Jim Crow & health disparities: exploring age-period-cohort effects

描述（由申请人提供）：我们提出的跨学科探索性研究，是为了响应PAR-10-137而准备的，重点关注一个重要但很少被探索的问题：如何在概念和方法上最好地整合使用年龄-时期-队列（APC）分析，以促进对健康不平等程度趋势的社会决定因素的理解。借鉴社会流行病学和政治社会学的框架和方法，以及APC模型的新进展，我们的创新理论动机案例涉及我们所谓的“吉姆·克劳死亡率地理”，这是一个缺乏实证工作的主题。我们项目的双重贡献将是：(1)概念性的，为使用APC模型分析政策变化如何影响人口健康和卫生不平等提供新的见解和指导；(2)实质性，考虑到1964年美国民权法案废除法律上的种族歧视对健康的影响缺乏研究。研究结果将是全因死亡率和癌症死亡率（总死亡率和<65岁（早产））以及婴儿死亡率（<1岁）；这两组差异涉及美国黑人与白人人口的比较，以及种族隔离州与非种族隔离州的黑人人口的比较，并根据时空尺度（生命历程、历史产生、空间效应）和水平(州、县、

DESCRIPTION (provided by applicant): Our proposed interdisciplinary exploratory study, prepared in response to PAR-10-137, focuses on a significant yet little explored problem: how best, conceptually and methodologically, to integrate use of age-period-cohort (APC) analysis to advance understanding of societal determinants of trends in the magnitude of health inequities. Drawing on social epidemiology and political sociology frameworks and methods, and also new advances in APC models, our innovative theoretically-motivated case example concerns what we term the "Jim Crow geography of mortality," a topic on which scant empirical work exists. The two-fold contributions of our project will be: (1) conceptual, providing new insights and guidance regarding use of APC models to analyze how policy changes can influence population health and health inequities; and (2) substantive, given the paucity of research on the health impact of the abolition of legal racial discrimination by the 1964 US Civil Rights Act. Study outcomes will be all-cause and cancer mortality (total and <65 y (premature)) and infant death (<1 y); the two sets of disparities pertain to comparisons of the US black vs white population, and the US black population in Jim Crow vs non-Jim Crow states, analyzed in relation to spatiotemporal scale (lifecourse, historical generation, spatial effects) and level (state, county, individual). Our Specific Aims accordingly are: (1) Aim 1: Conduct exploratory and graphical APC analysis of a database comprised of 1960-2006 county-level US black and white mortality and denominator data linked to annual county median family income data and newly linked to data on state Jim Crow status (i.e., did vs did not have legalized racial discrimination prior to te 1964 US Civil Rights Act); steps include creating detailed A, P, and C categories, calculating the study outcome annual rates and disparities, and performing APC tabulations and graphical analyses; Aim 2: Explore use of diverse APC modeling approaches to analyze the impact of the abolition of Jim Crow on the specified mortality outcomes: (a) theoretically, in relation to etiologic and statistical assumptions, and (b) empirically, using: (i) a widely-used conventional solution to address the "identification problem" due to linear dependence of A, P, and C, by assuming only 2 of the 3 affect the outcome; (ii) a new - and debated - statistical approach, called the "intrinsic estimator"; and (iii) an approach based on generalized linear mixed models which can be extended to address group disparities and spatial effects; and (3) Aim 3: Disseminate findings and use results to inform preparation of an NIH R01 grant to conduct APC analyses of the impact of policy change on the magnitude of health inequities. The proposed project thus will directly address key objectives of PAR-10-137, and also Healthy People (HP) 2010 and HP 2020, since it will conduct theoretically-motivated empirical tests of APC approaches relevant to understanding the impact of policy, social context, levels, lifecourse, and racial discrimination on the magnitude of health inequities, substantively in relation to Jim Crow and more broadly for other policies as well.