Cooper R S, Kennelly J F, Durazo-Arvizu R, Oh H J, Kaplan G, Lynch J
Department of Preventive Medicine and Epidemiology, Loyola University Medical School, Maywood, IL 60153, USA.
Public Health Rep. 2001 Sep-Oct;116(5):464-73. doi: 10.1093/phr/116.5.464.
examined the association of mortality with selected socioeconomic indicators of inequality and segregation among blacks and whites younger than age 65 in 267 US metropolitan areas. The primary aim of the analysis was to operationalize the concept of institutional racism in public health.
Socioeconomic indicators were drawn from Census and vital statistics data for 1989-1991 and included median household income; two measures of income inequality; percentage of the population that was black; and a measure of residential segregation.
Age-adjusted premature mortality was 81% higher in blacks than in whites, and median household income was 40% lower. Income inequality, as measured by the Gini coefficient, was greater within the black population (0.45) than within the white population (0.40; p < 0.001). To confirm that the proxy socioeconomic variables were relevant markers of population health status, regression analysis was performed initially on data for the total population. These variables were all independently and significantly related to premature mortality (p < or = 0.01; R(2) = 0.74). Income inequality for the total population was significantly correlated with premature mortality (r = 0.33). Black (r = 0.26) and white (r = 0.20) population-specific correlations between income inequality and premature mortality, while still significant, were smaller. Residential segregation was significantly related to premature mortality and income inequality for blacks (r = 0.38 for both); among whites, however, segregation was modestly correlated with premature mortality (r = 0.19) and uncorrelated with income inequality. Regional analyses demonstrated that the association of segregation with premature mortality was much more pronounced in the South and in areas with larger black populations.
Social factors such as income inequality and segregation strongly influence premature mortality in the US. Ecologic studies of the relationships among social factors and population health can measure attributes of the social context that may be relevant for population health, providing the basis for imputing macro-level relationships.
研究美国267个大都市区65岁以下黑人和白人的死亡率与选定的社会经济不平等和隔离指标之间的关联。该分析的主要目的是将公共卫生领域的制度性种族主义概念付诸实践。
社会经济指标取自1989 - 1991年的人口普查和人口动态统计数据，包括家庭收入中位数；两种收入不平等衡量指标；黑人人口百分比；以及居住隔离衡量指标。
经年龄调整后，黑人的过早死亡率比白人高81%，家庭收入中位数比白人低40%。以基尼系数衡量的收入不平等在黑人人口中（0.45）比在白人人口中（0.40；p < 0.001）更大。为确认替代社会经济变量是人口健康状况的相关指标，最初对总人口数据进行了回归分析。这些变量均与过早死亡率独立且显著相关（p ≤ 0.01；R² = 0.74）。总人口的收入不平等与过早死亡率显著相关（r = 0.33）。收入不平等与过早死亡率之间针对黑人（r = 0.26）和白人（r = 0.20）的特定人群相关性虽然仍然显著，但较小。居住隔离与黑人的过早死亡率和收入不平等显著相关（两者r = 0.38）；然而，在白人中，隔离与过早死亡率适度相关（r = 0.19），与收入不平等不相关。区域分析表明，隔离与过早死亡率之间的关联在南部和黑人人口较多的地区更为明显。
收入不平等和隔离等社会因素对美国的过早死亡率有强烈影响。社会因素与人口健康关系的生态学研究可以衡量可能与人口健康相关的社会背景属性，为推断宏观层面的关系提供依据。
