The Impacts of County-Level COVID-19-Related Public Health and Social Policies on Racial/Ethnic and Socioeconomic Disparities in Mental Health and Healthcare Utilization

县级 COVID-19 相关公共卫生和社会政策对心理健康和医疗保健利用方面种族/民族和社会经济差异的影响

• 批准号: 10490467
• 负责人: Rita Hamad
• 金额: $ 69.4万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-17 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10490467
• 关键词: Accounting; Acute; Address; Adult; Adverse effects; Affect; Alcohol consumption; American; Anxiety; Behavioral Risk Factor Surveillance System; Black race; Businesses; COVID-19; COVID-19 pandemic; Catalogs; Collaborations; Contact Tracing; Containment; County; County Government; Data; Data Set; Databases; Disadvantaged; Documentation; Drug usage; Economic Policy; Economics; Ensure; Expenditure; Experimental Models; Family; Financial Hardship; Geography; Goals; Health; Health Policy; Health Services Accessibility; Health Surveys; Health behavior; Home; Household; Housing; Income; Individual; Intervention; Job loss; Latinx; Lead; Leadership; Link; Low income; Measures; Medicaid; Medical; Mental Depression; Mental Health; Mental Health Services; Minority Women; National Health Interview Survey; Occupations; Outcome; Outcomes Research; Patient Self-Report; Persons; Play; Policies; Policy Making; Population; Poverty; Primary Health Care; Public Health; Quasi-experiment; Race; Reporting; Research; Research Personnel; Resources; Role; Rural; Sampling; Services; Smoking; Social Policies; Socioeconomic Status; Source; Stress; Subgroup; Surveys; Testing; Unemployment; Vaccination; Variant; Vulnerable Populations; Work; behavioral health; coronavirus disease; ethnic minority; experience; falls; geographic difference; health care disparity; health care service utilization; health disparity; high risk population; illicit drug use; medical specialties; pandemic disease; people of color; psychological distress; public health intervention; racial and ethnic; racial and ethnic disparities; racial disparity; social determinants; social health determinants; socioeconomic disparity; socioeconomics; trend; urban residence; vulnerable community

ABSTRACT The COVID-19 pandemic and related mitigating measures have brought on tremendous financial hardship for vulnerable Americans, with nearly 15% unemployment at its peak and millions falling into poverty. There have been striking racial and socioeconomic disparities in these hardships, particularly for Black and Latinx families, which build on longstanding inequities in income, housing, and other social determinants of health. Recent research has demonstrated the impact of the pandemic and its resulting socioeconomic inequities on disparities in mental health and healthcare utilization. It is increasingly recognized that policies play a role in mitigating or exacerbating these disparities. For example, mandated closures lead to job and income loss, which disproportionately affect low-income and minority women. Conversely, economic support policies ensure that vulnerable families have the resources to stay healthy at home. While some studies have examined the effects of state-level COVID-19-related policies, there has been little systematic documentation of county-level policies and their effects on disadvantaged groups. The goal of this study is to leverage, expand upon, and link existing national data sets to test the hypothesis that county-level public health and social policies have affected disparities in mental health and healthcare utilization. In Aim 1, we will gather county-level COVID-19- related policy data for 2020-2021 for a nationwide sample of 250 counties, selected to ensure coverage of over half of the U.S. population as well as diversity in racial/ethnic, socioeconomic, and urban/rural composition. Policies will be drawn from online sources and grouped into 3 domains chosen due to likely impacts on mental health and utilization: (1) containment and closure, (2) economic support, and (3) public health. We will characterize geographic and temporal variation in county-level policies and make this database freely available. In Aim 2, we will examine which county-level COVID-19-related policies contributed to or ameliorated pandemic-related disparities in mental health and health behaviors, linking the policy database from Aim 1 with national health surveys that provide individual-level data on self-reported psychological distress, smoking, alcohol use, and illicit drug use. In Aim 3, we will estimate the association of county-level COVID-19-related policies with disparities in healthcare utilization for mental health problems, linking the policy database from Aim 1 with national data sets that provide individual-level data on healthcare utilization. Aims 2 and 3 exploit temporal and geographic variation in county-level policies and employ quasi-experimental methods to estimate policy effects. Conducted in close collaboration with other SBECCC investigators, the expected outcome of this research is the creation of a county-level policy database that will serve as a valuable resource for researchers and stakeholders working to understand how local policies contributed to and continue to influence pandemic- related health disparities, as well as specific evidence on policy effects on mental health outcomes. This will guide policies and interventions to reduce mental health burden especially for vulnerable communities.

抽象的 COVID-19 大流行和相关缓解措施带来了巨大的财务困难 对于弱势美国人来说，失业率最高时接近 15%，数百万人陷入贫困。那里 在这些困难中，种族和社会经济差异非常显着，尤其是黑人和拉丁裔 家庭，其建立在收入、住房和其他健康社会决定因素方面长期不平等的基础上。 最近的研究表明，这一流行病及其造成的社会经济不平等对人们的影响 心理健康和医疗保健利用方面的差异。人们越来越认识到政策在 减轻或加剧这些差距。例如，强制关闭会导致工作和收入损失， 这对低收入和少数民族妇女影响尤为严重。相反，经济支持政策确保 弱势家庭有资源在家中保持健康。虽然一些研究已经检验了 尽管州级 COVID-19 相关政策的影响，但县级的系统记录很少 政策及其对弱势群体的影响。本研究的目标是利用、扩展和链接 现有的国家数据集来检验县级公共卫生和社会政策的假设 影响心理健康和医疗保健利用方面的差异。在目标 1 中，我们将收集县级 COVID-19- 全国样本250个县2020-2021年相关政策数据，确保覆盖超过 一半的美国人口以及种族/族裔、社会经济和城乡构成的多样性。 政策将取自在线资源，并根据可能对心理的影响而分为 3 个领域。 健康和利用：(1) 遏制和封闭，(2) 经济支持，(3) 公共卫生。我们将 描述县级政策的地理和时间变化，并自由建立该数据库 可用的。在目标 2 中，我们将研究哪些县级 COVID-19 相关政策促进或改善了 与大流行相关的心理健康和健康行为差异，将目标 1 的政策数据库与 全国健康调查提供有关自我报告的心理困扰、吸烟、 饮酒和使用非法药物。在目标 3 中，我们将估计县级 COVID-19 相关的关联性 在心理健康问题的医疗保健利用方面存在差异的政策，将政策数据库与 目标 1：利用国家数据集提供有关医疗保健利用的个人层面数据。目标 2 和 3 的利用 县级政策的时间和地理变化，并采用准实验方法进行估计 政策影响。与其他 SBECCC 调查人员密切合作进行，本次调查的预期结果 研究是创建一个县级政策数据库，该数据库将作为研究人员的宝贵资源 利益相关者致力于了解当地政策如何促成并继续影响大流行 - 相关的健康差异，以及政策对心理健康结果影响的具体证据。这将 指导政策和干预措施，以减轻特别是弱势群体的心理健康负担。