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针对 PAR-10-137 准备的，重点关注一个重要但很少探讨的问题：如何在概念上和方法上最好地整合年龄-时期-队列 (APC) 分析的使用，以增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，我们的创新性理论驱动案例涉及我们所说的“吉姆·克劳死亡率地理学”，这是一个鲜有实证研究的主题。我们的项目有两方面的贡献：（1）概念性，提供有关使用 APC 模型分析政策变化如何影响人口健康和健康不平等的新见解和指导； (2) 实质性，因为关于 1964 年美国民权法案废除法律种族歧视对健康影响的研究很少。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（<1 岁）；两组差异涉及美国黑人与白人人口以及吉姆·克劳州与非吉姆·克劳州黑人人口的比较，并根据时空尺度（生命历程、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：对数据库进行探索性和图形 APC 分析，该数据库由 1960-2006 年美国县级黑人和白人死亡率和分母数据组成，该数据与各县家庭收入中位数数据相关联，并新与州吉姆·克劳状态数据相关联（即，在 1964 年美国民权法案之前，种族歧视是否合法化）；步骤包括创建详细的 A、P 和 C 类别，计算研究结果的年率和差异，以及执行 APC 表格和图形分析；目标 2：探索使用不同的 APC 建模方法来分析废除吉姆·克劳法对特定死亡率结果的影响：(a) 理论上，与病因学和统计假设相关；(b) 经验上，使用：(i) 广泛使用的传统解决方案，通过假设 3 项中只有 2 项影响结果，解决由于 A、P 和 C 的线性依赖性而导致的“识别问题”； (ii) 一种新的、有争议的统计方法，称为“内在估计量”； (iii) 基于广义线性混合模型的方法，可以扩展到解决群体差异和空间效应； (3) 目标 3：传播调查结果并利用结果为 NIH R01 拨款的准备工作提供信息，以对政策变化对卫生不平等程度的影响进行 APC 分析。 因此，拟议项目将直接解决 PAR-10-137 以及健康人民 (HP) 2010 和 HP 2020 的关键目标，因为它将对 APC 方法进行理论上的实证测试，以了解政策、社会背景、水平、生命历程和种族歧视对健康不平等程度的影响，实质上与吉姆·克劳法以及更广泛的其他政策有关。

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.