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 COVID-19疫情及相关缓解措施带来巨大的财政困难 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大，特别是对黑人和拉丁美洲人来说， 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，这一大流行病及其造成的社会经济不平等对 心理健康和医疗保健利用的差异。人们日益认识到，政策在以下方面发挥作用： 缓解或加剧这些差异。例如，强制关闭导致工作和收入损失， 这对低收入和少数民族妇女的影响尤为严重。相反，经济支持政策确保 弱势家庭有资源在家保持健康。虽然一些研究已经检查了 由于国家一级COVID-19相关政策的影响，很少有县级的系统文件 政策及其对弱势群体的影响。本研究的目标是利用、扩展和联系 现有的国家数据集，以检验假设，县级公共卫生和社会政策， 影响心理健康和医疗保健利用的差异。在目标1中，我们将收集县级COVID-19- 2020-2021年全国250个县的相关政策数据，选择这些县是为了确保覆盖超过 美国人口的一半，以及种族/民族，社会经济和城市/农村组成的多样性。 政策将从网上资源中提取，并根据对心理健康的可能影响分为3个领域。 健康和利用：（1）遏制和关闭，（2）经济支持，（3）公共卫生。我们将 描述县级政策的地理和时间变化，并使该数据库自由 available.在目标2中，我们将研究哪些县级COVID-19相关政策有助于或改善 在心理健康和健康行为方面与流行病相关的差异，将目标1的政策数据库与 提供自我报告的心理困扰、吸烟、 酒精和非法药物的使用。在目标3中，我们将估计县级COVID-19相关 在精神健康问题的医疗保健利用方面存在差异的政策， 目标1：国家数据集，提供关于医疗保健利用的个人层面数据。目标2和3利用 县一级政策时间和地理变化，并采用准实验方法估计 政策效应。在与SBECCC其他调查人员密切合作下进行， 研究是建立一个县级政策数据库，作为研究人员的宝贵资源 和利益相关者，努力了解当地政策如何促成并继续影响大流行- 相关的健康差距，以及政策对心理健康结果影响的具体证据。这将 指导政策和干预措施，以减轻心理健康负担，特别是对弱势群体。

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.