Health Resources and Services Administration, Maternal and Child Health Bureau, US Department of Health and Human Services, Rockville, MD, USA.
J Urban Health. 2013 Jun;90(3):388-405. doi: 10.1007/s11524-012-9744-0.
We analyzed international patterns and socioeconomic and rural-urban disparities in all-cause mortality and mortality from homicide, suicide, unintentional injuries, and HIV/AIDS among US youth aged 15-24 years. A county-level socioeconomic deprivation index and rural-urban continuum measure were linked to the 1999-2007 US mortality data. Mortality rates were calculated for each socioeconomic and rural-urban group. Poisson regression was used to derive adjusted relative risks of youth mortality by deprivation level and rural-urban residence. The USA has the highest youth homicide rate and 6th highest overall youth mortality rate in the industrialized world. Substantial socioeconomic and rural-urban gradients in youth mortality were observed within the USA. Compared to their most affluent counterparts, youth in the most deprived group had 1.9 times higher all-cause mortality, 8.0 times higher homicide mortality, 1.5 times higher unintentional-injury mortality, and 8.8 times higher HIV/AIDS mortality. Youth in rural areas had significantly higher mortality rates than their urban counterparts regardless of deprivation levels, with suicide and unintentional-injury mortality risks being 1.8 and 2.3 times larger in rural than in urban areas. However, youth in the most urbanized areas had at least 5.6 times higher risks of homicide and HIV/AIDS mortality than their rural counterparts. Disparities in mortality differed by race and sex. Socioeconomic deprivation and rural-urban continuum were independently related to disparities in youth mortality among all sex and racial/ethnic groups, although the impact of deprivation was considerably greater. The USA ranks poorly in all-cause mortality, youth homicide, and unintentional-injury mortality rates when compared with other industrialized countries.
我们分析了美国 15-24 岁青少年全因死亡率以及凶杀、自杀、意外伤害和艾滋病毒/艾滋病死亡率的国际模式和社会经济及城乡差异。将县级社会经济剥夺指数和城乡连续体测量值与 1999-2007 年美国死亡率数据相关联。为每个社会经济和城乡群体计算死亡率。使用泊松回归来计算按贫困程度和城乡居住情况调整的青年死亡率的相对风险。美国是工业化国家中青少年凶杀率最高和整体青少年死亡率第六高的国家。在美国，青少年死亡率存在显著的社会经济和城乡梯度。与最富裕的同龄人相比，最贫困群体中的青少年全因死亡率高出 1.9 倍，凶杀死亡率高出 8.0 倍，意外伤害死亡率高出 1.5 倍，艾滋病毒/艾滋病死亡率高出 8.8 倍。无论贫困程度如何，农村地区的青年死亡率都明显高于城市地区，农村地区的自杀和意外伤害死亡率风险分别比城市地区高 1.8 倍和 2.3 倍。然而，最城市化地区的青年凶杀和艾滋病毒/艾滋病死亡率比农村地区高至少 5.6 倍。死亡率的差异因种族和性别而异。社会经济剥夺和城乡连续体与所有性别和种族/族裔群体的青年死亡率差异独立相关，尽管贫困的影响要大得多。与其他工业化国家相比，美国在全因死亡率、青少年凶杀率和意外伤害死亡率方面的排名较低。
