Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
J Natl Cancer Inst. 2024 Aug 1;116(8):1238-1245. doi: 10.1093/jnci/djae073.
Communities and researchers have called for a paradigm shift from describing health disparities to a health equity research agenda that addresses structural drivers. Therefore, we examined whether the cancer survivorship research portfolio has made this shift.
We identified grants focused on populations experiencing health disparities from the National Institutes of Health (NIH) Cancer Survivorship Research Portfolio (N = 724), Fiscal Years 2017-2022. Grant characteristics were abstracted, drivers of health disparities were mapped onto the levels and domains of influence, and opportunities for future research were identified.
A total of 147 survivorship grants focused on health disparities were identified, of which 73.5% of grants focused on survivors from racial and ethnic minoritized groups, 25.9% living in rural areas, 24.5% socioeconomically disadvantaged, and 2.7% sexual and gender minority groups. Study designs were 51.0% observational; 82.3% of grants measured or intervened on at least 1 individual-level of influence compared to higher levels of influence (32.7% interpersonal, 41.5% institutional and community, and 12.2% societal). Behavioral and health care system domains of influence were commonly represented, especially at the individual level (47.6% and 36.1%, respectively). Less frequently represented was the physical and built environment (12.2%).
NIH-funded cancer survivorship research on health disparities is still focused on individual level of influence. However, the proportion of grants examining structural and social drivers as well as the mechanisms that drive disparities in health care and health outcomes among cancer survivors have increased over time. Gaps in funded research on specific populations, cancer types, and focus areas of survivorship science were identified and warrant priority.
社区和研究人员呼吁从描述健康差距转变为关注结构性驱动因素的健康公平研究议程。因此，我们研究了癌症生存者研究组合是否已经进行了这种转变。
我们从美国国立卫生研究院（NIH）癌症生存者研究组合（N=724）中确定了关注存在健康差距的人群的赠款。提取了赠款特征，将健康差距的驱动因素映射到影响的水平和领域，并确定了未来研究的机会。
确定了 147 项关注健康差距的生存者赠款，其中 73.5%的赠款关注少数族裔和种族的生存者，25.9%生活在农村地区，24.5%处于社会经济劣势地位，2.7%为性少数群体和性别少数群体。研究设计为 51.0%观察性；82.3%的赠款至少测量或干预了 1 个个体层面的影响，而不是更高水平的影响（32.7%人际间，41.5%机构和社区，12.2%社会）。行为和医疗保健系统影响领域通常具有代表性，特别是在个体层面（分别为 47.6%和 36.1%）。物理和建筑环境的代表性较低（分别为 12.2%）。
NIH 资助的癌症生存者健康差距研究仍集中在个体层面的影响上。然而，随着时间的推移，检查结构性和社会驱动因素以及导致癌症幸存者医疗保健和健康结果差距的机制的赠款比例有所增加。确定了特定人群、癌症类型和生存研究重点领域的资助研究差距，并需要优先考虑。
