CLINICAL PROGNOSTIC FACTORS FOR OLDER PEOPLE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Ageing Research Reviews, Год журнала: 2024, Номер 98, С. 102345 - 102345

Опубликована: Май 21, 2024

To explore the accuracy and precision of prognostic tools used in older people predicting mortality, hospitalization, nursing home admission across different settings timings.

Язык: Английский

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Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 231 - 245

Опубликована: Июль 14, 2023

Abstract Purpose Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, health care. However, there has been limited focus incorporating structural into simulation models designed identify practice policy strategies support equity. We reviewed studies evaluating highlight challenges, future directions capture this concept modeling research. Methods used the Preferred Reporting Items for Systematic Reviews Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 2023 were searched including terms related race, ethnicity, cancer-specific all-cause mortality, racism. included of United States. Results A total 8345 articles identified, 183 included. Studies different measures, data sources, methods. For example, 20 studies, residential segregation, one component racism, was measured by indices dissimilarity, concentration at extremes, redlining, or isolation. Data sources registries, claims, institutional linked area-level metrics from US census historical mortgage data. Segregation associated with worse survival. Nine location specific, segregation measures developed Black, Hispanic, White residents. Conclusions range are available provide a set recommendations best practices modelers consider when models.

Язык: Английский

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Black-White disparities in colorectal cancer outcomes: a simulation study of screening benefit

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 196 - 203

Опубликована: Ноя. 1, 2023

Abstract The US Black population has higher colorectal cancer (CRC) incidence rates and worse CRC survival than the White population, as well historically lower of screening. Surveillance, Epidemiology, End Results rate data in people diagnosed between ages 20 45 years, before routine screening is recommended, were analyzed to estimate temporal changes risk populations. There was a rapid rise rectal distal colon but not little change proximal for both groups. In 2014-2018, per 100 000 17.5 (95% confidence interval [CI] = 15.3 19.9) among individuals aged 40-44 years 16.6 CI 15.6 17.6) years; 42.3% CRCs patients cancer, 41.1% cancer. Analyses used race-specific microsimulation model project benefits, based on life-years gained lifetime reduction incidence, assuming these Black–White differences location. projected benefits (via either colonoscopy or fecal immunochemical testing) greater suggesting that observed are driven by risk. Projected sensitive assumptions made Building racial disparities into reduced which can bias policy decisions.

Язык: Английский

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Data gaps and opportunities for modeling cancer health equity

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 246 - 254

Опубликована: Ноя. 1, 2023

Abstract Population models of cancer reflect the overall US population by drawing on numerous existing data resources for parameter inputs and calibration targets. Models require that are appropriately representative, collected in a harmonized manner, have minimal missing or inaccurate values, adequate sample sizes. Data resource priorities modeling to support health equity include increasing availability 1) arise from uninsured underinsured individuals those traditionally not included health-care delivery studies, 2) relevant exposures groups historically intentionally excluded across full control continuum, 3) disaggregate categories (race, ethnicity, socioeconomic status, gender, sexual orientation, etc.) their intersections conceal important variation outcomes, 4) identify specific populations interest clinical databases whose outcomes been understudied, 5) enhance records through expanded elements linkage with other types (eg, patient surveys, provider and/or facility level information, neighborhood data), 6) decrease misclassified underrecognized populations, 7) capture potential measures effects systemic racism corresponding intervenable targets change.

Язык: Английский

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Using simulation modeling to guide policy to reduce disparities and achieve equity in cancer outcomes: state of the science and a road map for the future

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 159 - 166

Опубликована: Ноя. 1, 2023

Язык: Английский

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Gerotherapeutics: Aging Mechanism-based Pharmaceutical and Behavioral Interventions to Reduce Cancer Racial and Ethnic Disparities

JNCI Journal of the National Cancer Institute, Год журнала: 2024, Номер unknown

Опубликована: Авг. 27, 2024

Abstract The central premise of this article is that a portion the established relationships between social determinants health and racial ethnic disparities in cancer morbidity mortality mediated through differences rates biological aging processes. We further posit using knowledge about could enable discovery testing new mechanism-based pharmaceutical behavioral interventions (“gerotherapeutics”) to differentially improve survivors from minority populations reduce disparities. These hypotheses are based on evidence lifelong adverse contribute (“social aging”), with individuals minoritized groups experiencing accelerated (ie, steeper slope or trajectory over time relative chronological age) more often than nonminoritized groups. Acceleration can increase risk, age onset, aggressiveness, stage many adult cancers. There also documented negative feedback loops whereby cellular damage caused by its therapies act as drivers additional aging. Together, these dynamic intersectional forces outcomes vs populations. highlight key targetable mechanisms potential applications reducing discuss methodological considerations for preclinical clinical impact gerotherapeutics Ultimately, promise will require broad societal policy changes address structural causes ensure equitable access all control paradigms.

