Jim Crow & health disparities: exploring age-period-cohort effects

吉姆克劳

基本信息

批准号：
8537876
负责人：
NANCY KRIEGER
金额：
$ 27.29万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2015-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8537876
关键词：
Address Adult Affect African American Age Biological Birth Cancer Etiology Categories Cessation of life Civil Rights Cohort Analysis Cohort Effect County Crows Data Databases Death Rate Dependence Development Distal Epidemiology Family Generations Geography Grant Health Healthy People 2010 Healthy People 2020 Income Individual Infant Infant Mortality Knowledge Laws Legal Link Measures Methods Modeling Outcome Outcome Study Pathway interactions Policies Policy Analysis Population Premature Infant Premature Mortality Preparation Publications Records Research Social Environment Sociology Solutions Specific qualifier value Testing Time United States National Institutes of Health Work base cohort health disparity improved infant death innovation insight intergenerational meetings mortality novel population health premature racial discrimination response social social inequality spatiotemporal theories trend

项目摘要

DESCRIPTION (provided by applicant): Our proposed interdisciplinary exploratory study, prepared in response to PAR-10-137, focuses on a significant yet little explored problem: how best, conceptually and methodologically, to integrate use of age-period-cohort (APC) analysis to advance understanding of societal determinants of trends in the magnitude of health inequities. Drawing on social epidemiology and political sociology frameworks and methods, and also new advances in APC models, our innovative theoretically-motivated case example concerns what we term the "Jim Crow geography of mortality," a topic on which scant empirical work exists. The two-fold contributions of our project will be: (1) conceptual, providing new insights and guidance regarding use of APC models to analyze how policy changes can influence population health and health inequities; and (2) substantive, given the paucity of research on the health impact of the abolition of legal racial discrimination by the 1964 US Civil Rights Act. Study outcomes will be all-cause and cancer mortality (total and <65 y (premature)) and infant death (<1 y); the two sets of disparities pertain to comparisons of the US black vs white population, and the US black population in Jim Crow vs non-Jim Crow states, analyzed in relation to spatiotemporal scale (lifecourse, historical generation, spatial effects) and level (state, county, individual). Our Specific Aims accordingly are: (1) Aim 1: Conduct exploratory and graphical APC analysis of a database comprised of 1960-2006 county-level US black and white mortality and denominator data linked to annual county median family income data and newly linked to data on state Jim Crow status (i.e., did vs did not have legalized racial discrimination prior to te 1964 US Civil Rights Act); steps include creating detailed A, P, and C categories, calculating the study outcome annual rates and disparities, and performing APC tabulations and graphical analyses; Aim 2: Explore use of diverse APC modeling approaches to analyze the impact of the abolition of Jim Crow on the specified mortality outcomes: (a) theoretically, in relation to etiologic and statistical assumptions, and (b) empirically, using: (i) a widely-used conventional solution to address the "identification problem" due to linear dependence of A, P, and C, by assuming only 2 of the 3 affect the outcome; (ii) a new - and debated - statistical approach, called the "intrinsic estimator"; and (iii) an approach based on generalized linear mixed models which can be extended to address group disparities and spatial effects; and (3) Aim 3: Disseminate findings and use results to inform preparation of an NIH R01 grant to conduct APC analyses of the impact of policy change on the magnitude of health inequities. The proposed project thus will directly address key objectives of PAR-10-137, and also Healthy People (HP) 2010 and HP 2020, since it will conduct theoretically-motivated empirical tests of APC approaches relevant to understanding the impact of policy, social context, levels, lifecourse, and racial discrimination on the magnitude of health inequities, substantively in relation to Jim Crow and more broadly for other policies as well.

描述（由申请人提供）：我们提议的跨学科探索性研究，响应于PAR-10-137，重点是一个重大而又很少的探索问题：如何最好地，概念和方法上的最佳方式整合使用年龄 - 周期 - 科罗特（APC）分析，以促进对健康量量的社会趋势的理解。借鉴了社会流行病学和政治社会学框架和方法，以及APC模型中的新进步，我们创新的理论动机案例示例涉及我们称其为“吉姆·克劳死亡地理的吉姆·克劳（Jim Crow）死亡地理”的内容，这一主题很少。我们项目的两倍贡献将是：（1）概念上，提供有关使用APC模型来分析政策变化如何影响人群健康和健康不平等的新见解和指导；（2）实质性，鉴于对废除1964年美国民权法案废除法律种族歧视的健康影响的研究很少。研究结果将是全因和癌症死亡率（总计<65 y（早产）和婴儿死亡（<1 y）；两组差异与美国黑人与白人人口的比较以及吉姆·克劳（Jim Crow）与非吉姆乌鸦国家的美国黑人人口有关，与时空量表（生命之旅，历史产生，空间效应）和水平（州，县，县，县，，，县，县，，，县，县，县，，个人）。 Our Specific Aims accordingly are: (1) Aim 1: Conduct exploratory and graphical APC analysis of a database comprised of 1960-2006 county-level US black and white mortality and denominator data linked to annual county median family income data and newly linked to data on state Jim Crow status (i.e., did vs did not have legalized racial discrimination prior to te 1964 US Civil Rights Act);步骤包括创建详细的A，P和C类别，计算研究结果的年度速率和差异，以及进行APC列表和图形分析；目的2：探索使用多种APC建模方法来分析吉姆·克劳（Jim Crow）对特定死亡率结果的影响的影响：（a）理论上，与病因和统计假设相关，以及（b）经验上，（b）使用以下方面，仅通过以下方面解决了以下方面，仅通过以下方面解决了一个常规的解决方案，以解决3个识别问题。（ii）一种新的和辩论的统计方法，称为“内在估计器”；（iii）一种基于广义线性混合模型的方法，该模型可以扩展以解决群体差异和空间效应；（3）目标3：传播发现并使用结果来告知NIH R01赠款，以进行APC分析，以分析政策变化对健康不平等程度的影响。因此，拟议的项目将直接解决PAR-10-137以及健康人员（HP）和HP 2020的关键目标，因为它将对APC方法进行理论上动机的经验测试，以了解与政策，社会背景，水平，生命力性和种族歧视的影响对健康状况的影响有关的政策歧视的影响，从而实质上是在jim和Jim上，以及其他范围的范围。