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

描述（申请人提供）：尽管世纪的死亡率出现了前所未有的下降，但在美国，所有原因和特定原因死亡率的黑人和白人差异仍然很大。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;获得保健的机会不平等，包括保健系统的差别待遇。尽管有大量关于黑人和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。该项目提出了新的方法来分析1980年至2005年间美国黑人与白人死亡率的差异，方法是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/行为干预来避免的死亡原因的贡献。虽然可避免死亡率（AM）的研究起源于美国，它主要在其他国家被用作卫生系统绩效的指标，因此它在解释美国B-W死亡率差异方面的作用尚不清楚。我们将估计各类AM和非AM对出生时预期寿命的黑白差异的贡献以及1980年至2005年期间的变化;调查1980年至2005年期间国家级政策，卫生系统和社会经济特征对国家级变化以及AM和非AM各类的黑白差异的影响;并研究了1986年至2002年期间，个人层面的社会人口特征和健康行为对各种AM和非AM人群的黑白差异的影响。该研究的优势包括使用多个数据源（生命统计和人口普查数据;州一级政策，卫生资源和社会人口特征;国家健康访谈调查-多种死因数据）和方法（人口统计学，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（例如医疗保健、公共政策、行为）分组的原因的影响，补充以前对黑人和白人在主要死亡原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/民族健康差距是美国公共卫生优先事项之一。拟议的项目有助于这一目标，通过提高我们的理解，由于死亡原因，是可以避免的高质量的医疗保健和政策/行为干预措施的顺从，在死亡率的黑白差距。研究结果将有助于监测健康不平等现象，并有助于将公共投资引导到最需要的领域。

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.