Comparative Assessment of Modifying Social Determinants of Health to Reduce Firearm-Related Mortality and Disparities

修改健康社会决定因素以减少枪支相关死亡率和差异的比较评估

• 批准号: 10322069
• 负责人: Daniel Kim
• 金额: $ 23.55万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10322069
• 关键词: Address; Adult; Affect; American; Americas; Area; Cessation of life; Characteristics; Communities; County; Data; Databases; Economic Policy; Epidemic; Epidemiology; Ethnic Origin; Firearms; Goals; Guns; Homicide; Investigation; Knowledge; Life Expectancy; Link; Measures; Minority; Neighborhoods; Outcome; Plant Roots; Policies; Population; Prevention Research; Public Health; Public Policy; Quasi-experiment; Race; Sampling; Shapes; Social Mobility; Social Policies; Socioeconomic Status; Suicide; Testing; Translating; United States National Institutes of Health; Vulnerable Populations; Wages; comparative; comparison group; development policy; evidence base; gun homicide; gun violence; high risk; income disparities; low socioeconomic status; mortality; mortality disparity; novel; population health; public health relevance; residence; rural area; rural residence; social; social capital; social determinants; social health determinants; social influence; tool; translational impact; welfare

PROJECT SUMMARY/ABSTRACT Gun violence is an escalating national crisis that shapes overall levels of population health including average life expectancy. Crucially, in order to effectively address this crisis, it is imperative that we identify its root social causes, which may include social determinants of health (SDoH) such as income disparities and social mobility, and that we modify these root causes through corresponding policies. While a handful of SDoH have been shown to predict gun homicides and suicides, important questions remain about which SDoH are root social drivers i.e., have the greatest impacts. Despite increasing calls for comparative assessments and comprehensive approaches to unpack and address the root causes—the social determinants—of gun violence, we lack knowledge on the firearm mortality burden associated with modifying SDoH and SDoH-related policies, including by using multilevel, longitudinal data and quasi-experimental methods that favor causal inference. Furthermore, we have yet to establish which subpopulations are most affected by SDoH. Given this information, there are critical needs to accurately estimate SDoH impacts, including by subpopulation; and to translate these estimates into population health metrics that may serve as priority-setting tools. Not addressing these critical needs will hinder the development of policies to more effectively reduce firearm mortality burden and inequities. Our overall objective is to use quasi-experimental approaches to provide the first comparative assessment evidence base on the social drivers of the gun homicide and suicide epidemics. We will accomplish our overall objective by pursuing the following specific aims using data on 3.4 million adults from the nationally- representative sample of the Mortality Disparities in American Communities Study, linked to SDoH measures by area of residence and containing death information from national mortality database linkages: Aim 1) To determine which SDoH and SDoH-related policies most strongly predict firearm homicides and suicides in adults. To strengthen causal inference, we will implement robust quasi-experimental and epidemiologic approaches including difference-in-difference, propensity score, and changes-in- changes analysis; Aim 2) To identify which subpopulations (defined by race/ethnicity, SES, and urban/rural residence) are most vulnerable to influences of SDoH and SDoH-related policies on firearm homicides and suicides; and Aim 3) To ascertain which SDoH and SDoH-related policies if modified are expected to yield the greatest reductions in firearm homicide and suicide burden, both nationally and by subpopulation. Regarding outcomes, we will identify the most promising SDoH on which to intervene to yield improvements in adult firearm mortality burden. We will further establish how differential vulnerabilities by subpopulations may explain disparities. By translating estimates into population health metrics, we expect that our project will have high translational impact through guiding policymakers' evidence-based decisions about policies to more effectively reduce the burden of and inequities in mortality from gun violence in America.

项目摘要/摘要 枪支暴力是一种不断升级的国家危机，塑造了总体人口健康水平 平均预期寿命。至关重要的是，为了有效解决这一危机，我们必须确定它 根源的社会原因，其中可能包括卫生社会决定者（SDOH），例如收入分配和 社会流动性，并通过相应的政策修改这些根本原因。虽然少数SDOH 已显示出可以预测枪杀和自杀，关于哪个SDOH的重要问题仍然存在 根部社会驱动力，即产生最大的影响。尽管越来越多要求进行比较评估，并且 全面的方法解开和解决枪支暴力的根本原因 - 社会决定者， 我们缺乏与修改SDOH和与SDOH相关的政策相关的枪支死亡率燃烧的知识， 包括使用有利于因果推断的多级，纵向数据和准实验方法。 此外，我们尚未确定哪些亚群受SDOH影响最大。鉴于此信息， 有至关重要的需要准确估计SDOH影响，包括通过亚群来估算；并翻译这些 估计可以用作优先设定工具的人口健康指标。没有解决这些关键 需求将阻碍政策的制定，以更有效地减少枪支死亡率燃烧和不平等。 我们的总体目标是使用准实验方法来提供第一个比较评估 证据基于枪支杀人罪和自杀流行的社会驱动因素。我们将完成整体 通过使用来自全国的340万成年人的数据来追求以下具体目标 - 美国社区研究中死亡率差异的代表性样本，与SDOH测量有关 居住区和包含来自国家死亡率数据库链接的死亡信息：目标1） 确定哪些SDOH和SDOH相关的政策最强烈预测枪支凶杀和自杀 在成年人中。为了加强因果推论，我们将实施强大的准实验和 流行病学方法包括差异差异，承诺得分和变化 变更分析；目标2）确定哪些亚群（由种族/种族，SES和SES定义 城市/农村住宅）最容易受到SDOH和SDOH相关政策对枪支的影响 凶杀和自杀；目标3）确定如果修改为哪种SDOH和SDOH相关政策 预计将在全国和通过 亚种群。关于结果，我们将确定可以干预的最有前途的SDOH屈服 成人枪支死亡率的改善伯恩。我们将进一步确定如何通过 亚群可以解释分布。通过将估计值转化为人口健康指标，我们希望 我们的项目将通过指导政策制定者对循证决策产生巨大的翻译影响。 更有效地减少美国枪支暴力死亡率和不平等现象的政策。