Explaining Black-White Differences in Avoidable Mortality, 1980-2005

解释 1980 年至 2005 年可避免死亡率方面的黑人与白人差异

• 批准号: 7936103
• 负责人: IRMA T. ELO
• 金额: $ 19.02万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7936103
• 关键词: Address; Area; Behavior; Behavior Therapy; Behavioral; Birth; Caring; Categories; Cause of Death; Censuses; Cessation of life; Characteristics; Complement; Consensus; Country; Data; Data Sources; Death Records; Disease; Education; Future; Goals; Health; Health Resources; Health Services; Health Services Accessibility; Health behavior; Health system; Healthcare; Healthcare Systems; Income; Individual; Investments; Life; Life Expectancy; Light; Link; Literature; Medical; Methods; Monitor; Mortality Decline; National Health Interview Survey; Performance; Play; Policies; Population; Public Health; Public Policy; Race; Role; Socioeconomic Status; Time; Time Factors; United States; Variant; Vital Statistics; base; health disparity; health inequalities; improved; insight; mortality; public health priorities; public health relevance; racial discrimination; social; socioeconomics; trend

DESCRIPTION (provided by applicant): Despite unprecedented mortality declines during the 20th century, black-white disparities in all cause and cause-specific mortality continue to be substantial in the United States. Explanations offered for these disparities include black-white differences in income, education and wealth, racial discrimination, and disparities in access to health care, including differential treatment in the health care system. Despite the vast literature on black-white differences in health and mortality there is little consensus regarding how best to reduce them. This project proposes new ways to analyze black-white mortality disparities in the U.S. between 1980 and 2005 by investigating the contribution of causes of death considered avoidable by (1) high-quality and timely medical care and (2) policy/behavior interventions. Although the study of avoidable mortality (AM) originated in the U.S., it has been applied mainly in other countries as an indicator of health system performance and thus its role in explaining B-W mortality disparities in the U.S. is not known. We will estimate the contribution of various categories of AM and non-AM to black-white differences in life expectancy at birth and to changes therein between 1980 and 2005; investigate the effect of state-level policies, health system and socioeconomic characteristics on state-level variation and black-white differences in various categories of AM and non-AM between 1980 and 2005; and examine effects of individual-level socio-demographic characteristics and health behaviors on black-white differences in various categories of AM and non-AM from 1986 to 2002. The strengths of the study include the use of multiple data sources (vital statistics and census data; state- level policies, health resources, and socio-demographic characteristics; and National Health Interview Survey- Multiple Cause of Death data) and methods (demographic, econometric). The analyses will complement prior individual- and disease-oriented studies of black-white disparities in the leading causes of death by estimating the impact of causes grouped by the main means of reducing them (e.g. medical care, public policy, behavior). PUBLIC HEALTH RELEVANCE: The elimination of race/ethnic health disparities is one of the public health priorities in the United States. The proposed project contributes to this goal by improving our understanding of black-white disparities in mortality due to causes of death that are avoidable by good quality medical care and amenable by policy /behavior interventions. The results will aid in monitoring health inequalities and help guide public investments to areas of greatest need.

描述（由申请人提供）：尽管 20 世纪死亡率出现了前所未有的下降，但美国黑人与白人在全因死亡率和特定原因死亡率方面的差异仍然很大。对这些差异的解释包括黑人与白人在收入、教育和财富方面的差异、种族歧视以及获得医疗保健方面的差异，包括医疗保健系统中的差别待遇。尽管有大量关于黑人与白人在健康和死亡率方面的差异的文献，但对于如何最好地减少这些差异几乎没有达成共识。该项目提出了分析 1980 年至 2005 年间美国黑人和白人死亡率差异的新方法，通过调查被认为可以通过 (1) 高质量和及时的医疗护理和 (2) 政策/行为干预措施避免的死亡原因的贡献。尽管可避免死亡率（AM）的研究起源于美国，但它主要在其他国家作为卫生系统绩效的指标而应用，因此它在解释美国男女死亡率差异方面的作用尚不清楚。我们将估计 1980 年至 2005 年间各种类型的 AM 和非 AM 对出生时预期寿命的黑人和白人差异及其变化的贡献；调查 1980 年至 2005 年间州级政策、卫生系统和社会经济特征对州级变异以及各类 AM 和非 AM 的黑人与白人差异的影响；并检验 1986 年至 2002 年间个人层面的社会人口特征和健康行为对各类 AM 和非 AM 的黑人与白人差异的影响。该研究的优势包括使用多种数据源（生命统计和人口普查数据；州级政策、卫生资源和社会人口特征；以及国家健康访谈调查 - 多种死因数据）和方法（人口学、计量经济学）。这些分析将通过估计按减少死亡原因的主要手段（例如医疗、公共政策、行为）分组的原因的影响，补充之前针对黑人和白人在主要死因方面的差异进行的以个人和疾病为导向的研究。公共卫生相关性：消除种族/民族健康差异是美国公共卫生的优先事项之一。拟议的项目通过提高我们对黑人和白人死亡率差异的理解来促进这一目标，这些差异可以通过高质量的医疗保健来避免，并且可以通过政策/行为干预来解决。结果将有助于监测健康不平等，并帮助引导公共投资流向最需要的领域。