County Health Rankings Relationships Between Determinant Factors and Health Outcomes
County Health Rankings Relationships Between Determinant Factors and Health Outcomes
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DOI：
10.1016/j.amepre.2015.08.024
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发表时间：
2016-02-01
影响因子：
5.5
通讯作者：
Catlin, Bridget B.
中科院分区：
文献类型：
--
作者：
Hood, Carlyn M.;Gennuso, Keith P.;Catlin, Bridget B.
简介：县健康排名（CHR）提供了美国几乎每个县关于四组可修改的健康因素的数据，包括健康行为、临床护理、物理环境和社会经济条件，以及健康结果，如寿命和生活质量。本研究的目的是通过经验估计这些健康因素与健康结果之间的关联强度，并按州描述CHR模型因子权重的表现。方法：本研究的数据来自2015年CHR。45个州的35项措施被汇编成4个健康因素综合得分和1个健康结果综合得分。2015年3月，使用层次线性回归模型估计健康因素对健康结果的相对贡献。县人口规模；农村/城市地位;性别、种族和年龄分布作为控制变量。结果：总体而言，社会经济因素、健康行为、临床护理和自然环境对健康结果综合得分的相对贡献分别为47%、34%、16%和3%。尽管CHR模型在某些州的表现优于其他州，但这些结果为CHR模型和权重提供了广泛的经验支持。结论：本文进一步提供了一个框架，通过该框架确定健康相关投资的优先次序，并呼吁医疗保健提供者和教育他们的学校采取行动。实现人口健康的最大改善将需要解决健康的社会和经济决定因素。由爱思唯尔公司代表美国预防医学杂志出版
Introduction: The County Health Rankings (CHR) provides data for nearly every county in the U.S. on four modifiable groups of health factors, including healthy behaviors, clinical care, physical environment, and socioeconomic conditions, and on health outcomes such as length and quality of life. The purpose of this study was to empirically estimate the strength of association between these health factors and health outcomes and to describe the performance of the CHR model factor weightings by state.Methods: Data for the current study were from the 2015 CHR. Thirty-five measures for 45 states were compiled into four health factors composite scores and one health outcomes composite score. The relative contributions of health factors to health outcomes were estimated using hierarchical linear regression modeling in March 2015. County population size; rural/urban status; and gender, race, and age distributions were included as control variables.Results: Overall, the relative contributions of socioeconomic factors, health behaviors, clinical care, and the physical environment to the health outcomes composite score were 47%, 34%, 16%, and 3%, respectively. Although the CHR model performed better in some states than others, these results provide broad empirical support for the CHR model and weightings.Conclusions: This paper further provides a framework by which to prioritize health-related investments, and a call to action for healthcare providers and the schools that educate them. Realizing the greatest improvements in population health will require addressing the social and economic determinants of health. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine