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Multilevel Determinants of Socioeconomic Disparities in Geographic Late Stage Hepatocellular Carcinoma Hotspots

Award Number: K23MD016963
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 07/25/2022
PERIOD OF PERFORMANCE END DATE: 03/31/2027

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Multilevel Determinants of Socioeconomic Disparities in Geographic Late Stage Hepatocellular Carcinoma Hotspots - PROJECT SUMMARY/ABSTRACT Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer-related deaths in the United States (US), with rising incidence among low-income individuals. Due to importance of cancer stage at diagnosis to survival, we applied small area estimation to the population-based cancer registry in urban Los Angeles County (LAC) to identify areas of highest late stage HCC burden for intervention. These geographic late stage HCC “hotspots” were disproportionately concentrated in areas of lowest socioeconomic status (SES). Few strategies to promote the early detection of HCC have been studied and most are not tailored to the low SES populations that experience the greatest disparity. The scientific objective of this proposal is to address this need by characterizing the individual-, organizational-, and community-level determinants of the geographic aggregation of late stage HCC in low SES communities. Specifically, we propose to use geospatial techniques to refine our population-based late stage hotspots and perform sensitivity analyses around spatial, clinical, and temporal inputs (Aim 1). We will analyze a multilevel dataset built from prospective survey, medical record, and geospatial linkage of 700 incident HCC registry cases to identify the root determinants of SES disparities (Aim 2). Last, semi-structured interviews will be conducted at multiple levels (e.g., patients, providers, and community leaders) to explore barriers to completion of the early detection pathway for HCC in low SES populations (Aim 3). Study constructs are conceptually grounded in the National Institute on Minority Health and Health Disparities Framework, with interviews guided by the Multi-Level Health Outcomes Framework. Together, our rich theory-driven data will directly inform the strategic plan for a multilevel early detection pilot intervention targeting late stage HCC hotspots in a future R34, followed by a cluster randomized controlled intervention trial in a R01. The training objectives in this proposal will foster Dr. Zhou’s growth as a cancer disparities researcher focused on geospatial innovation in early detection strategies to mitigate disparities and improve outcomes among underserved populations with HCC. The four core components of Dr. Zhou’s training plan combine advanced didactics with applied experience: (1) proficiency in spatial methodology and geovisualization; (2) foundation in multilevel modeling and qualitative methods to support effective disparities research; (3) introduction to multilevel intervention design and delivery; and (4) professional development in cancer disparities. Dr. Zhou has access to an academic research environment enriched for cancer disparities and cancer control research, a socioeconomically diverse urban population in LAC, and a strong transdisciplinary mentorship team, comprised of primary mentor Dr. Cockburn (spatial sciences and cancer control) and co-mentors Dr. Mack (multilevel modeling), Dr. Bastani (multilevel interventions), and Dr. Terrault (career development). In summary, this proposal embeds detailed training goals within a practical sequence of research aims to provide Dr. Zhou with a clear path to investigator independence.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $165,735 )
2025	2025	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90033	LOS ANGELES	USA	Minority Health and Health Disparities Research	001	4	4/17/2025	NON-COMPETING CONTINUATION	$165,735
2025	2024	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90033	LOS ANGELES	USA	Minority Health and Health Disparities Research	000	3	3/18/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $165,735

Issue Date FY: 2024 ( Subtotal = $165,774 )
2024	2024	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90089	LOS ANGELES	USA	Minority Health and Health Disparities Research	002	3	6/18/2024	NON-COMPETING CONTINUATION	$0
2024	2024	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90089	LOS ANGELES	USA	Minority Health and Health Disparities Research	001	3	5/28/2024	NON-COMPETING CONTINUATION	$16,577
2024	2024	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90089	LOS ANGELES	USA	Minority Health and Health Disparities Research	000	3	3/31/2024	NON-COMPETING CONTINUATION	$149,197
														Subtotal = $165,774

Issue Date FY: 2023 ( Subtotal = $165,774 )
2023	2023	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST	LOS ANGELES	CA	90089	LOS ANGELES	USA	Minority Health and Health Disparities Research	001	2	3/16/2023	NON-COMPETING CONTINUATION	$165,774
2023	2022	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST	LOS ANGELES	CA	90089	LOS ANGELES	USA	Minority Health and Health Disparities Research	000	1	3/2/2023	NEW	$0
														Subtotal = $165,774

Issue Date FY: 2022 ( Subtotal = $165,718 )
2022	2022	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90007	LOS ANGELES	USA	Minority Health and Health Disparities Research	000	1	7/25/2022	NEW	$165,718
														Subtotal = $165,718

Grand Total All Awards = $663,001

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Multilevel Determinants of Socioeconomic Disparities in Geographic Late Stage Hepatocellular Carcinoma Hotspots

Award Number: K23MD016963

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 07/25/2022

PERIOD OF PERFORMANCE END DATE: 03/31/2027

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