EXPLORING TRENDS IN US HEALTH INEQUITIES IN CONTEXT: NHES TO NHANES, 1959-2006

描述(由申请人提供)：我们建议的探索性研究是为回应PA-10-069而准备的，重点是一个重要的问题：关于美国社会经济和种族/民族不平等在测量的健康状况方面的长期趋势的数据不足。因此，我们试图确定创建和分析一个新的多层次美国国家数据库的可行性，该数据库结合了：(A)个人层面的健康数据，(B)可随时间进行有意义比较的社会经济地位(SEP)的新衡量标准，以及(C)关于“吉姆·克罗”法律(即，允许种族歧视的法律，被1964年美国民权法案废除的法律)的新背景数据。这些数据是应对一场具有关键公共卫生和政策影响的新辩论的关键：随着总体人口健康的改善，社会经济差距的绝对和相对程度是增加、保持不变还是缩小？-在美国，这些模式是否因种族/民族和性别而异？如果结果显示所有三种模式都是可能的，他们将驳斥基于1980年后数据的假设，即不平等必然会扩大。因此，我们的具体目标是：(A)目标1：使用美国国家健康检查调查(NHES；周期一：1959-1962年；周期二：1963-1965年；周期三：1966-1970年)和随后的美国国家健康和营养检查调查(NHANES I：1971-1975；NHANES II：1976-1980年；NHANES III：1988-1994；以及NHANES 1999-2000；2001-2002；2003-2004；(2005-2006年)，并通过国家卫生统计中心(NCHS)研究数据中心(RDC)，将这些数据与：(1)详细的个人收入和教育数据，以及(2)关于1964年以前吉姆·克罗状况的数据；(B)目标2：探索制定可随时间进行有意义比较的社会经济措施；(C)目标3：利用为目标2制定的措施，探索卫生领域社会经济不平等程度的时间模式，以检验卫生领域社会经济不平等在1960年至1980年期间减少(特别是在美国黑人中)，然后停滞不前或扩大的假设；(D)目标4：[删除的案文]测试以下假设：1980年前下降最快，1980年后上升最大：(A)健康方面的社会经济不平等(特别是在美国黑人中)，以及(B)吉姆·克罗各州居民中出现的黑人/白人不平等(特别是在低收入阶层)；和(E)目标5：通过出版科学手稿传播成果，并利用这些成果为编制R01提供参考，以对美国健康不平等程度的长期时间模式(1959年至今)进行第一次多层次背景分析。解决这些目标有可能显著改变有关美国社会经济和种族/民族健康差距的概念、方法和预防干预措施，消除这些差距是《2010年健康人》的关键目标。 公共卫生相关性：我们的目标是探索新的多层次方法来开发方法和数据库，从而能够应对一场新的辩论，即随着总体人口健康的改善，社会经济差距的绝对和相对规模是增加、保持不变还是减少？根据试探性赠款(R21)的目的，目的是为随后的应用程序(R01)奠定基础，以便能够生成适合用适当方法严格测试感兴趣的假设的成熟数据库。这项拟议研究产生的知识有可能显著改变有关美国社会经济和种族/民族健康差异的概念、方法和预防干预措施，消除这些差异是《2010年健康人》的关键目标。

DESCRIPTION (provided by applicant): OUR PROPOSED EXPLORATORY STUDY, PREPARED IN RESPONSE TO PA-10-069, FOCUSES ON A SIGNIFICANT PROBLEM: INADEQUATE DATA ON LONG-TERM TRENDS IN US SOCIOECONOMIC AND RACIAL/ETHNIC INEQUITIES IN MEASURED HEALTH STATUS. WE THEREFORE SEEK TO DETERMINE THE FEASIBILITY OF CREATING AND ANALYZING A NOVEL MULTILEVEL US NATIONAL DATABASE THAT COMBINES: (A) INDIVIDUAL-LEVEL HEALTH DATA, (B) NOVEL MEASURES OF SOCIOECONOMIC POSITION (SEP) THAT CAN BE MEANINGFULLY COMPARED OVER TIME, AND (C) NOVEL CONTEXTUAL DATA ON "JIM CROW" LAWS (I.E., LAWS THAT PERMITTED RACIAL DISCRIMINATION ABOLISHED BY THE 1964 US CIVIL RIGHTS ACT). THESE DATA ARE KEY FOR ADDRESSING a new debate WITH CRITICAL PUBLIC HEALTH AND POLICY IMPLICATIONS: as overall population health improves, do the absolute and relative magnitudes of socioeconomic disparities increase, stay the same, or decrease? - and, in the US, do these patterns vary by race/ethnicity and gender? WERE RESULTS TO SHOW ALL 3 PATTERNS ARE POSSIBLE, THEY WOULD REFUTE HYPOTHESES, BASED ON POST-1980 DATA, THAT INEQUITIES NECESSARILY WIDEN. [TEXT DELETED] Our specific aims thus are: (a) Aim 1: Create a US national health outcomes database spanning 1959- 2006 using data from the