Understanding US regional health & mortality disparities: A Life Course Approach

了解美国地区健康状况

• 批准号: 8526337
• 负责人: SCOTT M. LYNCH
• 金额: $ 9.45万
• 依托单位: PRINCETON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8526337
• 关键词: Accounting; Address; Adolescence; Adopted; Affect; Age; Behavior; Birth; Categories; Cause of Death; Censuses; Characteristics; Climate; Collection; Data; Data Set; Diabetes Mellitus; Diet; Dimensions; Elderly; Epidemiology; Growth; Health; Health Surveys; Heterogeneity; Individual; Investigation; Learning; Left; Life; Life Cycle Stages; Life Table Method; Literature; Live Birth; Measurement; Measures; Mediating; Mediator of activation protein; Methods; Modeling; Neighborhoods; Outcome; Pathway interactions; Pattern; Physical Function; Physicians; Public Health; Research; Respondent; Retirement; Risk Factors; Role; Sampling; Socialization; Statistical Methods; Stroke; Surveys; Temperature; Time; Vacuum; Variant; base; cohort; density; depressive symptoms; follow-up; health disparity; lens; mortality; regional difference; residence; social

DESCRIPTION (provided by applicant): Regional disparities in health and mortality in the U.S. have been observed repeatedly, but little attempt has been made to explain them. At best, anecdotal explanations are usually offered. For example, poorer health among southerners is often attributed to diet without any empirical support. Extant literature suffers from several additional shortcomings. First, many studies focus on a single health outcome, like stroke mortality, thereby underestimating the full extent of regional variation in health. Second, many studies measure region coarsely. Often, only one region is contrasted against all others. This approach also leads to underestimation of the full range of regional variation in health and hinders our ability to understand the precise mechanisms that account for it, because within-region cultural and structural heterogeneity is extensive. Third, studies of regional disparities have generally failed to take a life course perspective, instead treating them as existing in a temporal vacuum. The proposed research will address these shortcomings, first by adopting a life course perspective. The life course perspective recognizes that neither region of residence, nor health, nor the relationship between them, is static at the individual level across age. Furthermore, regional characteristics and the distribution of health outcomes also vary across sociohistoric time, implying that the relationship between region and health may differ across birth cohorts. The life course perspective therefore provides a more comprehensive and detailed lens through which to begin to explain regional differences in health. Given this perspective, the proposed research will establish the full extent of regional disparities in health using a variety of longitudinal statistical methods applied to at least three nationally-representative, large sample data sets: the General Social Survey, the Health and Retirement Study, and the National Health Epidemiologic Follow-up Surveys. These data will be augmented via the collection of region-year contextual variables like physician density, climate, etc. Collectively, these surveys contain a wide variety of health measures, including self-rated health, physical functioning, depressive symptoms, mortality, and diabetes, as well as refined measures of region (i.e., the nine-category Census measure). Importantly, these three surveys also contain at least one measure of region of residence in early life (birth and adolescence), which, from a life course perspective, is useful in helping differentiate the role of early life socialization into regional culture from the role of structural characteristics of an individual's current region of residence in influencing health. In addition, this early life region measure, as well as the use of longitudinal methods, will enable the investigation of the extent to which health influences regional mobility, an issue (i.e., endogeneity) commonly ignored in research. Basic descriptive methods, typical regression models, multistate life table methods for both panel and cross-sectional data, and hierarchical growth models, including autoregressive latent trajectory models, will be used to flesh out the extent of regional differences in health as well as the mechanisms that account for them.

描述（由申请人提供）：已经反复观察到美国健康和死亡率的区域差异，但几乎没有尝试解释它们。充其量通常提供轶事解释。例如，南方人的健康状况较差，通常归因于饮食，而没有任何经验支持。现有的文献还有其他几个缺点。首先，许多研究集中于单一的健康结果，例如中风死亡率，从而低估了健康状况差异的全部程度。其次，许多研究衡量了区域。通常，只有一个地区与其他所有区域形成鲜明对比。这种方法还导致低估了健康方面的全部差异，并阻碍了我们理解所解释其确切机制的能力，因为区域内文化和结构异质性是广泛的。第三，对区域差异的研究通常未能采用人生的观点，而是将其视为存在于时间真空中。拟议的研究将首先通过采用人生课程的观点来解决这些缺点。生命课程的观点认识到，居住区，健康或它们之间的关系都不是在各个年龄段的个体层面上静止的。此外，在社会历史时期，区域特征和健康成果的分布也有所不同，这意味着地区与健康之间的关系可能会在整个出生人群中有所不同。因此，生命课程的观点提供了更全面和详细的视角，通过这些视角开始解释健康的区域差异。鉴于这一观点，拟议的研究将使用适用于至少三个全国代表性的大型样本数据集的各种纵向统计方法来确定健康方面的全面差异：一般社会调查，健康和退休研究，以及健康和退休研究，以及国家健康流行病学后续调查。这些数据将通过收集区域年度上下文变量（例如医师密度，气候等）来增强。总的来说，这些调查包含各种各样的健康措施，包括自我评估的健康，身体功能，抑郁症状，死亡率和糖尿病，以及区域的精致度量（即九类普查量度）。重要的是，这三项调查还包含至少一种在早期生活（出生和青春期）中的居住区域，从人生的角度来看，这对于帮助区分早期生活社会化对区域文化的作用很​​有用。个人当前居住区域影响健康的结构特征。此外，这一早期生命区域的测量以及纵向方法的使用将使健康影响区域流动性，一个问题（即内生性）在研究中通常被忽略的程度。基本描述性方法，典型的回归模型，面板和横截面数据的多态寿命表方法以及包括自回归潜在潜在轨迹模型在内的等级增长模型，将用于充实健康区域差异的程度以及机制那是他们的。