Community and Individual Predictors of Health Inequality

大量研究表明，美国黑人和白人之间存在着长期存在的健康差异，这种差异几乎遍及所有健康领域。除了少数例外，收入、教育水平和保险状况的差异已经缩小，但这并不能解释黑人和白人老年人之间的全部健康差距。这些个人层面的测量无法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，迄今为止，研究主要只考虑个人特征，如个人经济资源，几乎忽略了“地方”对种族健康差异的相对影响。本研究的目的是系统地研究个人和社区对65岁及以上黑人和白人成年人健康差异的影响。这项研究将检查社区层面的措施（在人口普查区层面测量），这些措施与北卡罗来纳州老年人流行病学研究既定人口（EPESE）有关，EPESE是来自北卡罗来纳州五个县的4,162名黑人和白人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特征对黑人和白人老年人后续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研究的项目之一，目的是检查黑人和白人老年人之间的种族健康差异。本研究有三个具体目的：1。测试社区背景、组成和稳定性对黑人和白人老年人健康地理差异的影响。2. 衡量个人和社区特征对老年人种族健康差异的相对影响，特别是对ADL和IADL残疾的影响。3. 确定易受社区影响的程度是否因种族或社会经济地位而异。

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.