The US Mortality Crisis: An Examination of Non-Hispanic White Mortality and Morbidity in Yavapai County, Arizona
The US Mortality Crisis: An Examination of Non-Hispanic White Mortality and Morbidity in Yavapai County, Arizona
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DOI：
10.1007/s10900-019-00648-3
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发表时间：
2019-08-01
影响因子：
5.9
通讯作者：
Barger, Steven D.
中科院分区：
文献类型：
--
作者：
Parsons, Michelle Anne;Barger, Steven D.
在美国，中年非西班牙裔白色人的死亡率正在上升，特别是在小城市和农村县。这篇文章回应了县级研究的呼吁。作为综合研究的一部分，我们研究了亚利桑那州亚瓦派县成年非西班牙裔白人发病率和死亡率的社会决定因素。我们使用CDC Wonder数据报告了Yavapai县的总体死亡率趋势，然后使用亚利桑那州行为风险因素监测系统（BRFSS）的6年（2011-2016）研究了Yavapai县报告的身体健康和精神痛苦的社会决定因素。BRFSS包括1,024名年龄在25-64岁的非西班牙裔白色受访者。我们还提供了最近成立的亚瓦派县过量死亡审查委员会（YCOFRB）的数据。死亡率趋势表明，自1999年以来，自杀以及与毒品和酒精有关的死亡率都有所上升。这些增长影响到25至64岁的所有5岁年龄组，包括男子和妇女。BRFSS数据显示，在多变量分析中，教育程度低和失业，而不是子女数量或房屋所有权，与报告的健康状况较差和频繁的精神困扰显著相关。YCOFRB指出了无家可归和心理健康的重要性。亚瓦派县的死亡率危机不仅限于中年人或与毒品有关的死亡。失业者和受教育程度低的人面临的风险尤其大。有必要采取综合办法，利用当地数据阐明发病率和死亡率的社会决定因素，并揭示结构性决定因素。
Midlife non-Hispanic white mortality in the United States is rising, particularly in small metro and rural counties. This article responds to calls for county-level studies. We examine social determinants of morbidity and mortality among adult non-Hispanic whites in Yavapai County, Arizona, as part of an integrative study. We report overall mortality trends in Yavapai County using CDC Wonder data and then examine social determinants of reported physical health and mental distress in Yavapai County data using 6 years (2011-2016) of the Arizona Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS includes 1,024 non-Hispanic white respondents aged 25-64. We also present data from the recently established Yavapai County Overdose Fatality Review Board (YCOFRB). Mortality trends indicate that suicide and drug and alcohol-related mortality have all increased since 1999. These increases affect all 5-year age groups from 25 to 64 and both men and women. BRFSS data show that low education and unemployment, but not number of children or home ownership, are significantly associated with worse reported health and frequent mental distress in multivariate analyses. The YCOFRB point to the importance of homelessness and mental health. The mortality crisis in Yavapai County is not restricted to midlife or to drug-related deaths. The unemployed and those with low levels of education are particularly at risk. There is a need for integrative approaches that use local data to elucidate social determinants of morbidity and mortality and to reveal structural determinants.