Язык: Английский

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Population simulation modeling of disparities in US breast cancer mortality

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 178 - 187

Опубликована: Авг. 14, 2023

Abstract Background Populations of African American or Black women have persistently higher breast cancer mortality than the overall US population, despite having slightly lower age-adjusted incidence. Methods Three Cancer Intervention and Surveillance Modeling Network simulation teams modeled disparities between female populations population. Model inputs used racial group–specific data from clinical trials, national registries, nationally representative surveys, observational studies. Analyses began with in population sequentially replaced parameters for to quantify percentage morality attributable differences demographics, incidence, access screening treatment, variation tumor biology response therapy. Results were similar across 3 models. In 2019, incidence competing accounted a net ‒1% disparities, while subtype stage distributions mean 20% (range models = 13%-24%), 3% 3%-4%) disparities. Treatment majority disparities: 17% 16%-19%) treatment initiation 61% 57%-63%) real-world effectiveness. Conclusion Our model results suggest that changes policies target improvements could increase equity. The findings also highlight efforts must extend beyond targeting equity include high-quality completion. This research will facilitate future modeling test effects different specific policy on

Язык: Английский

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Contribution of smoking, disease history, and survival to lung cancer disparities in Black individuals

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 204 - 211

Опубликована: Июнь 24, 2023

Abstract Background Lung cancer is the leading cause of deaths and disproportionately affects self-identified Black or African American (“Black”) people, especially considering their relatively low self-reported smoking intensity rates. This study aimed to determine relative impact history lung incidence risk, histology, stage, survival on these disparities. Methods We used 2 models (MichiganLung-All Races MichiganLung-Black) understand why people have higher rates deaths. studied how different factors, such as behaviors, development, stage at diagnosis, survival, contribute differences. Results Adjusted for history, approximately 90% difference in between overall populations (born 1960) was result differences risk getting cancer. Differences histology had a small (4% 6% each). Similar results were observed 1950 1970 birth cohorts, regardless patterns from 1960 cohort. Conclusions After taking into account, rate can mostly be explained by developing As treatments detection improve, however, other factors may become more important determining mortality populations. To prevent current disparities becoming worse, it make sure that improvements are available everyone an equitable way.

Язык: Английский

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Commentary: Some water in the data desert: the Cancer Intervention and Surveillance Modeling Network’s capacity to guide mitigation of cancer health disparities

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 167 - 172

Опубликована: Сен. 14, 2023

Despite significant progress in cancer research and treatment, a persistent knowledge gap exists understanding addressing care disparities, particularly among populations that are marginalized. This deficit has led to "data divide," where certain groups lack adequate representation cancer-related data, hindering their access personalized data-driven care. divide disproportionately affects marginalized minoritized communities such as the U.S. Black population. We explore concept of deserts," wherein entire populations, often based on race, ethnicity, gender, disability, or geography, comprehensive high-quality health data. Several factors contribute data deserts, including underrepresentation clinical trials, poor quality, limited digital technologies, rural lower-socioeconomic communities.The consequences divides deserts far-reaching, impeding equitable precision medicine perpetuating disparities. To bridge this divide, we highlight role Cancer Intervention Surveillance Modeling Network (CISNET), which employs population simulation modeling quantify emphasize importance collecting quality from various sources improve model accuracy. CISNET's collaborative approach, utilizing multiple independent models, offers consistent results identifies gaps knowledge. It demonstrates impact systemic racism incidence mortality, paving way for evidence-based policies interventions eliminate suggest potential use voting districts/precincts unit aggregation future CISNET modeling, enabling targeted informed policy decisions.

Язык: Английский

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Approaches to developing de novo cancer population models to examine questions about cancer and race in bladder, gastric, and endometrial cancer and multiple myeloma: the Cancer Intervention and Surveillance Modeling Network incubator program

JNCI Monographs, Год журнала: 2023, Номер 2023(62), С. 219 - 230

Опубликована: Ноя. 1, 2023

We are developing 10 de novo population-level mathematical models in 4 malignancies (multiple myeloma and bladder, gastric, uterine cancers). Each of these sites has documented disparities outcome that believed to be downstream effects systemic racism. Ten being independently developed as part the Cancer Intervention Surveillance Modeling Network incubator program. These simulate trends cancer incidence, early diagnosis, treatment, mortality for general population stratified by racial subgroup. Model inputs based on large datasets, clinical trials, observational studies. Some core parameters shared, other model specific. All microsimulation use self-reported race stratify inputs. They can distribution relevant risk factors (eg, smoking, obesity) insurance status (for multiple cancer) US birth cohorts population. The aim refine approaches prevention, detection, management cancers given uncertainties constraints. will help explore whether observed explainable inequities, assess existing potential prevention control policies health equity disparities, identify balance efficiency fairness decreasing mortality.

Язык: Английский

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