Changes in the National Cancer Institute's R01 workforce: growth, aging, retention, and policy implications

Association of publication record and independent NIH funding

Background

Publications may be a modifiable factor toward research project grant (RPG) funding decisions, the objective was to determine the association of publication record with later RPG receipt.

Methods

This was a retrospective cohort study of recipients of K01, K08, or K23 US career development awards (CDAs) starting from 2000–2015. Exposures were CDA awardees’ first-, middle-, and last-author publication counts, and the quartile of awardees’ highest and mean publication impact factors. The independent association of each exposure with time to RPG (R01 or equivalent) was determined using a Cox model, after adjustment for CDA type, awardee change in institution, and institutional CDA count. The proportion of CDA recipients with later independent funding was also determined by publication count.

Results

Among 6744 CDA awardees, 3943 obtained an RPG. The median time to RPG was 5.6 years (interquartile range 4.2–7.5). The number of first-authorships was associated with a shorter time to RPG (1–4 versus 0: hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.10–1.36; 5–9: 1.59, 95% CI 1.40–1.79; 10–24: 1.78, 95% CI 1.54–2.07; 25+: 2.40, 95% CI 1.61–3.56). Last-authorships were associated with a shorter time to RPG (1–4 versus 0: HR 1.99, 95% CI 1.83–2.16; 5–9: 2.72, 95% CI 2.45–3.03; 10–24: 3.17, 95% CI 2.78–3.62; 25+: 3.12, 95% CI 2.17–4.50). Higher maximum impact factor was associated with a shorter time to RPG (Q2 versus lowest: HR 1.28, 95% CI 1.12–1.46; Q3: 1.45, 95% CI 1.24–1.70; Q4: 1.67, 95% CI 1.39–2.02). Mean impact factor and middle-authorships were not associated with time to RPG. Among 687 CDAs with zero associated first- or last-authorships, 158 (23%) achieved later RPG funding. Among those with at least 10 total first- or last-authorships, 1288/1554 (83%) obtained a later RPG.

Conclusions

A higher number and impact of publications was associated with later independent funding.

American Cancer Society's report on the status of cancer disparities in the United States, 2021

In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.