A US-UK Comparison of Discrimination & Disparities in Health & Health Service Use

描述(由申请者提供)：在美国和英国，越来越多的证据表明，种族和社会经济地位(SES)存在巨大的健康差距。该项目汇集了一个由美国和英国调查人员组成的跨学科团队，他们建立了既定的联系和共同的目标，以在两国创建可比较的数据，从而更好地了解健康差距以及如何缩小这些差距。我们建议调查美国和英国在社会背景方面的相似和差异，以及在按种族/民族和社会经济地位在功能、身心健康和卫生服务使用方面产生差异方面的歧视和劣势。该项目包括三个具体目标：1)正式确定美国和英国团队之间的合作；2)开发一种社会历史方法来表征社会背景，从而能够比较美国和英国在医疗和医疗服务使用方面的差异；并阐明政策在塑造国家内部和国家之间观察到的模式方面的作用；以及3)检查国家内部和国家之间感知到的歧视流行率的差异；以及歧视在多大程度上可以解释种族/民族和社会保障制度在功能、抑郁、一般身体健康和医疗服务使用方面的差异。该项目利用了美国和英国现有的两项关于社会经济和种族多元化人口的研究。使用横断面设计，我们协调这些研究，以构建每个地点800名受试者(250名黑人和550名白人)的可比数据，涉及：a)四个关键结果(功能、抑郁、一般身体健康和卫生服务使用)；b)歧视、应对、应激环境和相关的心理社会变量；c)社会背景，使用社会历史方法进行有意义的跨国比较；以及d)个人SES。这些数据将提供一个新的、多学科的基础，以便在美国和英国的系统差异和相似的社会结构的背景下，更详细地了解按种族/民族和社会地位划分的歧视对健康差距的影响。此外，这项比较研究有可能为正在进行的健康差异的跨国检查提供基础，因为这些中成年人样本随着时间的推移而老化。本项目侧重于美国和英国的种族/民族、社会经济地位和社会背景歧视对卫生和卫生服务使用差异的贡献。虽然这些差距是两国公共卫生的一个主要问题，但尚未彻底审查歧视和社会背景在每个国家内部和国家之间造成这些差距方面所起的作用。公共卫生相关性：该项目侧重于按种族/族裔以及社会经济地位和社会背景进行的歧视对美国和联合王国卫生和保健服务使用方面的差异的贡献。虽然这些差距是两国公共卫生的一个主要问题，但尚未彻底审查歧视和社会背景在推动两国境内这些差距方面所起的作用；此外，以前还没有进行过这种性质的跨国比较。本项目提出的跨国比较将阐明在美国和英国，歧视和社会背景对按种族/族裔和社会经济地位在功能、身心健康和卫生服务使用方面的差异的贡献的异同。

DESCRIPTION (provided by applicant): A growing body of evidence in the US and UK documents large health disparities by race and socioeconomic status (SES). This project brings together an interdisciplinary team of US and UK investigators with established ties and common objectives to create comparable data in both countries that will permit a better understanding of health disparities and how they might be reduced. We propose to investigate the similarities and differences in social context and discrimination and disadvantage in generating disparities by race/ethnicity and SES in functioning, physical and mental health, and health service use in the US and UK. This project comprises three specific aims: 1) to formalize a collaboration between the US and UK teams; 2) to develop a socio-historical approach to characterizing social context that will enable comparisons of disparities in health and health service use between the US and UK; and illuminate the role of policy in shaping observed patterns within and between countries; and 3) to examine within- and between-country differences in the prevalence of perceived discrimination; and the extent to which discrimination may account for disparities by race/ethnicity and SES in functioning, depression, general physical health, and health service use. This project capitalizes on two extant studies of socioeconomically and racially diverse populations in the US and UK. Using a cross sectional design, we harmonize these studies to construct comparable data on 800 subjects (250 black and 550 white) at each site regarding: a) four key outcomes (functioning, depression, general physical health, and health service use); b) discrimination, coping, stressful circumstances, and related psychosocial variables; c) social context, characterized using a socio-historical approach that will render meaningful cross-country comparisons; and d) individual SES. These data will provide a novel, multi-disciplinary basis for a more detailed understanding the impact of discrimination on health disparities by race/ethnicity and SES in the context of systematic differences and similar social structures in US and UK. In addition, this comparative study has the potential to provide the basis for an ongoing cross-national examination of health disparities as these mid-adult samples age over time. This project focuses on the contribution of discrimination by race/ethnicity, SES, and social context to disparities in health and health service use in the US and the UK. Although these disparities constitute a major public health concern in both countries, there has not yet been a thorough examination of the role discrimination and social context play in driving these disparities both within and between each country. PUBLIC HEALTH RELEVANCE: This project focuses on the contribution of discrimination by race/ethnicity and socioeconomic status and social context to disparities in health and health service use in the United States and the United Kingdom. Although these disparities constitute a major public health concern in both countries, there has not yet been a thorough examination of the role discrimination and social context play in driving these disparities within each country; moreover, a cross-national comparison of this nature has not been undertaken previously. The cross- national comparison proposed in this project will elucidate the similarities and differences in the contributions of discrimination and social context to disparities by race/ethnicity and SES in functioning, physical and mental health, and health service use in the United States and the United Kingdom.