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: 10630346
• 负责人: IGOR AKUSHEVICH
• 金额: $ 31.26万
• 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 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10630346
• 关键词: Address; Adherence; Affect; Air; Behavioral; Bypass; Caring; Characteristics; Clinic; Clinical; Communities; County; Data; Data Set; Deceleration; Developed Countries; Development; Diabetes Mellitus; Diagnostic; Diagnostic Procedure; Disease; Disparity; 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; Time; Time trend; 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; regional difference; screening; socioeconomics; time use; treatment adherence; treatment choice; treatment pattern; 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.

工作声明 理解健康结果中区域间差异的性质和 美国的长寿 （女性）比健康结果更好的州少。这个差距的持久性，甚至扩大 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，医疗保健系统中的健康支出增加，并展示了 与其他工业化国家相比，观察到健康和寿命的滞后。此应用的目的 是确定观察到的地理差异的基础机制，并阐明诊所和临床的作用 非临床相关因素在其中扮演。我们希望可以在 单个医疗保险轨迹以及补充5％Medicare数据集的大小和范围 与健康和退休研究相关的Medicare记录将使我们能够发现这种原因 差异。在这个项目中，我们将测试有关如何在健康中反映这些差异的四种情况 从医疗保险数据中提取的措施：预期寿命较低的地区表现出较高的疾病 发病率（场景＃1），患者生存较差（方案＃2），更高的多发病（方案＃3）和/或更糟 65岁的个人健康状况（即进入Medicare系统时）（方案＃4）。在目标1中我们 将测试每种情况（或其组合）在何种程度上可以解释观察到的地理差异 死亡。我们将确定特定的疾病，这些疾病对健康差异最大的疾病。 要研究的方案。在AIM 2中，我们将确定与诊所相关的特征，例如使用特定的特征 治疗，治疗选择和遵守治疗，筛查的利用和诊断程序 （尤其是对于早期诊断）影响健康结果并导致地理差异。 最后，在AIM 3中，我们将确定与社会经济，行为，行为，行为，行为，行为， 环境特征，并获得和质量护理措施（从5％的Medicare构建 数据）影响AIM 2中确定为地理差异的决定因素所鉴定的临床指标。结果将 提供有关临床和非临床相关障碍的新知识，以改善健康和增加 表现不佳的美国地区的预期寿命，确定受影响最大的人群，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。提议的结果 研究将使实现我们的长期目标的下一步成为可能：改善疾病策略 预防，优化医疗资源分配，重点是贫困社区 提高医疗保健标准，以减慢或阻止美国健康差异的差距增加