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，准备响应PAR-10-137，重点放在一个重要的，但很少探索的问题：如何最好地，概念和方法，整合使用年龄阶段队列（APC）分析，以促进了解健康不公平的程度趋势的社会决定因素。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，我们的创新理论驱动的案例涉及我们所谓的“吉姆·克劳死亡地理学”，一个缺乏实证研究的主题。我们的项目的双重贡献将是：（1）概念性的，提供新的见解和指导，关于使用APC模型来分析政策变化如何影响人口健康和健康不公平;（2）实质性的，鉴于缺乏研究的健康影响废除法律的种族歧视的1964年美国民权法案。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））和婴儿死亡率（<1岁）;两组差异涉及美国黑人与白色人口的比较，以及吉姆·克劳州与非吉姆·克劳州的美国黑人人口的比较，分析与时空尺度（生命过程，历史世代，空间效应）和水平（州，县， 个人）。 因此，我们的具体目标是：（1）目标1：对由1960-2006年美国县级黑人和白色人死亡率和分母数据组成的数据库进行探索性和图形APC分析，该数据库与年度县家庭收入中位数数据相关联，并与州吉姆·克劳状态（即，在1964年美国民权法案之前没有合法化的种族歧视）;步骤包括创建详细的A，P和C类别，计算研究结果的年比率和差异，并进行APC表格和图形分析;目的2：探索使用不同的APC建模方法来分析废除吉姆·克劳对特定死亡率结果的影响：（a）理论上，与病因学和统计学假设有关，以及（B）经验上，使用：（i）广泛使用的传统解决方案，通过假设3个中只有2个影响结果，来解决由于A、P和C的线性依赖性而引起的“识别问题”;（ii）新的且有争议的统计方法，称为“内在估计”;（3）目标3：传播研究结果，并利用研究结果为准备NIH R 01拨款提供信息，以进行政策变化对卫生不公平程度影响的APC分析。 因此，拟议的项目将直接涉及PAR-10-137以及2010年和2020年健康人的关键目标，因为它将对APC方法进行理论驱动的实证测试，以了解政策、社会背景、水平、生命过程和种族歧视对健康不平等程度的影响，在实质上与吉姆克劳和更广泛的其他政策以及。

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.