SL, Harzke AJ, Davidson NO, Schootman M
Source: Cancer Causes Control, 2013 May;24(5), p. 961-77.
EPub date: 2013 Feb 28.
PMID: 23446843
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The modifying effect of patient location on stage-specific survival following colorectal cancer using geosurvival models.
Authors: Chien LC, Schootman M, Pruitt SL
Source: Cancer Causes Control, 2013 Mar;24(3), p. 473-84.
EPub date: 2013 Jan 10.
PMID: 23306551
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Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence.
Authors: Doubeni CA, Major JM, Laiyemo AO, Schootman M, Zauber AG, Hollenbeck AR, Sinha R, Allison J
Source: J Natl Cancer Inst, 2012 Sep 19;104(18), p. 1353-62.
EPub date: 2012 Sep 5.
PMID: 22952311
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Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the National Institutes of Health-AARP Diet and Health Study.
Authors: Doubeni CA, Laiyemo AO, Major JM, Schootman M, Lian M, Park Y, Graubard BI, Hollenbeck AR, Sinha R
Source: Cancer, 2012 Jul 15;118(14), p. 3636-44.
EPub date: 2012 Jan 3.
PMID: 22898918
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Socioeconomic deprivation impact on meat intake and mortality: NIH-AARP Diet and Health Study.
Authors: Major JM, Cross AJ, Doubeni CA, Park Y, Lian M, Hollenbeck AR, Schatzkin A, Graubard BI, Sinha R
Source: Cancer Causes Control, 2011 Dec;22(12), p. 1699-707.
EPub date: 2011 Oct 5.
PMID: 21971817
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Health status, neighborhood socioeconomic context, and premature mortality in the United States: The National Institutes of Health-AARP Diet and Health Study.
Authors: Doubeni CA, Schootman M, Major JM, Stone RA, Laiyemo AO, Park Y, Lian M, Messer L, Graubard BI, Sinha R, Hollenbeck AR, Schatzkin A
Source: Am J Public Health, 2012 Apr;102(4), p. 680-8.
EPub date: 2011 Nov 28.
PMID: 21852636
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Geographic variation in colorectal cancer survival and the role of small-area socioeconomic deprivation: a multilevel survival analysis of the NIH-AARP Diet and Health Study Cohort.
Authors: Lian M, Schootman M, Doubeni CA, Park Y, Major JM, Stone RA, Laiyemo AO, Hollenbeck AR, Graubard BI, Schatzkin A
Source: Am J Epidemiol, 2011 Oct 1;174(7), p. 828-38.
EPub date: 2011 Aug 11.
PMID: 21836166
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Temporal trends in geographic disparities in small-area-level colorectal cancer incidence and mortality in the United States.
Authors: Schootman M, Lian M, Deshpande AD, McQueen A, Pruitt SL, Jeffe DB
Source: Cancer Causes Control, 2011 Aug;22(8), p. 1173-81.
EPub date: 2011 Jun 19.
PMID: 21688130
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Neighborhood socioeconomic deprivation and mortality: NIH-AARP diet and health study.
Authors: Major JM, Doubeni CA, Freedman ND, Park Y, Lian M, Hollenbeck AR, Schatzkin A, Graubard BI, Sinha R
Source: PLoS One, 2010 Nov 23;5(11), p. e15538.
EPub date: 2010 Nov 23.
PMID: 21124858
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National estimates of racial disparities in health status and behavioral risk factors among long-term cancer survivors and non-cancer controls.
Authors: Schootman M, Deshpande AD, Pruitt SL, Aft R, Jeffe DB
Source: Cancer Causes Control, 2010 Sep;21(9), p. 1387-95.
EPub date: 2010 Apr 17.
PMID: 20401529
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An evaluation of lower-body functional limitations among long-term survivors of 11 different types of cancers.
Authors: Schootman M, Aft R, Jeffe DB
Source: Cancer, 2009 Nov 15;115(22), p. 5329-38.
PMID: 19676109
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