Causes of Geographic Divergence in American Mortality Between 1990 and 2015: Health Behaviors, Health Care Access and Migration

1990 年至 2015 年间美国死亡率地理差异的原因：健康行为、医疗保健获取和移民

基本信息

批准号：
10442979
负责人：
IRMA T. ELO
金额：
$ 17.21万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2023-03-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY/ABSTRACT Coronavirus disease-2019 (COVID-19) is an international public health emergency caused by the respiratory droplet transmission of the coronavirus-2 (SARS CoV-2) virus. The United States has emerged as an epicenter of the pandemic, with distinctive regional patterning. To date, COVID- 19 mortality has largely been monitored using death certificates that contain reference to COVID- 19. However, prior analyses of excess mortality reveal that between 12% to 25% of excess deaths in 2020 were not directly assigned to COVID-19. The percent of deaths not assigned to COVID- 19 is also known to vary significantly by state and by county-level sociodemographic factors. However, it remains unknown to what extent excess mortality and excess mortality not assigned to COVID-19 differs by region and across the urban-rural continuum. The proposed Supplement will build upon and expand on current work on geographic inequalities in mortality by integrating a focus on COVID-19. Our preliminary work on excess mortality associated with COVID-19 has shown that mortality from COVID-19 and excess mortality not assigned to COVID-19 varies substantially across subsets of U.S. counties defined by their sociodemographic and health characteristics and along the urban-rural continuum. This preliminary work has also raised questions about the quality of the coding of causes of death across states and counties. The proposed supplement will enable us to expand our analyses to excess mortality and directly assigned COVID-19 mortality by geography and race/ethnicity. There is considerable evidence that excess mortality and COVID-19 mortality varies by race/ethnicity but little is known how the impact of the pandemic on the various U.S. racial/ethnic subgroups varies by geography. We will also investigate the potential impact of cause of death coding differentials on estimates of geographic inequalities in excess mortality and mortality directly assigned to COVID-19. Concerns about the quality of cause-of-death coding were also raised by the new report of the National Academy of Sciences, Engineering and Medicine, High and Rising Mortality Rates among Working-age Adults.

项目摘要/摘要冠状病毒疾病2019年（Covid-19）是由国际公共卫生紧急事件。冠状病毒-2（SARS COV-2）病毒的呼吸液滴传递。美国有成为大流行的震中，具有独特的区域模式。迄今为止，covid- 19死亡率很大程度上是使用死亡证明的，其中包含参考的参考 19.但是，先前对过剩死亡率的分析表明，超额死亡的12％至25％在2020年，未直接分配到Covid-19。未分配给共同死亡的百分比众所周知，19也因州和县级的社会人口统计学因素而有很大差异。但是，未知的多大过度死亡率和未分配过多的死亡率在多大程度上仍然未知与地区相互差异，区域以及整个城乡连续体的不同。拟议的补充将通过整合而建立并扩大有关死亡地理不平等现象的当前工作重点是COVID-19。我们关于与Covid-19相关的过剩死亡率的初步工作已有表明COVID-19的死亡率和未分配给Covid-19的过剩死亡率有所不同在社会人口统计学和健康所定义的美国县的基本上很大特征和沿着城市农村连续体。这项初步工作也提高了关于跨州和县死亡原因编码质量的问题。这拟议的补充剂将使我们能够将分析扩展到过多的死亡率，直接通过地理和种族/种族分配了COVID-19的死亡率。有大量证据多余的死亡率和共同死亡率因种族/种族而异，但鲜为人知大流行对美国各种种族/族裔亚组的影响因地理而有所不同。我们将还要研究死亡原因差异原因对估计的潜在影响直接分配给COVID-19的过多死亡和死亡率的地理不平等现象。关注关于死亡原因编码的质量也由国家的新报告提高科学，工程和医学学院，死亡率高和上升成年人。