Population Health Institute, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison 53726, USA.
Public Health Rep. 2010 Mar-Apr;125(2):160-7. doi: 10.1177/003335491012500203.
We predicted the amount of health outcome improvement any state might achieve if it could reach the highest level of key health determinants any individual state has already achieved.
Using secondary county-level data on modifiable and nonmodifiable health determinants from 1994 to 2003, we used regression analysis to predict state age-adjusted mortality rates in 2000 for those younger than age 75, under the scenario of each state's "ideal" predicted mortality if that state had the best observed level among all states of modifiable determinants.
We found considerable variation in predicted improvement across the states. The state with the lowest baseline mortality, New Hampshire, was predicted to improve by 23% to a mortality rate of 250 per 100,000 population if New Hampshire had the most favorable profile of modifiable health determinants. However, West Virginia, with a much higher baseline, would be predicted to improve the most-by 46% to 254 per 100,000 population. Individual states varied in the pattern of specific modifiable variables associated with their predicted improvement.
The results support the contention that health improvement requires investment in three major categories: health care, behavioral change, and socioeconomic factors. Different states will require different investment portfolios depending on their pattern of modifiable and nonmodifiable determinants.
如果一个州能够达到其已经实现的最高健康决定因素水平，那么我们预测该州能够在多大程度上改善健康结果。
利用 1994 年至 2003 年关于可改变和不可改变健康决定因素的二级县级数据，我们使用回归分析预测了在每个州的可改变决定因素的最佳观察水平下，如果各州处于“理想”预测死亡率，那么各州在 2000 年的年龄调整死亡率，对于 75 岁以下的人群。
我们发现各州之间的预测改善存在相当大的差异。新罕布什尔州的死亡率最低，预计将提高 23%，达到每 10 万人 250 人，如果新罕布什尔州具有最有利的可改变健康决定因素的特征。然而，西弗吉尼亚州的死亡率基数较高，预计将提高 46%，达到每 10 万人 254 人。各个州的具体可改变变量的模式与它们的预测改善有关。
结果支持以下观点，即健康改善需要在三个主要领域投资：医疗保健、行为改变和社会经济因素。不同的州将根据其可改变和不可改变决定因素的模式需要不同的投资组合。
