提升县健康排名模型中的环境质量组成部分。
Improving the environmental quality component of the County Health Rankings model.
机构信息
Department of Community Medicine, West Virginia University, Morgantown, WV 26506, USA.
出版信息
Am J Public Health. 2013 Apr;103(4):727-32. doi: 10.2105/AJPH.2012.301016. Epub 2013 Feb 14.
OBJECTIVES
We examined the association between environmental quality measures and health outcomes by using the County Health Rankings data, and tested whether a revised environmental quality measure for 1 state could improve the models.
METHODS
We conducted state-by-state, county-level linear regression analyses to determine how often the model's 4 health determinants (social and economic factors, health behaviors, clinical care, and physical environment) were associated with mortality and morbidity outcomes. We then developed a revised measure of environmental quality for West Virginia, and tested whether the revised measure was superior to the original measure.
RESULTS
Measures of social and economic conditions, and health behaviors, were related to health outcomes in 58% to 88% of state models; measures of environmental quality were related to outcomes in 0% to 8% of models. In West Virginia, the original measure of environmental quality was unrelated to any of the 8 health outcome measures, but the revised measure was significantly related to all 8.
CONCLUSIONS
The County Health Rankings model underestimates the impact of the physical environment on public health outcomes. Suggestions for other data sources that may contribute to improved measurement of the physical environment are provided.
目的
我们利用县健康排名数据，研究了环境质量指标与健康结果之间的关联，并检验了对 1 个州的环境质量指标进行修正是否能改进模型。
方法
我们进行了逐州、县级的线性回归分析，以确定模型的 4 个健康决定因素（社会和经济因素、健康行为、临床护理和物理环境）与死亡率和发病率结果之间的关联频率。然后，我们为西弗吉尼亚州制定了一个修订后的环境质量衡量标准，并检验了修订后的衡量标准是否优于原始衡量标准。
结果
在 58%至 88%的州模型中，社会和经济条件以及健康行为的衡量标准与健康结果有关；在 0%至 8%的模型中，环境质量的衡量标准与结果有关。在西弗吉尼亚州，原始的环境质量衡量标准与任何 8 个健康结果衡量标准都没有关系，但修订后的衡量标准与所有 8 个都有显著关系。
结论
县健康排名模型低估了物理环境对公共健康结果的影响。提供了有关可能有助于改进物理环境衡量标准的其他数据源的建议。
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