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.

项目摘要 暴露于非最佳室外温度造成125,000人死亡和180万 每年在美国达利斯。但是，仍然不知道哪些个人和人口是 最脆弱的。特别是，将健康的社会决定者与温度联系起来的证据不足 脆弱性，它限制了决策者通过有针对性政策保护高风险群体的能力 干预措施。在这里，我们利用了最近引入ICD-10 Z-codes的介绍 - 编码社交 健康的决定因素 - 研究与温度相关的发病率的潜在危险因素。研究将 专注于六个州的2016 - 2020年期：亚利桑那州，加利福尼亚，佐治亚州，密苏里州，纽约和俄勒冈州。 温度数据将来自国家级别的1 km2气象产品和健康数据 政府卫生机构或医院协会。我们将使用案例交叉研究设计来估计 室外温度与急诊室访问全场访问之间的短期关联和 心肺原因。通过个人级别的社会评估这些关联的效果修改 卫生的决定因素（源自Z代码）将重点关注与住房有关的社会领域， 收入/剥夺，社会隔离和机构生活（目标1）。此外，我们将探索潜力 个体水平和地区级别的社会决定者之间的相互作用，与温度脆弱性的社会决定者与 后者主要来自美国社区调查（AIM 2）。在区域级别的指标上进行分层 健康的社会决定者将使我们能够探索任何个人级别的影响如何取决于 它们发生的上下文；某些影响可能会因特征而有所不同 更广泛的生活环境。及时了解温度脆弱性可以帮助定制干预措施 公共卫生消息传递，警告系统，基础设施投资和邻里外展计划。作为 气候变化的影响预计会不成比例地影响已经存在的人群，这是 必须更好地了解各个子组的气候敏感风险，以防止 健康分布。这些目的的结果还将为未来使用Z代码提供方法论方向 在环境流行病学中，可以扩展到包括其他美国州和其他环境暴露， 并可以指导其他类型的研究，以探讨温度脆弱性。