Studnicki James, Gipson Linda S, Berndt Donald J, Fisher John W, Callandar Matthew, Pracht Etienne, Langland-Orban Barbara
College of Health and Human Services, Department of Health Behavior and Administration, University of North Carolina, Charlotte, North Carolina 28223-0001, USA.
Am J Prev Med. 2007 Feb;32(2):116-23. doi: 10.1016/j.amepre.2006.11.001.
Locally generated special healthcare taxes are an important component of community infrastructure, but their impact on the health status of populations has not been systematically addressed.
Florida counties were segmented on the basis of the use/nonuse of locally generated tax dollars for health care during the 1992-1996 period and analyzed in 2004. Linear mixed-effects regression analysis was used to test a model in which taxing behavior served as the primary predictor variable for total age-adjusted and selected cause-specific mortality. Race/ethnicity, rurality, poverty, access to a public hospital, and physician availability were controlled.
Local taxation was associated with lower total age-adjusted mortality, and lower mortality for the major causes of death, except stroke, when compared to the state mean. Local taxation is protective relative to total age-adjusted mortality (odds ratio [OR]=0.63, 95% confidence interval [CI]=0.40-0.98) and age-adjusted mortality from chronic obstructive lung disease (OR=0.50, CI=0.32-0.79), cancers (OR=0.53, CI=0.34-0.084), and intentional injury (OR=0.50, CI=0.38-0.92).
Locally generated tax revenues used for the provision of healthcare services are consistently associated with improved health outcomes of major public health importance. The means by which this advantage is achieved will require additional research.
地方征收的专项医疗税是社区基础设施的重要组成部分，但它们对人群健康状况的影响尚未得到系统研究。
根据1992 - 1996年期间佛罗里达州各县是否将地方税收用于医疗保健进行划分，并于2004年进行分析。采用线性混合效应回归分析来检验一个模型，其中征税行为作为年龄调整后的总死亡率及特定死因死亡率的主要预测变量。对种族/族裔、农村地区、贫困状况、公立医院可及性和医生可获得性进行了控制。
与该州平均水平相比，地方征税与年龄调整后的总死亡率较低以及除中风外的主要死因死亡率较低相关。地方征税相对于年龄调整后的总死亡率具有保护作用（优势比[OR]=0.63，95%置信区间[CI]=0.40 - 0.98），以及相对于慢性阻塞性肺病（OR=0.50，CI=0.32 - 0.79）、癌症（OR=0.53，CI=0.34 - 0.84）和故意伤害（OR=0.50，CI=0.38 - 0.92）的年龄调整后死亡率也具有保护作用。
用于提供医疗服务的地方税收收入始终与具有重要公共卫生意义的健康改善结果相关。实现这一优势的方式需要进一步研究。
