What to Do When Everything Happens at Once: Analytic Approaches to Estimate the Health Effects of Co-Occurring Social Policies.
What to Do When Everything Happens at Once: Analytic Approaches to Estimate the Health Effects of Co-Occurring Social Policies.
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DOI：
10.1093/epirev/mxab005
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发表时间：
2022-01-14
影响因子：
5.5
通讯作者：
Glymour MM
中科院分区：
文献类型：
--
作者：
Matthay EC;Gottlieb LM;Rehkopf D;Tan ML;Vlahov D;Glymour MM
社会政策在改善人口健康和减少健康差距方面具有巨大潜力。越来越多的实证研究人员试图通过利用各地政策变化时间的差异来量化社会政策对健康的影响。多种社会政策往往在同一地点同时或连续采用，从而产生共现现象，必须对其进行分析处理才能得出有效的推论。尽管这对于旨在分离社会政策影响的研究人员来说是一个重大的方法论挑战，但只有在有限的研究中，研究人员在因果框架内系统地考虑了分析解决方案或评估了这些解决方案是否被采用。我们指定了政策共现的 7 种分析解决方案，包括努力解开单个政策的影响以及努力估计同时发生的政策的综合影响。我们利用现有的社会政策和健康系统回顾来评估政策共现被识别为有效性威胁的频率以及每个分析解决方案在实践中应用的频率。在 55 项研究中，只有 17 项 (31%) 的作者报告检查了任何同时发生的政策，尽管在 36 项研究 (67%) 中，至少使用了一种方法来帮助解决政策同时发生的问题。最常见的方法是针对同时发生的政策措施进行调整；确定可能受相关政策（但不包括其他同时发生的政策）影响的亚人群的结果；并选择相关性较低的政策敞口衡量标准。随着健康研究越来越关注政策变化，我们必须系统地评估政策共现并应用分析解决方案来加强对社会政策对健康影响的研究。
Social policies have great potential to improve population health and reduce health disparities. Increasingly, those doing empirical research have sought to quantify the health effects of social policies by exploiting variation in the timing of policy changes across places. Multiple social policies are often adopted simultaneously or in close succession in the same locations, creating co-occurrence that must be handled analytically for valid inferences. Although this is a substantial methodological challenge for researchers aiming to isolate social policy effects, only in a limited number of studies have researchers systematically considered analytic solutions within a causal framework or assessed whether these solutions are being adopted. We designated 7 analytic solutions to policy co-occurrence, including efforts to disentangle individual policy effects and efforts to estimate the combined effects of co-occurring policies. We used an existing systematic review of social policies and health to evaluate how often policy co-occurrence is identified as a threat to validity and how often each analytic solution is applied in practice. Of the 55 studies, only in 17 (31%) did authors report checking for any co-occurring policies, although in 36 studies (67%), at least 1 approach was used that helps address policy co-occurrence. The most common approaches were adjusting for measures of co-occurring policies; defining the outcome on subpopulations likely to be affected by the policy of interest (but not other co-occurring policies); and selecting a less-correlated measure of policy exposure. As health research increasingly focuses on policy changes, we must systematically assess policy co-occurrence and apply analytic solutions to strengthen studies on the health effects of social policies.
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