Determinants of geographic disparities in mortality and multimorbidity in the U.S.

美国死亡率和多重发病率地理差异的决定因素

• 批准号: 10410496
• 负责人: IGOR AKUSHEVICH
• 金额: $ 34.96万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10410496
• 关键词: Address; Adherence; Affect; Air; Behavioral; Caring; Characteristics; Clinic; Clinical; Communities; County; Data; Data Set; Deceleration; Developed Countries; Development; Diabetes Mellitus; Diagnostic; Diagnostic Procedure; Disease; Early Diagnosis; Education; Environmental Risk Factor; Evaluation; Exhibits; Family; Female; Geography; Goals; Health; Health Expenditures; Health Services Accessibility; Health and Retirement Study; Health system; Healthcare; Healthcare Systems; Incidence; Income; Individual; Knowledge; Life Expectancy; Link; Longevity; Mammography; Measures; Medical; Medicare; Mission; Modernization; Morbidity - disease rate; Nature; Neighborhoods; Outcome; Patients; Pattern; Performance; Persons; Pharmacologic Substance; Platinum; Play; Policies; Population Group; Positron-Emission Tomography; Prevalence; Prevention strategy; Public Health; Quality of Care; Records; Research; Research Design; Resource Allocation; Resources; Risk; Role; Screening procedure; Socioeconomic Factors; System; Testing; Thromboplastin; Time; United States National Institutes of Health; Variant; Work; aged; burden of illness; chemotherapy; comorbidity; compliance behavior; design; disorder prevention; disparities in morbidity; geographic difference; geographic disparity; health difference; health disparity; improved; male; mortality; mortality disparity; multiple chronic conditions; novel strategies; population health; screening; socioeconomics; time use; treatment adherence; treatment choice; trend

Statement of Work There is a fundamental gap in understanding the nature of interregional differences in health outcomes and longevity in the U.S.: people in certain U.S. states and counties live up to 3.5 years (males) and 4.6 years (females) less than in states with better health outcomes. The persistence, and even widening, of this gap over time represents an important problem for the U.S. health system. These geographic disparities are associated with increased burden of disease, increased health expenditures in the health-care system, and showcase an observed lag in health and longevity compared to other industrialized nations. The objective of this application is to identify the mechanisms underlying the observed geographic disparities and clarify the role clinic- and non-clinic-related factors play in them. We expect that these geographic differences can be observed in individual Medicare trajectories and that the size and scope of the 5% Medicare dataset supplemented by Medicare records linked to the Health and Retirement Study will allow us to discover the causes of such disparities. In this project, we will test four scenarios on how these disparities could be reflected in health measures extracted from Medicare data: the regions with lower life expectancy exhibit higher disease incidence (scenario #1), worse patient survival (scenario #2), higher multimorbidity (scenario #3), and/or worse health state of individuals aged 65 (i.e., at time of entry into the Medicare system) (scenario #4). In Aim 1 we will test in what extent each scenario (or their combinations) can explain observed geographic disparities in mortality. We will identify specific diseases that contribute most to health disparities through each of the scenarios to be studied. In Aim 2, we will identify how clinic-related characteristics such as use of specific treatments, treatment choice and adherence to treatment, utilization of screening and diagnostic procedures (especially for early-stage diagnostics) impact the health outcomes and contribute to geographic disparities. Finally, in Aim 3 we will identify how non-clinic-related factors such as socioeconomic, behavioral, environmental characteristics, and access to and quality of care measures (constructed from 5%-Medicare data) impact the clinical measures identified in Aim 2 as determinants of geographic disparities. The results will provide new knowledge about clinic- and non-clinic-related barriers to improvement of health and increase of life expectancy in underperforming U.S. regions, identify the most affected population groups, and explain the role of the clinic and non-clinic-related factors in morbidity and mortality trends. The results of the proposed study will make possible the next step in approaching our long-term goal: to improve strategies of disease prevention, optimize allocations of medical resources with the focus on underprivileged communities and to improve health care standards to slow down or stop the growing gap in health disparities in the U.S.

工作说明书 对健康结果和区域间差异的本质的理解存在着根本性的差距。 美国的长寿：美国某些州和县的人们的寿命分别为 3.5 岁（男性）和 4.6 岁 （女性）低于健康状况较好的州。这种差距持续存在，甚至不断扩大 时间是美国卫生系统的一个重要问题。这些地理差异是相关的 随着疾病负担的增加，卫生保健系统的卫生支出增加，并展示了 与其他工业化国家相比，人们在健康和寿命方面存在滞后。此应用程序的目的 的目的是确定观察到的地理差异背后的机制，并阐明临床和 非临床相关因素在其中发挥作用。我们预计这些地理差异可以在 个人医疗保险轨迹以及补充的 5% 医疗保险数据集的大小和范围 与健康和退休研究相关的医疗保险记录将使我们能够发现这种情况的原因 差异。在这个项目中，我们将测试四种情景，以了解这些差异如何反映在健康方面 从医疗保险数据中提取的衡量标准：预期寿命较低的地区患病率较高 发生率（情况#1）、患者生存率较差（情况#2）、较高的多重发病率（情况#3）和/或更差 65 岁（即进入医疗保险系统时）个人的健康状况（情景#4）。在目标 1 中，我们 将测试每种情景（或其组合）在多大程度上可以解释观察到的地理差异 死亡。我们将通过以下各项来确定对健康差异影响最大的特定疾病： 要研究的场景。在目标 2 中，我们将确定临床相关特征（例如特定药物的使用）如何 治疗、治疗选择和治疗依从性、筛查和诊断程序的利用 （尤其是早期诊断）会影响健康结果并造成地理差异。 最后，在目标 3 中，我们将确定非临床相关因素（例如社会经济、行为、 环境特征、医疗服务的获取和质量衡量指标（由 5%-医疗保险构成） 数据）影响目标 2 中确定的作为地理差异决定因素的临床措施。结果将 提供有关临床和非临床相关障碍的新知识，以改善健康并增加 表现不佳的美国地区的预期寿命，确定受影响最严重的人口群体，并解释 临床和非临床相关因素在发病率和死亡率趋势中的作用。拟议的结果 研究将使我们的下一步目标成为可能：改善疾病策略 预防为主，优化医疗资源配置，重点关注贫困人群 提高医疗保健标准，以减缓或阻止美国健康差距日益扩大的趋势