Comparative Assessment of Modifying Social Determinants of Health to Reduce Firearm-Related Mortality and Disparities

项目摘要/摘要 枪支暴力是一种不断升级的国家危机，它影响着人口健康的总体水平，包括 平均预期寿命。至关重要的是，为了有效解决这场危机，我们必须确定其 根本的社会原因，可能包括健康的社会决定因素(SDoH)，如收入差距和 社会流动，我们通过相应的政策改变这些根本原因。而几个SDoH 已经被证明可以预测持枪杀人和自杀，但关于SDoH是什么仍然是重要的问题 也就是说，根本的社会驱动因素具有最大的影响。尽管越来越多的人呼吁进行比较评估和 采取综合办法解决枪支暴力的根源--社会决定因素-- 我们缺乏与修改SDoH和SDoH相关政策相关的枪支死亡负担的知识， 包括使用支持因果推理的多水平、纵向数据和准实验方法。 此外，我们还没有确定哪些亚群受到SDoH的影响最大。根据这些信息， 有必要准确地估计SDoH的影响，包括按亚群进行估计；并将这些 将估计纳入人口健康指标，可作为确定优先事项的工具。没有解决这些关键问题 需求将阻碍制定政策，以便更有效地减少枪支死亡率负担和不平等。 我们的总体目标是使用准实验方法来提供第一个比较评估 证据基于枪支杀人和自杀流行的社会驱动因素。我们将全面完成我们的 目标通过使用全国340万成年人的数据来实现以下具体目标- 美国社区死亡率差异研究的代表性样本，与SDoH测量相关联 居住地和包含来自国家死亡率数据库的死亡信息的链接：目标1)至 确定哪些SDoH和SDoH相关政策最能预测枪杀和自杀 在成年人身上。为了加强因果推理，我们将实施稳健的准实验和 流行病学方法包括差异差异、倾向评分和变化性。 变化分析；目标2)确定哪些亚群(由种族/民族、社会经济地位和 城市/农村居民)最容易受到SDoH和SDoH相关政策对枪支的影响 杀人和自杀；以及目标3)确定哪些SDoH和SDoH相关政策如果修改 预计将最大限度地减少全国和#年的枪支杀人和自杀负担 亚群。关于结果，我们将确定最有希望的SDoH，对其进行干预以产生收益 成人枪支死亡负担的改善。我们将进一步确定如何通过以下方式区分漏洞 亚群可能解释了差异。通过将估计转化为人口健康指标，我们预计 我们的项目将通过指导政策制定者基于证据的决策来产生很高的翻译影响 更有效地减少美国枪支暴力造成的死亡负担和不平等的政策。

PROJECT SUMMARY/ABSTRACT Gun violence is an escalating national crisis that shapes overall levels of population health including average life expectancy. Crucially, in order to effectively address this crisis, it is imperative that we identify its root social causes, which may include social determinants of health (SDoH) such as income disparities and social mobility, and that we modify these root causes through corresponding policies. While a handful of SDoH have been shown to predict gun homicides and suicides, important questions remain about which SDoH are root social drivers i.e., have the greatest impacts. Despite increasing calls for comparative assessments and comprehensive approaches to unpack and address the root causes—the social determinants—of gun violence, we lack knowledge on the firearm mortality burden associated with modifying SDoH and SDoH-related policies, including by using multilevel, longitudinal data and quasi-experimental methods that favor causal inference. Furthermore, we have yet to establish which subpopulations are most affected by SDoH. Given this information, there are critical needs to accurately estimate SDoH impacts, including by subpopulation; and to translate these estimates into population health metrics that may serve as priority-setting tools. Not addressing these critical needs will hinder the development of policies to more effectively reduce firearm mortality burden and inequities. Our overall objective is to use quasi-experimental approaches to provide the first comparative assessment evidence base on the social drivers of the gun homicide and suicide epidemics. We will accomplish our overall objective by pursuing the following specific aims using data on 3.4 million adults from the nationally- representative sample of the Mortality Disparities in American Communities Study, linked to SDoH measures by area of residence and containing death information from national mortality database linkages: Aim 1) To determine which SDoH and SDoH-related policies most strongly predict firearm homicides and suicides in adults. To strengthen causal inference, we will implement robust quasi-experimental and epidemiologic approaches including difference-in-difference, propensity score, and changes-in- changes analysis; Aim 2) To identify which subpopulations (defined by race/ethnicity, SES, and urban/rural residence) are most vulnerable to influences of SDoH and SDoH-related policies on firearm homicides and suicides; and Aim 3) To ascertain which SDoH and SDoH-related policies if modified are expected to yield the greatest reductions in firearm homicide and suicide burden, both nationally and by subpopulation. Regarding outcomes, we will identify the most promising SDoH on which to intervene to yield improvements in adult firearm mortality burden. We will further establish how differential vulnerabilities by subpopulations may explain disparities. By translating estimates into population health metrics, we expect that our project will have high translational impact through guiding policymakers' evidence-based decisions about policies to more effectively reduce the burden of and inequities in mortality from gun violence in America.