Community and Individual Predictors of Health Inequality

大量研究表明，美国黑人和白人之间存在着健康差距，这种差距随着时间的推移持续存在，几乎渗透到所有健康领域。除了少数例外，收入、教育水平和保险状况的差异已经缩小，但没有考虑到黑人和白人老年人之间的整个健康差距。这些个人水平的测量未能解释种族健康差距的一个可能原因是，许多健康结果受到一个人的环境的影响。然而，到目前为止，研究主要只考虑个人的特征，如个人的经济资源，而实际上忽略了“地点”对种族健康差距的相对影响。这项拟议的研究的目的是系统地检查个人和社区对65岁及以上黑人和白人成年人健康差距的影响。这项研究将检验与北卡罗来纳州老年人流行病学研究(EPESE)的既定人口有关的社区层面的衡量标准(在人口普查区域层面衡量)，该研究是来自北卡罗来纳州五个县的4162名黑人和白人老年人的多阶段样本，并使用多水平模型来估计个人和社区层面的特征对黑人和白人老年人随后身体功能的相对影响。这个拟议的项目是第一个将更广泛的背景纳入个人健康结果研究的项目之一，目的是检查黑人和白人老年人之间的种族健康差距。本研究有三个具体目的：1.测试社区背景、组成和稳定性对黑人和白人老年人健康的地理差异的影响。2.衡量个人和社区特征对老年人种族健康差距的相对影响，特别是对ADL和IADL残疾的影响。3.确定对社区影响的脆弱性是否因种族或社会经济地位而异。

A wealth of research has demonstrated that there are health disparities between Black and White Americans that are enduring over time and pervasive into almost all health domains. With few exceptions, differences in income, education level, and insurance status has narrowed, but not accounted for the entire health gap between Black and White older adults. One possible reason why these individual-level measurements have failed to explain the racial health gap is that many health outcomes are influenced by one's environment. However, to date, research has primarily considered only individual characteristics such as personal economic resources and has virtually ignored the relative impact of "place" on the racial health disparity. The intent of this proposed study is to systematically examine both individual and community influences on the health disparity between Black and White adults ages 65 and older. This research will examine community-level measures (measured at the Census tract level) that have been linked with the North Carolina Established Populations for the Epidemiologic Study of the Elderly (EPESE), which is a multi-stage sample of 4,162 Black and White older adults from five counties in North Carolina, and employ multi-level models to estimate the relative influence of individual- and community-level characteristics on the subsequent physical functioning of Black and White older adults. This proposed project is one of the first to integrate broader context into the study of individual health outcomes for the purposes of examining the racial health disparity between Black and White older adults. There are three specific aims of this study: 1. Test the impact of community context, composition, and stability on geographic variations in the health of Black and White older adults. 2. Measure the relative influence of individual and community characteristics on the racial health disparity among older adults, specifically on ADL and IADL disability. 3. Determine whether vulnerability to community influences varies by race or socioeconomic status.