Community and Individual Predictors of Health Inequality

健康不平等的社区和个人预测因素

• 批准号: 6899977
• 负责人: JESSICA A KELLEY
• 金额: $ 5.76万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6899977
• 关键词: African American; caucasian American; clinical research; community; epidemiology; functional ability; geographic difference; health disparity; health services research tag; human data; human old age (65+); human subject; racial /ethnic difference; socioeconomics

A wealth of research has demonstrated that there are health disparities between Black and White Americans that are enduring over time and pervasive into almost all health domains. With few exceptions, differences in income, education level, and insurance status has narrowed, but not accounted for the entire health gap between Black and White older adults. One possible reason why these individual-level measurements have failed to explain the racial health gap is that many health outcomes are influenced by one's environment. However, to date, research has primarily considered only individual characteristics such as personal economic resources and has virtually ignored the relative impact of "place" on the racial health disparity. The intent of this proposed study is to systematically examine both individual and community influences on the health disparity between Black and White adults ages 65 and older. This research will examine community-level measures (measured at the Census tract level) that have been linked with the North Carolina Established Populations for the Epidemiologic Study of the Elderly (EPESE), which is a multi-stage sample of 4,162 Black and White older adults from five counties in North Carolina, and employ multi-level models to estimate the relative influence of individual- and community-level characteristics on the subsequent physical functioning of Black and White older adults. This proposed project is one of the first to integrate broader context into the study of individual health outcomes for the purposes of examining the racial health disparity between Black and White older adults. There are three specific aims of this study: 1. Test the impact of community context, composition, and stability on geographic variations in the health of Black and White older adults. 2. Measure the relative influence of individual and community characteristics on the racial health disparity among older adults, specifically on ADL and IADL disability. 3. Determine whether vulnerability to community influences varies by race or socioeconomic status.

大量的研究表明，美国黑人和白色人之间的健康差距随着时间的推移而持续存在，并渗透到几乎所有的健康领域。除了少数例外，收入，教育水平和保险状况的差异已经缩小，但不能解释黑人和白色老年人之间的整个健康差距。这些个人水平的测量未能解释种族健康差距的一个可能原因是，许多健康结果受到一个人的环境的影响。然而，到目前为止，研究主要只考虑个人特征，如个人经济资源，几乎忽略了“地点”对种族健康差距的相对影响。这项拟议研究的目的是系统地研究个人和社区对65岁及以上黑人和白色成年人之间健康差距的影响。这项研究将审查社区一级的措施，（在人口普查区一级测量），已与北卡罗来纳州老年人流行病学研究（EPESE）建立人口联系，EPESE是来自北卡罗来纳州五个县的4,162名黑人和白色老年人的多阶段样本，并采用多层次模型来估计个体和社区水平的特征对黑人和白色老年人随后的身体功能的相对影响。这个拟议的项目是第一个将更广泛的背景纳入个人健康结果的研究，以研究黑人和白色老年人之间的种族健康差距。本研究的具体目的有三：1.测试社区背景、组成和稳定性对黑人和白色老年人健康的地理差异的影响。2.测量个人和社区特征对老年人种族健康差异的相对影响，特别是ADL和IADL残疾。3.确定对社区影响的脆弱性是否因种族或社会经济地位而异。