Modification of temperature-morbidity associations by social determinants of health: the use of Z-coding

健康社会决定因素对温度-发病率关联的修改：Z编码的使用

• 批准号: 10593712
• 负责人: Noah C Scovronick
• 金额: $ 23.23万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10593712
• 关键词: Accident and Emergency department; Affect; American; Area; Arizona; California; Categories; Cessation of life; Characteristics; Climate; Clinical; Code; Community Surveys; Cross-Over Studies; Data; Data Set; Diagnosis; Disparity population; Economics; Emergency department visit; Environment; Environmental Epidemiology; Environmental Exposure; Ethnic Origin; Exposure to; Frequencies; Future; Government; Health; Health Personnel; Heat Waves; Homelessness; Hospitals; Household; Housing; Income; Individual; Infrastructure; Institution; International Classification of Diseases; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); Intervention; Investments; Knowledge; Link; Location; Low income; Methodology; Missouri; Modification; Morbidity - disease rate; Neighborhoods; New York; Oregon; Outcome; Patients; Policies; Policy Maker; Population; Poverty; Public Health; Race; Records; Reporting; Research; Research Design; Resources; Risk; Risk Factors; Social Environment; Social isolation; Standardization; State Hospitals; Stratification; Subgroup; System; Temperature; US State; Unemployment; United States; Visit; Weather; climate change; climate impact; deprivation; disability-adjusted life years; epidemiology study; extreme heat; health data; health disparity; high risk population; models and simulation; outreach program; population survey; prevent; social; social determinants; social health determinants

PROJECT SUMMARY Exposure to non-optimal outdoor temperatures is responsible for an estimated 125,000 deaths and 1.8 million DALYs in the United States each year. However, it is still not well known which individuals and populations are most vulnerable. In particular, there is a shortage of evidence linking social determinants of health to temperature vulnerability, which constrains the ability of decision makers to protect high-risk groups through targeted policy interventions. Here we leverage the recent introduction of ICD-10 Z-codes – which encode the social determinants of health – to investigate potential risk factors for temperature-related morbidity. The study will focus on the period 2016-2020 in six states: Arizona, California, Georgia, Missouri, New York and Oregon. Temperature data will come from a national 1km2 meteorological product and health data from state-level government health agencies or hospital associations. We will use a case-crossover study design to estimate short-term associations between outdoor temperature and emergency department visits for all-causes and cardiorespiratory causes. Assessment of effect modification of these associations by individual-level social determinants of health (derived from Z-codes) will focus on social domains related to housing, income/deprivation, social isolation, and institutional living (Aim 1). In addition, we will explore potential interactions between individual-level and area-level social determinants of temperature vulnerability, with the latter derived primarily from the American Community Survey (Aim 2). Stratifying on area-level indicators of the social determinants of health will allow us to explore how any individual-level effects are dependent on the context within which they occur; it is possible that some effects will vary with respect to characteristics of the broader living environment. Timely knowledge of temperature vulnerability can help tailor interventions including public health messaging, warning systems, infrastructure investments and neighborhood outreach programs. As climate change impacts are expected to disproportionately affect already-disadvantaged populations, it is essential to better understand climate-sensitive risks across sub-groups in order to prevent the exacerbation of health disparities. Results from these aims will also provide methodological directions for future use of Z-codes in environmental epidemiology, can be expanded to include other US states and other environmental exposures, and can guide other types of studies exploring vulnerability to temperature.

项目概要 据估计，暴露在非最佳室外温度下导致 125,000 人死亡，180 万人死亡 美国每年的伤残调整生命年 (DALY) 然而，目前尚不清楚哪些个人和人群。 尤其是，缺乏将健康的社会决定因素与温度联系起来的证据。 脆弱性，限制了决策者通过有针对性的政策保护高风险群体的能力 在这里，我们利用最近推出的 ICD-10 Z 代码——它对社会进行编码。 健康的决定因素——调查与温度相关的发病率的潜在危险因素。 重点关注 2016 年至 2020 年期间六个州：亚利桑那州、加利福尼亚州、佐治亚州、密苏里州、纽约州和俄勒冈州。 温度数据来自全国1km2气象产品和国家级健康数据 我们将使用病例交叉研究设计来估计。 室外温度与各种原因的急诊就诊之间的短期关联 评估个体层面的社会因素对这些关联的影响。 健康的决定因素（源自 Z 代码）将重点关注与住房相关的社会领域， 收入/剥夺、社会孤立和机构生活（目标 1）。 个人层面和地区层面的温度脆弱性社会决定因素之间的相互作用 后者主要源自美国社区调查（目标 2）。 健康的社会决定因素将使我们能够探索任何个人层面的影响如何取决于 它们发生的背景可能会根据其特征而变化； 及时了解温度脆弱性有助于制定干预措施，包括 公共卫生信息、预警系统、基础设施投资和社区外展计划。 预计气候变化的影响将不成比例地影响已经处于不利地位的人口， 对于更好地了解各个子群体的气候敏感风险至关重要，以防止气候恶化 这些目标的结果也将为 Z 代码的未来使用提供方法方向。 在环境流行病学中，可以扩展到包括美国其他州和其他环境暴露， 并可以指导探索温度脆弱性的其他类型的研究。