Area-level Socio-economic Conditions and Individual-level Health and Mortality: Exploring Place-Based Mechanisms and Individual-level Psychosocial Processes

项目总结 自1999年以来，美国已发生100多万例药物过量死亡事件，同时在减少吸毒过量死亡方面取得了进展 自2010年以来，心血管疾病和糖尿病的死亡率一直停滞不前。这是发病率上升的证据 中年死亡率引起了人们对劳动年龄人口健康风险的关注。渐增 过早死亡的地理差异，在成年期早期和中期最为明显，突出了这一作用 当然了。需要系统地确定基于地点的要素如何对美国做出贡献的研究 中年健康和死亡危机。从健康的社会生态观点出发，本研究将 测试一个全面的概念框架，以检查 地点和健康关系。我们将使用两个唯一的数据集来解决以下限制 阻碍了过去的努力。首先，美国中年研究(MIDUS)招募了7108名成年人参加 1995-1996年连续调查的美国人年龄在25岁到74岁之间，2004-2006年和2013-2014年再次调查了他们，并补充道 2004-2006年592名黑人成年人的样本，2016-2017年再次接受调查。第二，犹他州 人口数据库(UPDB)包括来自超过12个州的各种重要和行政记录的数据 100年内有数百万人，由家庭联系在一起，包含地理编码的居住地址。从 UPDB，我们将在2000年创建一个居住在四个县城市地区的160万年龄在25岁到74岁之间的成年人的样本， 他们的死亡率被跟踪到2020年，有记录的死亡人数为142,330人。这两个数据集都支持基于地点 纵向健康研究。 在检查药物滥用、精神健康、心脏代谢健康和死亡率的健康后果时， 我们将：确定地区层面的社会经济状况对个人层面的健康和 死亡率结果(目标1)；并记录基于地点的建筑、社会和自然的预期影响 环境对个人一级的健康和死亡结果的影响(目标2)。我们将关注如何 环境特征对区域一级社会经济条件的中等和中等预期影响，以及 到个人层面的调解过程。我们将使用创新的方法来衡量一系列以地点为基础的 使用严格的统计方法(例如，多层结构方程)改进估计 建模、空间分析和高级生存分析)。通过这次全面调查，我们将 记录基于地点的因素如何推动中年健康和死亡率差异，并提供有价值的见解 人和地方系统中复杂而动态的关系。这项全方位的研究工作 将产生新的证据来支持以地点为基础的有效干预措施的发展。

PROJECT SUMMARY More than 1 million drug overdose deaths have occurred in the US since 1999, while progress in reducing mortality from cardiovascular disease and diabetes has stalled since 2010. This evidence of rising morbidity and mortality in midlife has drawn attention to health risks among the working-age population. Increasing geographic variation in premature mortality, most pronounced during early to mid-adulthood, highlights the role of place. Research is needed that systematically identifies how place-based features contribute to the US midlife health and mortality crisis. Drawing from socio-ecological perspectives of health, the present study will test a comprehensive conceptual framework to examine the direct, indirect, and moderating effects within the place and health relationship. We will use two unique datasets that allow us to address limitations that have stymied past efforts. First, the Midlife in the United States study (MIDUS) enrolled 7,108 adults in the contiguous US aged 25 to 74 in 1995-1996 and surveyed them again in 2004-2006 and in 2013-2014, adding a sample of 592 Black adults in 2004-2006 who were surveyed again in 2016-2017. Second, the Utah Population Database (UPDB) includes data from a variety of state vital and administrative records for over 12 million individuals over 100 years, linked by family and containing geocoded residential addresses. From the UPDB, we will create a sample of 1.6 million adults aged 25 to 74 residing in a four-county urban area in 2000, for whom mortality is tracked until 2020 with 142,330 deaths recorded. Both datasets enable place-based longitudinal health research. In examining the health outcomes of substance misuse, mental health, cardiometabolic health, and mortality, we will: identify the prospective effects of area-level socioeconomic conditions on individual-level health and mortality outcomes (Aim 1); and document the prospective effects of place-based built, social, and natural environments on individual-level health and mortality outcomes (Aim 2). Attention will be given to how environmental features moderate and mediate prospective effects of area-level socioeconomic conditions, and to the individual-level mediating processes. We will use innovative methods to measure a range of place-based features and improve estimation using rigorous statistical methods (e.g., multi-level structural equation modeling, spatial analysis, and advanced survival analysis). Through this comprehensive investigation, we will document how place-based factors drive midlife health and mortality disparities and provide valuable insights into the complex and dynamic relationships within systems of people and places. This holistic research effort will produce novel evidence to support the development of effective place-based interventions.