Comparative Assessment of Modifying Social Determinants of Health to Reduce Firearm-Related Mortality and Disparities

修改健康社会决定因素以减少枪支相关死亡率和差异的比较评估

• 批准号: 10322069
• 负责人: Daniel Kim
• 金额: $ 23.55万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10322069
• 关键词: Address; Adult; Affect; American; Americas; Area; Cessation of life; Characteristics; Communities; County; Data; Databases; Economic Policy; Epidemic; Epidemiology; Ethnic Origin; Firearms; Goals; Guns; Homicide; Investigation; Knowledge; Life Expectancy; Link; Measures; Minority; Neighborhoods; Outcome; Plant Roots; Policies; Population; Prevention Research; Public Health; Public Policy; Quasi-experiment; Race; Sampling; Shapes; Social Mobility; Social Policies; Socioeconomic Status; Suicide; Testing; Translating; United States National Institutes of Health; Vulnerable Populations; Wages; comparative; comparison group; development policy; evidence base; gun homicide; gun violence; high risk; income disparities; low socioeconomic status; mortality; mortality disparity; novel; population health; public health relevance; residence; rural area; rural residence; social; social capital; social determinants; social health determinants; social influence; tool; translational impact; welfare

PROJECT SUMMARY/ABSTRACT Gun violence is an escalating national crisis that shapes overall levels of population health including average life expectancy. Crucially, in order to effectively address this crisis, it is imperative that we identify its root social causes, which may include social determinants of health (SDoH) such as income disparities and social mobility, and that we modify these root causes through corresponding policies. While a handful of SDoH have been shown to predict gun homicides and suicides, important questions remain about which SDoH are root social drivers i.e., have the greatest impacts. Despite increasing calls for comparative assessments and comprehensive approaches to unpack and address the root causes—the social determinants—of gun violence, we lack knowledge on the firearm mortality burden associated with modifying SDoH and SDoH-related policies, including by using multilevel, longitudinal data and quasi-experimental methods that favor causal inference. Furthermore, we have yet to establish which subpopulations are most affected by SDoH. Given this information, there are critical needs to accurately estimate SDoH impacts, including by subpopulation; and to translate these estimates into population health metrics that may serve as priority-setting tools. Not addressing these critical needs will hinder the development of policies to more effectively reduce firearm mortality burden and inequities. Our overall objective is to use quasi-experimental approaches to provide the first comparative assessment evidence base on the social drivers of the gun homicide and suicide epidemics. We will accomplish our overall objective by pursuing the following specific aims using data on 3.4 million adults from the nationally- representative sample of the Mortality Disparities in American Communities Study, linked to SDoH measures by area of residence and containing death information from national mortality database linkages: Aim 1) To determine which SDoH and SDoH-related policies most strongly predict firearm homicides and suicides in adults. To strengthen causal inference, we will implement robust quasi-experimental and epidemiologic approaches including difference-in-difference, propensity score, and changes-in- changes analysis; Aim 2) To identify which subpopulations (defined by race/ethnicity, SES, and urban/rural residence) are most vulnerable to influences of SDoH and SDoH-related policies on firearm homicides and suicides; and Aim 3) To ascertain which SDoH and SDoH-related policies if modified are expected to yield the greatest reductions in firearm homicide and suicide burden, both nationally and by subpopulation. Regarding outcomes, we will identify the most promising SDoH on which to intervene to yield improvements in adult firearm mortality burden. We will further establish how differential vulnerabilities by subpopulations may explain disparities. By translating estimates into population health metrics, we expect that our project will have high translational impact through guiding policymakers' evidence-based decisions about policies to more effectively reduce the burden of and inequities in mortality from gun violence in America.

项目概要/摘要 枪支暴力是一场不断升级的国家危机，影响着人口健康的整体水平，包括 至关重要的是，为了有效应对这场危机，我们必须确定其平均预期寿命。 根本社会原因，其中可能包括健康的社会决定因素 (SDoH)，例如收入差距和 社会流动性，我们通过相应的政策来改变这些根本原因，而少数 SDoH。 已被证明可以预测枪支杀人和自杀，但关于哪些 SDoH 是重要的问题仍然存在 尽管对比较评估和评估的呼声越来越高，但根本社会驱动因素具有最大的影响。 揭示和解决枪支暴力的根本原因（社会决定因素）的综合方法， 我们缺乏对与修改 SDoH 和 SDoH 相关政策相关的枪支死亡率负担的了解， 包括使用多层次、纵向数据和有利于因果推理的准实验方法。 此外，鉴于此信息，我们尚未确定哪些亚人群受 SDoH 影响最大。 迫切需要准确估计 SDoH 影响（包括按亚群体划分）并转化这些影响； 对人口健康指标的估计可以作为确定优先事项的工具，但没有解决这些关键问题。 需求将阻碍更有效地减少枪支死亡率负担和不平等现象的政策的制定。 我们的总体目标是使用准实验方法来提供第一个比较评估 基于枪支杀人和自杀流行的社会驱动因素的证据我们将完成我们的总体目标。 通过使用全国 340 万成年人的数据来实现以下具体目标： 美国社区死亡率差异研究的代表性样本，与 SDoH 措施相关 居住地区并包含来自国家死亡率数据库链接的死亡信息：目标 1) 确定哪些 SDoH 和 SDoH 相关政策最有力地预测枪支凶杀和自杀 为了加强成人的因果推理，我们将实施稳健的准实验和 流行病学方法，包括双重差异、倾向评分和变化 变化分析；目标 2) 确定哪些亚群（按种族/族裔、SES 和 城市/乡村居住区）最容易受到 SDoH 和 SDoH 相关枪支政策的影响 凶杀和自杀；以及 目标 3) 确定哪些 SDoH 和 SDoH 相关政策（如果修改） 预计将最大程度地减少全国范围内的枪支凶杀和自杀负担 关于结果，我们将确定最有希望进行干预以产生成果的 SDoH。 我们将进一步确定如何通过以下方式区分脆弱性。 通过将估计值转化为人口健康指标，我们预计亚人群可以解释差异。 我们的项目将通过指导政策制定者基于证据的决策来产生巨大的转化影响 更有效地减轻美国枪支暴力造成的负担和死亡率不平等的政策。