验证基于区域的社会风险指标以预测健康和死亡率。

IF 11.3 Q1 HEALTH CARE SCIENCES & SERVICES
Aubrey Limburg, David H Rehkopf, Nicole Gladish, Robert L Phillips, Victoria Udalova
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引用次数: 0

摘要

重要性:在美国,基于区域的社会风险度量越来越多地用于政策应用。虽然有几个指标已被证明可以预测一般人口的健康和死亡率,但仍需要确定在政策应用方面最可靠的基于地区的指标,包括在各个亚群体中始终如一地与健康和死亡率相关的指标。目的:比较地区和个人社会风险措施与健康结果和死亡率相关的相对强度,以及这些关联在不同种族、民族、农村、年龄和性别之间的一致性程度。设计、设置和参与者:本横断面研究包括来自所有50个州初级保健诊所的患者样本,这些州是PRIME注册表的一部分,使用电子健康记录(2019-2021),这些记录与美国人口普查局947个美国初级保健实践的个人层面限制使用数据相关。暴露:研究了八种常用的基于区域的社会风险测量方法:(1)社会剥夺指数,(2)社会脆弱性指数,(3)区域剥夺指数(来自威斯康星大学),(4)区域剥夺指数(使用Gophal Singh的原始设计构建),(5)邻里压力评分,(6)种族和收入的极端集中指数,(7)法国社会剥夺指数,(8)社区恢复力估计。对教育、贫困和职业的个人社会经济指标也进行了研究。主要结果和措施:来自电子健康记录的高血压、糖尿病和慢性肾病,以及来自人口普查数据的死亡率。结果:分析了2 801 000例患者的数据。其中雄性个体占44%,雌性个体占56%;25岁以下占20%,25 ~ 44岁占23%,45 ~ 64岁占30%,65岁及以上占27%;0.5%是美洲印第安人或阿拉斯加原住民,2.1%是亚洲人,7.6%是黑人,0.2%是夏威夷原住民和太平洋岛民,0.03%是两个或两个以上种族,70%是白人。基于区域的社会风险指标通常能更好地预测高血压、糖尿病和慢性肾脏疾病,而个体社会经济指标通常能更好地预测死亡率。在所有健康结果中,最有力的预测指标是地区剥夺指数,而戈帕尔·辛格的版本在农村地区和所有种族和族裔亚群体中都是最公平的预测指标。结论和相关性:在这项横断面研究中,基于区域的测量方法比个体社会经济测量方法更能预测健康结果,并且总体上对亚人群的健康预测公平;因此,它们的使用应结合起来考虑,而不是针对选定的卫生政策应用使用个人层面的措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Validating 8 Area-Based Measures of Social Risk for Predicting Health and Mortality.

Importance: Area-based measures of social risk are increasingly being used in policy applications in the US. While several have been demonstrated to be predictive of health and mortality in the general population, there is a need to identify area-based measures that are most reliable for policy applications, including measures that are associated with health and mortality consistently across subpopulations.

Objective: To compare the relative strength with which area and individual social risk measures are correlated with health outcomes and mortality, and the extent to which these associations are consistent across race, ethnicity, rurality, age, and gender.

Design, setting, and participants: This cross-sectional study included a sample of patients from primary care clinics across all 50 states that are part of the PRIME registry using electronic health records (2019-2021) linked to US Census Bureau restricted-use data at the individual level from 947 US primary care practices.

Exposures: Eight commonly used area based measures of social risk were examined: (1) Social Deprivation Index, (2) Social Vulnerability Index, (3) Area Deprivation Index (from University of Wisconsin), (4) Area Deprivation Index (constructed using Gophal Singh's original design), (5) Neighborhood Stress Score, (6) Index of Concentration at the Extremes for race and income, (7) French Index of Social Deprivation, and (8) the Community Resilience Estimates. Individual socioeconomic measures of education, poverty, and occupation were also examined.

Main outcomes and measures: Hypertension, diabetes, and chronic kidney disease derived from electronic health records, and mortality from the Census Numident.

Results: Data from 2 801 000 patients were analyzed. Among these, 44% were male individuals and 56% were female individuals; 20% were younger than 25 years, 23% were aged 25 to 44 years, 30% were aged 45 to 64 years, and 27% were aged 65 years and older; 0.5% were American Indian or Alaskan Native, 2.1% Asian, 7.6% Black, 0.2% Native Hawaiian and Pacific Islander, 0.03% were 2 or more races, and 70% were White. Area-based measures of social risk were generally better predictors of hypertension, diabetes, and chronic kidney disease, whereas individual socioeconomic measures were generally better predictors of mortality. The strongest predictor across health outcomes was the Area Deprivation Index, and that Gopal Singh's version was the most equitably predictive across rural areas and across all racial and ethnic subgroups.

Conclusions and relevance: In this cross-sectional study, area-based measures predicted health outcomes better than individual socioeconomic measures, and generally predicted health equitably across subpopulations; thus, their use should be considered in conjunction or instead of using individual-level measures for selected health policy applications.

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来源期刊
CiteScore
4.00
自引率
7.80%
发文量
0
期刊介绍: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health, and health care. The journal publishes original research, evidence-based reports, and opinion about national and global health policy. It covers innovative approaches to health care delivery and health care economics, access, quality, safety, equity, and reform. In addition to publishing articles, JAMA Health Forum also features commentary from health policy leaders on the JAMA Forum. It covers news briefs on major reports released by government agencies, foundations, health policy think tanks, and other policy-focused organizations. JAMA Health Forum is a member of the JAMA Network, which is a consortium of peer-reviewed, general medical and specialty publications. The journal presents curated health policy content from across the JAMA Network, including journals such as JAMA and JAMA Internal Medicine.
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