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

描述（由申请方提供）：我们根据PA-10-069准备的探索性研究，重点关注一个重要问题：关于美国社会经济长期趋势和测量健康状况的种族/民族不平等的数据不足。因此，我们试图确定创建和分析新颖的多层次US数据库的可行性，该数据库组合：（A）个人层次的健康数据，（B）可以随时间进行充分比较的社会经济地位（SEP）的新颖度量，以及（C）关于“吉姆·克劳”法律的新颖背景数据（即，1964年美国民权法案废除了允许种族歧视的法律）。这些数据是解决具有关键公共卫生和政策含义的新辩论的关键：随着整体人口健康状况的改善，社会经济差距的绝对和相对幅度是增加，保持不变还是减少？- 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3种模式都是可能的，那么基于1980年后的数据，他们将驳回不平等必然扩大的假设。[TEXT因此，我们的具体目标是：（a）目标1：利用美国国家健康检查调查的数据，建立一个1959- 2006年美国国家健康结果数据库（NHES;周期I：1959-1962;周期II：1963- 1965;周期III：1966-1970）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; NHANES III：1988-1994;和NHANES 1999-2000; 2001- 2002; 2003-2004; 2005-2006），并通过卫生统计数据中心（NCHS）研究数据中心（RDC），将这些数据链接到：（1）详细的个人收入和教育数据，（2）关于1964年以前各州吉姆·克劳地位的数据;（B）目标2：探索制定可以在不同时间进行有意义的比较的社会经济衡量标准;（c）目标3：利用为目标2制定的措施，探索量化卫生方面社会经济不平等程度的时间模式，为了检验1960年至1980年间健康方面的社会经济不平等现象有所减少的假设，（特别是在美国黑人中），然后停滞或扩大;（d）目标4：[正文删除]测试假设，即1980年前的最大降幅和1980年后的最大涨幅：（a）保健方面的社会经济不平等（尤其是在美国黑人中），（B）黑人/白色不平等（特别是在低收入阶层），发生在吉姆克劳州的居民中;和（e）目标5：通过发表科学手稿传播结果，并利用结果为R 01的编写提供信息，以对长期时间模式进行首次多层次背景分析（1959年至今）美国健康不平等的程度。实现这些目标有可能显著改变有关美国社会经济和种族/民族健康差异的概念、方法和预防性干预措施，消除这些差异是2010年健康人的一个关键目标。 公共卫生相关性：我们的目标是探索新的多层次的方法来开发的方法和数据库，这将使解决一个新的辩论是否，作为整体人口健康的改善，社会经济差距的绝对和相对幅度增加，保持不变，或减少？雅阁探索性补助金（R21）的目的，其目的是为随后的申请（R 01）奠定基础，从而可以生成适用于采用适当方法严格测试感兴趣假设的完整数据库。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、方法和预防性干预措施，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.