EXPLORING TRENDS IN US HEALTH INEQUITIES IN CONTEXT: NHES TO NHANES, 1959-2006

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DESCRIPTION (provided by applicant): OUR PROPOSED EXPLORATORY STUDY, PREPARED IN RESPONSE TO PA-10-069, FOCUSES ON A SIGNIFICANT PROBLEM: INADEQUATE DATA ON LONG-TERM TRENDS IN US SOCIOECONOMIC AND RACIAL/ETHNIC INEQUITIES IN MEASURED HEALTH STATUS. WE THEREFORE SEEK TO DETERMINE THE FEASIBILITY OF CREATING AND ANALYZING A NOVEL MULTILEVEL US NATIONAL DATABASE THAT COMBINES: (A) INDIVIDUAL-LEVEL HEALTH DATA, (B) NOVEL MEASURES OF SOCIOECONOMIC POSITION (SEP) THAT CAN BE MEANINGFULLY COMPARED OVER TIME, AND (C) NOVEL CONTEXTUAL DATA ON "JIM CROW" LAWS (I.E., LAWS THAT PERMITTED RACIAL DISCRIMINATION ABOLISHED BY THE 1964 US CIVIL RIGHTS ACT). THESE DATA ARE KEY FOR ADDRESSING a new debate WITH CRITICAL PUBLIC HEALTH AND POLICY IMPLICATIONS: as overall population health improves, do the absolute and relative magnitudes of socioeconomic disparities increase, stay the same, or decrease? - and, in the US, do these patterns vary by race/ethnicity and gender? WERE RESULTS TO SHOW ALL 3 PATTERNS ARE POSSIBLE, THEY WOULD REFUTE HYPOTHESES, BASED ON POST-1980 DATA, THAT INEQUITIES NECESSARILY WIDEN. [TEXT DELETED] Our specific aims thus are: (a) Aim 1: Create a US national health outcomes database spanning 1959- 2006 using data from the US National Health Examination Survey (NHES; Cycle I: 1959-1962; Cycle II: 1963- 1965; Cycle III: 1966-1970) and the subsequent US National Health and Nutrition Examination Surveys (NHANES I: 1971-1975; NHANES II: 1976-1980; NHANES III: 1988-1994; and NHANES 1999-2000; 2001- 2002; 2003-2004; 2005-2006), AND VIA THE NATIONAL CENTER FOR HEALTH STATISTICS (NCHS) RESEARCH DATA CENTER (RDC), LINK THESE DATA TO: (1) DETAILED INDIVIDUAL-LEVEL INCOME AND EDUCATION DATA, AND (2) DATA ON STATE'S PRE-1964 JIM CROW STATUS; (b) Aim 2: Explore developing socioeconomic measures that can meaningfully be compared over time; (c) Aim 3: Explore quantifying temporal patterns in the magnitude of socioeconomic inequities in health, using the measures developed for Aim 2, to test the hypothesis that socioeconomic inequities in health decreased between 1960 and 1980 (especially among black Americans) and then stagnated or widened thereafter; (d) Aim 4: [TEXT DELETED] Test the hypothesis that the sharpest reductions in pre-1980 and the largest rises in post-1980: (a) socio-economic inequities in health (especially among black Americans), and (b) black/white inequities (especially in lower income strata), occurred among residents of Jim Crow states; and (e) Aim 5: Disseminate results by publishing scientific manuscripts and use the results to inform preparation of an R01 to conduct the first multilevel contextual analysis of long-term temporal patterns (1959-present) in the magnitude of US HEALTH INEQUITIES. ADDRESSING THESE AIMS HAS THE POTENTIAL TO CHANGE SIGNIFICANTLY CONCEPTS, METHODS, AND PREVENTIVE INTERVENTIONS REGARDING US SOCIOECONOMIC AND RACIAL/ETHNIC DISPARITIES IN HEALTH, WHOSE ELIMINATION IS a key objective of Healthy People 2010. PUBLIC HEALTH RELEVANCE: Our objective is to explore novel multilevel approaches to developing the methods and database that would enable addressing a new debate about whether, as overall population health improves, the absolute and relative magnitude of socioeconomic disparities increase, stay the same, or decrease? In accord with the purpose of an exploratory grant (R21), the intent is to set the basis for a subsequent application (R01) that would permit generating the full-fledged database suitable for rigorously testing, with appropriate methods, the hypotheses of interest. Knowledge produced by the proposed study HAS THE POTENTIAL TO CHANGE SIGNIFICANTLY CONCEPTS, METHODS, AND PREVENTIVE INTERVENTIONS REGARDING US SOCIOECONOMIC AND RACIAL/ETHNIC DISPARITIES IN HEALTH, WHOSE ELIMINATION IS A KEY OBJECTIVE OF Healthy People 2010.