Understanding US regional health & mortality disparities: A Life Course Approach

了解美国地区健康状况

• 批准号: 8172295
• 负责人: SCOTT M. LYNCH
• 金额: $ 20万
• 依托单位: PRINCETON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8172295
• 关键词: Accounting; Address; Adolescence; Adopted; Affect; Age; Behavior; Birth; Categories; Cause of Death; Censuses; Characteristics; Climate; Collection; Data; Data Set; Diabetes Mellitus; Diet; Dimensions; Elderly; Epidemiology; Growth; Health; Health Surveys; Heterogeneity; Individual; Investigation; Learning; Left; Life; Life Cycle Stages; Life Table Method; Literature; Live Birth; Measurement; Measures; Mediating; Mediator of activation protein; Methods; Modeling; Neighborhoods; Outcome; Pathway interactions; Pattern; Physical Function; Physicians; Public Health; Research; Respondent; Retirement; Risk Factors; Role; Sampling; Socialization; Statistical Methods; Stroke; Surveys; Temperature; Time; Vacuum; Variant; base; cohort; density; depressive symptoms; follow-up; health disparity; lens; mortality; regional difference; residence; social

DESCRIPTION (provided by applicant): Regional disparities in health and mortality in the U.S. have been observed repeatedly, but little attempt has been made to explain them. At best, anecdotal explanations are usually offered. For example, poorer health among southerners is often attributed to diet without any empirical support. Extant literature suffers from several additional shortcomings. First, many studies focus on a single health outcome, like stroke mortality, thereby underestimating the full extent of regional variation in health. Second, many studies measure region coarsely. Often, only one region is contrasted against all others. This approach also leads to underestimation of the full range of regional variation in health and hinders our ability to understand the precise mechanisms that account for it, because within-region cultural and structural heterogeneity is extensive. Third, studies of regional disparities have generally failed to take a life course perspective, instead treating them as existing in a temporal vacuum. The proposed research will address these shortcomings, first by adopting a life course perspective. The life course perspective recognizes that neither region of residence, nor health, nor the relationship between them, is static at the individual level across age. Furthermore, regional characteristics and the distribution of health outcomes also vary across sociohistoric time, implying that the relationship between region and health may differ across birth cohorts. The life course perspective therefore provides a more comprehensive and detailed lens through which to begin to explain regional differences in health. Given this perspective, the proposed research will establish the full extent of regional disparities in health using a variety of longitudinal statistical methods applied to at least three nationally-representative, large sample data sets: the General Social Survey, the Health and Retirement Study, and the National Health Epidemiologic Follow-up Surveys. These data will be augmented via the collection of region-year contextual variables like physician density, climate, etc. Collectively, these surveys contain a wide variety of health measures, including self-rated health, physical functioning, depressive symptoms, mortality, and diabetes, as well as refined measures of region (i.e., the nine-category Census measure). Importantly, these three surveys also contain at least one measure of region of residence in early life (birth and adolescence), which, from a life course perspective, is useful in helping differentiate the role of early life socialization into regional culture from the role of structural characteristics of an individual's current region of residence in influencing health. In addition, this early life region measure, as well as the use of longitudinal methods, will enable the investigation of the extent to which health influences regional mobility, an issue (i.e., endogeneity) commonly ignored in research. Basic descriptive methods, typical regression models, multistate life table methods for both panel and cross-sectional data, and hierarchical growth models, including autoregressive latent trajectory models, will be used to flesh out the extent of regional differences in health as well as the mechanisms that account for them. PUBLIC HEALTH RELEVANCE: Regional differences in health and mortality in the US have been observed in numerous studies but have been left largely unexplained. Understanding the mechanisms that account for regional differences is important for determining how health disparities can be reduced. Our proposed project aims to determine the full extent of regional differences in health and to explain them (1) by using more refined measures of region and a broader array of health outcomes than used in previous research, and (2) by employing a life course perspective and methods to differentiate with greater precision and accuracy the pathways via which region may affect health.

描述（由申请人提供）：在美国，健康和死亡率的地区差异已经被反复观察到，但很少有人试图解释它们。最好的情况是，通常会提供一些轶事解释。例如，南方人较差的健康状况往往归咎于饮食，而没有任何经验支持。现存文献还存在其他一些缺点。首先，许多研究集中于单一的健康结果，如中风死亡率，从而低估了区域健康差异的全部程度。其次，许多研究对区域进行了粗略的测量。通常，只有一个地区与所有其他地区形成对比。这种方法还会导致低估区域健康差异的全部范围，并阻碍我们理解造成这种差异的确切机制的能力，因为区域内文化和结构的异质性是广泛的。第三，对区域差异的研究通常未能采取生命历程的观点，而是将其视为存在于时间真空中。拟议的研究将解决这些缺点，首先通过采用生命历程的观点。生命历程观点认识到，无论是居住区域、健康状况，还是两者之间的关系，在不同年龄的个人层面上都不是一成不变的。此外，区域特征和健康结果的分布在不同的社会历史时期也有所不同，这意味着区域与健康之间的关系可能在不同的出生队列中有所不同。因此，生命历程视角提供了一个更全面和详细的视角，通过它可以开始解释健康方面的区域差异。鉴于这一观点，拟议的研究将利用各种纵向统计方法，对至少三个具有全国代表性的大样本数据集：综合社会调查、健康和退休研究以及国家卫生流行病学后续调查，确定卫生方面的区域差异的全部程度。这些数据将通过收集地区-年背景变量（如医生密度、气候等）来增强。总的来说，这些调查包含各种各样的健康措施，包括自评健康、身体功能、抑郁症状、死亡率和糖尿病，以及精细的区域措施（即九类普查措施）。重要的是，这三项调查还包含至少一项关于早期生活（出生和青春期）居住地区的测量，从生命历程的角度来看，这有助于区分早期生活社会化对区域文化的作用，以及个人当前居住地区的结构特征对健康的影响。此外，这种早期生活区域测量以及纵向方法的使用将能够调查健康对区域流动性的影响程度，这是研究中通常忽略的一个问题（即内生性）。将使用基本描述方法、典型回归模型、面板和横断面数据的多状态生命表方法以及分层增长模型（包括自回归潜在轨迹模型）来充实健康区域差异的程度以及解释这些差异的机制。