A US-UK Comparison of Discrimination & Disparities in Health & Health Service Use

描述（由申请人提供）：在美国和英国，越来越多的证据证明了种族和社会经济地位（SES）的巨大健康差异。该项目汇集了一个由美国和英国研究人员组成的跨学科团队，他们建立了联系和共同目标，以在两国创建可比数据，从而更好地了解健康差异以及如何减少这些差异。我们建议调查的相似性和差异，在社会背景和歧视和劣势产生的种族/民族和SES的功能，身心健康和健康服务的使用在美国和英国的差距。该项目包括三个具体目标：1）使美国和英国团队之间的合作正式化; 2）开发一种社会历史方法来描述社会背景，从而能够比较美国和英国之间在卫生和卫生服务使用方面的差异;并阐明政策在塑造国家内部和国家之间观察到的模式中的作用;以及3）检查国家内部和国家之间在感知歧视流行方面的差异;以及歧视在多大程度上可以解释种族/民族和社会经济地位在功能、抑郁、一般身体健康和卫生服务使用方面的差异。该项目利用了两个现存的研究，在美国和英国的社会经济和种族多样化的人口。采用横断面设计，我们协调这些研究，以构建800名受试者的可比数据（250名黑人和550名白色），涉及：a）四个关键成果（功能、抑郁、一般身体健康和卫生服务使用）; B）歧视、应对、压力环境和相关的心理社会变量;（c）社会背景，采用社会历史方法，进行有意义的跨国比较;（d）社会经济地位个体。这些数据将为更详细地了解美国和英国系统性差异和相似社会结构背景下种族/民族和社会经济地位歧视对健康差异的影响提供新颖的多学科基础。此外，这项比较研究有可能提供一个正在进行的跨国检查的基础上的健康差距，因为这些中年样本年龄随着时间的推移。该项目的重点是种族/民族，社会经济地位和社会背景的歧视，在美国和英国的健康和医疗服务使用的差距的贡献。虽然这些差异在这两个国家都是一个重大的公共卫生问题，但尚未彻底审查歧视和社会背景在推动每个国家内部和国家之间的这些差异方面所起的作用。公共卫生相关性：该项目的重点是种族/民族和社会经济地位和社会背景的歧视在美国和英国的健康和卫生服务使用的差异的贡献。虽然这些差异在这两个国家都是一个重大的公共卫生问题，但还没有对歧视和社会背景在推动每个国家内部的这些差异方面所起的作用进行彻底的审查;此外，以前也没有进行过这种性质的跨国比较。本项目中提出的跨国比较将阐明美国和英国在种族/族裔和社会经济地位方面的歧视和社会背景对功能、身心健康和卫生服务使用方面的差异的贡献的相似性和差异性。

DESCRIPTION (provided by applicant): A growing body of evidence in the US and UK documents large health disparities by race and socioeconomic status (SES). This project brings together an interdisciplinary team of US and UK investigators with established ties and common objectives to create comparable data in both countries that will permit a better understanding of health disparities and how they might be reduced. We propose to investigate the similarities and differences in social context and discrimination and disadvantage in generating disparities by race/ethnicity and SES in functioning, physical and mental health, and health service use in the US and UK. This project comprises three specific aims: 1) to formalize a collaboration between the US and UK teams; 2) to develop a socio-historical approach to characterizing social context that will enable comparisons of disparities in health and health service use between the US and UK; and illuminate the role of policy in shaping observed patterns within and between countries; and 3) to examine within- and between-country differences in the prevalence of perceived discrimination; and the extent to which discrimination may account for disparities by race/ethnicity and SES in functioning, depression, general physical health, and health service use. This project capitalizes on two extant studies of socioeconomically and racially diverse populations in the US and UK. Using a cross sectional design, we harmonize these studies to construct comparable data on 800 subjects (250 black and 550 white) at each site regarding: a) four key outcomes (functioning, depression, general physical health, and health service use); b) discrimination, coping, stressful circumstances, and related psychosocial variables; c) social context, characterized using a socio-historical approach that will render meaningful cross-country comparisons; and d) individual SES. These data will provide a novel, multi-disciplinary basis for a more detailed understanding the impact of discrimination on health disparities by race/ethnicity and SES in the context of systematic differences and similar social structures in US and UK. In addition, this comparative study has the potential to provide the basis for an ongoing cross-national examination of health disparities as these mid-adult samples age over time. This project focuses on the contribution of discrimination by race/ethnicity, SES, and social context to disparities in health and health service use in the US and the UK. Although these disparities constitute a major public health concern in both countries, there has not yet been a thorough examination of the role discrimination and social context play in driving these disparities both within and between each country. PUBLIC HEALTH RELEVANCE: This project focuses on the contribution of discrimination by race/ethnicity and socioeconomic status and social context to disparities in health and health service use in the United States and the United Kingdom. Although these disparities constitute a major public health concern in both countries, there has not yet been a thorough examination of the role discrimination and social context play in driving these disparities within each country; moreover, a cross-national comparison of this nature has not been undertaken previously. The cross- national comparison proposed in this project will elucidate the similarities and differences in the contributions of discrimination and social context to disparities by race/ethnicity and SES in functioning, physical and mental health, and health service use in the United States and the United Kingdom.