US National Health Examination Survey (NHES; Cycle I: 1959-1962; Cycle II: 1963- 1965; Cycle III: 1966-1970) and the subsequent US National Health and Nutrition Examination Surveys (NHANES I: 1971-1975; NHANES II: 1976-1980; NHANES III: 1988-1994; and NHANES 1999-2000; 2001- 2002; 2003-2004; 2005-2006), AND VIA THE NATIONAL CENTER FOR HEALTH STATISTICS (NCHS) RESEARCH DATA CENTER (RDC), LINK THESE DATA TO: (1) DETAILED INDIVIDUAL-LEVEL INCOME AND EDUCATION DATA, AND (2) DATA ON STATE'S PRE-1964 JIM CROW STATUS; (b) Aim 2: Explore developing socioeconomic measures that can meaningfully be compared over time; (c) Aim 3: Explore quantifying temporal patterns in the magnitude of socioeconomic inequities in health, using the measures developed for Aim 2, to test the hypothesis that socioeconomic inequities in health decreased between 1960 and 1980 (especially among black Americans) and then stagnated or widened thereafter; (d) Aim 4: [TEXT DELETED] Test the hypothesis that the sharpest reductions in pre-1980 and the largest rises in post-1980: (a) socio-economic inequities in health (especially among black Americans), and (b) black/white inequities (especially in lower income strata), occurred among residents of Jim Crow states; and (e) Aim 5: Disseminate results by publishing scientific manuscripts and use the results to inform preparation of an R01 to conduct the first multilevel contextual analysis of long-term temporal patterns (1959-present) in the magnitude of US HEALTH INEQUITIES. ADDRESSING THESE AIMS HAS THE POTENTIAL TO CHANGE SIGNIFICANTLY CONCEPTS, METHODS, AND PREVENTIVE INTERVENTIONS REGARDING US SOCIOECONOMIC AND RACIAL/ETHNIC DISPARITIES IN HEALTH, WHOSE ELIMINATION IS a key objective of Healthy People 2010. PUBLIC HEALTH RELEVANCE: Our objective is to explore novel multilevel approaches to developing the methods and database that would enable addressing a new debate about whether, as overall population health improves, the absolute and relative magnitude of socioeconomic disparities increase, stay the same, or decrease? In accord with the purpose of an exploratory grant (R21), the intent is to set the basis for a subsequent application (R01) that would permit generating the full-fledged database suitable for rigorously testing, with appropriate methods, the hypotheses of interest. Knowledge produced by the proposed study HAS THE POTENTIAL TO CHANGE SIGNIFICANTLY CONCEPTS, METHODS, AND PREVENTIVE INTERVENTIONS REGARDING US SOCIOECONOMIC AND RACIAL/ETHNIC DISPARITIES IN HEALTH, WHOSE ELIMINATION IS A KEY OBJECTIVE OF Healthy People 2010.