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

• 批准号: 9754755
• 负责人: IRMA T. ELO
• 金额: $ 33.43万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 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
• 来源: https://reporter.nih.gov/project-details/9754755
• 关键词: AIDS/HIV problem; Accounting; Address; Affect; Age; Alcohol consumption; American; Area; Attention; Automobile Driving; Behavior; Behavioral; Cause of Death; Characteristics; Communities; Country; County; Data; Data Set; Databases; Development; Differential Mortality; Dimensions; Education; Ethnic Origin; Geography; Hazard Models; Health; Health behavior; Healthcare Systems; Heterogeneity; Homicide; Income; Individual; Inequality; Internal Migrations; International; International Migrations; Life Cycle Stages; Life Expectancy; Life Experience; Life Tables; Light; Link; Methodology; Methods; Migrant; National Health Interview Survey; Obesity; Overdose; Pattern; Performance; Pharmaceutical Preparations; Play; Policies; Population; Quality of Care; Race; Risk Factors; Role; Rural; Site; Smoking; Socioeconomic Status; Suicide; Time; United States; Violence; Vital Statistics; attributable mortality; contextual factors; discrete time; experience; falls; geographic difference; health care availability; health care quality; health care service; improved; metropolitan; migration; mortality; mortality disparity; peer; residence; rural area; socioeconomics; suburb; trend

PROJECT SUMMARY/ABSTRACT This project aims to identify factors responsible for levels and trends in geographic inequalities in mortality across the urban-rural continuum and regions of the United States. Urbanicity of one’s place of residence is itself an important stratifying dimension of socioeconomic status (SES) and access to health care services, and it has been largely overlooked in existing studies of SES gradients in life expectancy. Large central metropolitan areas and their suburbs, which experienced remarkable improvements in life expectancy between 1990 and 2015, were the only areas to have experienced life expectancy gains between 2010 and 2015. By contrast, smaller metros and non-metros experienced much slower improvements between 1990 and 2010, and actually experienced life expectancy declines between 2010 and 2015. Specific mechanisms hypothesized to contribute to urban-rural mortality inequalities include: (1) health behaviors and behavioral risk factors, (2) health care access and quality, and (3) domestic and international migration. To identify the contribution of each of these three mechanisms to the magnitudes of and widening in these inequalities between 1990 and 2015, we use three unique, restricted-use datasets (the National Health Interview Survey, the National Longitudinal Mortality Study, and the Mortality Disparities in American Communities database) in conjunction with vital statistics and several area-level datasets covering a wide array of contextual factors. These restricted-use datasets contain detailed information on cause of death, geography, and migration, and they have not been used in prior studies to identify mortality differences or mechanisms driving these differences across the urban-rural continuum. We will employ multiple methodological approaches including standard demographic methods, cause-deleted life tables, indirect estimation methods for quantifying smoking- attributable mortality, and discrete-time hazard models applied to both aggregate and individual-level data. Our rigorous and thorough assessment of the contribution of behavioral risk factors to mortality inequalities across the urban-rural continuum and regions improves on prior studies by focusing on multiple behaviors and causes of death (versus a single behavior or underlying cause), employing multiple methods, and accounting for the life course effects of behaviors like smoking on mortality. Migration’s impacts on mortality inequalities have received little attention to date. However, given the increased volume of migration to the United States, selective migration into different regions and metro/non-metro areas within the county, and the health advantages of migrants, migration is likely to play an important role in widening geographic inequalities in life expectancy. This project is the first study to quantify the impact of both international and domestic migration on mortality differentials within the United States. We will also examine how SES (education and income) inequalities in life expectancy vary across the urban-rural continuum and establish how growing inequality within the United States contributes to our life expectancy shortfall relative to other high-income countries.

项目摘要/摘要 该项目旨在确定负责死亡率地理不平等水平和趋势的因素 在整个城市农村连续体和美国地区。一个人居住地的城市化是 本身是社会经济地位（SES）和获得医疗服务的重要分层维度，以及 在预期寿命中的SES梯度研究中，它在很大程度上被忽略了。大中央 大都市地区及其郊区，在预期寿命之间取得了显着改善 1990年和2015年是2010年至2015年之间唯一经历预期寿命增长的领域。 对比，较小的大都市和非米特罗人在1990年至2010年之间的进步速度较慢， 实际上，预期寿命在2010年至2015年之间下降。 促进城乡死亡率不平等的贡献包括：（1）健康行为和行为风险因素，（2） 医疗保健访问和质量，以及（3）国内和国际移民。确定的贡献 在1990年至 2015年，我们使用三个独特的，有限的使用数据集（国家健康访谈调查，国家 纵向死亡率研究以及美国社区数据库中的死亡率差异） 具有重要的统计数据和几个区域级别的数据集，涵盖了各种各样的上下文因素。这些 限制使用数据集包含有关死亡，地理和迁移原因的详细信息，它们 尚未在先前的研究中使用以确定驱动这些差异的死亡率差异或机制 跨越城市农村连续体。我们将采用多种方法论方法，包括标准 人口统计学方法，删除寿命表，量化吸烟的间接估计方法 - 可归因的死亡率以及应用于骨料和个体级别数据的离散时间危害模型。我们的 严格而彻底评估行为风险因素对死亡率不平等的贡献 城市农村连续体和地区通过关注多种行为和原因来改善先前的研究 死亡（与单一行为或根本原因相比），采用多种方法，并考虑 行为的生活课程诸如吸烟对死亡率的影响。移民对死亡率不平等的影响有 到目前为止很少关注。但是，鉴于向美国移民的数量增加， 选择性迁移到县内的不同地区和地铁/非米特罗地区，卫生 移民的优势，移民可能在扩大生活中的地理位置中发挥重要作用 期待。该项目是量化国际和国内移民对 美国境内的死亡率差异。我们还将研究SES（教育和收入）如何 预期寿命的不平等在整个城市农村连续体中各不平等，并确定不平等的增长如何 在美国，相对于其他高收入国家，我们的预期寿命短缺。