The Impacts of County-Level COVID- 19 -Related Public Health and Social Policies on Racial/Ethnic and Socioeconomic Disparities in Mental Health and Healthcare Utilization

摘要 新冠肺炎疫情和相关缓解措施带来了巨大的财政困难 对于脆弱的美国人来说，失业率最高时接近15%，数百万人陷入贫困。那里 在这些困难中，种族和社会经济差距一直很明显，特别是对黑人和拉丁裔来说 家庭，建立在收入、住房和其他健康社会决定因素长期不平等的基础上。 最近的研究表明，这一大流行及其造成的社会经济不平等对 心理健康和医疗保健利用方面的差距。人们越来越认识到，政策在 缓解或加剧这些差距。例如，强制关闭会导致工作和收入损失， 这对低收入和少数族裔妇女的影响不成比例。相反，经济支持政策确保 脆弱的家庭有足够的资源在家里保持健康。虽然一些研究已经检查了 对于国家级新冠肺炎相关政策的效果，县级的系统文献还很少 政策及其对弱势群体的影响。本研究的目标是利用、扩展和链接 现有的国家数据集，以检验县级公共卫生和社会政策具有 心理健康和医疗保健利用方面的差异受到影响。目标一，汇聚县级新冠肺炎-- 2020-2021年全国250个县样本的相关政策数据，以确保覆盖超过 美国一半的人口以及种族/民族、社会经济和城市/农村构成的多样性。 策略将从在线来源中提取，并分组为3个域，根据可能对心理的影响而选择 健康和利用：(1)遏制和关闭，(2)经济支持，(3)公共健康。我们会 描述县级政策的地理和时间变化，并自由创建该数据库 可用。在目标2中，我们将考察哪些县级新冠肺炎相关政策做出了贡献或改善 精神健康和健康行为方面与流行病有关的差异，将目标1的政策数据库与 国家健康调查，提供个人层面的自我报告的心理困扰，吸烟， 酗酒和非法吸毒。在目标3中，我们将估计县级新冠肺炎相关协会 在针对精神健康问题的医疗保健利用方面存在差异的政策，将政策数据库从 目标1，国家数据集，提供关于医疗保健利用的个人数据。AIMS 2和3漏洞 县级政策的时间和地理变化，并使用准实验方法估计 政策效应。与SBECCC的其他调查人员密切合作进行，这一预期结果 研究是创建一个县级政策数据库，作为研究人员的宝贵资源 以及致力于了解当地政策如何促进并继续影响大流行的利益相关者- 与之相关的健康差距，以及关于政策对精神健康结果影响的具体证据。这将是 指导政策和干预措施，以减轻心理健康负担，特别是弱势社区的心理健康负担。

ABSTRACT The COVID-19 pandemic and related mitigating measures have brought on tremendous financial hardship for vulnerable Americans, with nearly 15% unemployment at its peak and millions falling into poverty. There have been striking racial and socioeconomic disparities in these hardships, particularly for Black and Latinx families, which build on longstanding inequities in income, housing, and other social determinants of health. Recent research has demonstrated the impact of the pandemic and its resulting socioeconomic inequities on disparities in mental health and healthcare utilization. It is increasingly recognized that policies play a role in mitigating or exacerbating these disparities. For example, mandated closures lead to job and income loss, which disproportionately affect low-income and minority women. Conversely, economic support policies ensure that vulnerable families have the resources to stay healthy at home. While some studies have examined the effects of state-level COVID-19-related policies, there has been little systematic documentation of county-level policies and their effects on disadvantaged groups. The goal of this study is to leverage, expand upon, and link existing national data sets to test the hypothesis that county-level public health and social policies have affected disparities in mental health and healthcare utilization. In Aim 1, we will gather county-level COVID-19- related policy data for 2020-2021 for a nationwide sample of 250 counties, selected to ensure coverage of over half of the U.S. population as well as diversity in racial/ethnic, socioeconomic, and urban/rural composition. Policies will be drawn from online sources and grouped into 3 domains chosen due to likely impacts on mental health and utilization: (1) containment and closure, (2) economic support, and (3) public health. We will characterize geographic and temporal variation in county-level policies and make this database freely available. In Aim 2, we will examine which county-level COVID-19-related policies contributed to or ameliorated pandemic-related disparities in mental health and health behaviors, linking the policy database from Aim 1 with national health surveys that provide individual-level data on self-reported psychological distress, smoking, alcohol use, and illicit drug use. In Aim 3, we will estimate the association of county-level COVID-19-related policies with disparities in healthcare utilization for mental health problems, linking the policy database from Aim 1 with national data sets that provide individual-level data on healthcare utilization. Aims 2 and 3 exploit temporal and geographic variation in county-level policies and employ quasi-experimental methods to estimate policy effects. Conducted in close collaboration with other SBECCC investigators, the expected outcome of this research is the creation of a county-level policy database that will serve as a valuable resource for researchers and stakeholders working to understand how local policies contributed to and continue to influence pandemic- related health disparities, as well as specific evidence on policy effects on mental health outcomes. This will guide policies and interventions to reduce mental health burden especially for vulnerable communities.