Centers for Disease Control and Prevention, Office of Minority Health and Health Equity, 4770 Buford Highway, TW-3, Atlanta, GA 30341, USA.
Int J Environ Res Public Health. 2019 Feb 2;16(3):436. doi: 10.3390/ijerph16030436.
The value of disaggregating non-metropolitan and metropolitan area deaths in illustrating place-based health effects is evident. However, how place interacts with characteristics such as race/ethnicity has been less firmly established. This study compared socioeconomic characteristics and age-adjusted mortality rates by race/ethnicity in six rurality designations and assessed the contributions of mortality rate disparities between non-Hispanic blacks (NHBs) and non-Hispanic whites (NHWs) in each designation to national disparities. Compared to NHWs, age-adjusted mortality rates for: (1) NHBs were higher for all causes (combined), heart disease, malignant neoplasms, and cerebrovascular disease; (2) American Indian and Alaska Natives were significantly higher for all causes in rural areas; (3) Asian Pacific islanders and Hispanics were either lower or not significantly different in all areas for all causes combined and all leading causes of death examined. The largest contribution to the U.S. disparity in mortality rates between NHBs and NHWs originated from large central metropolitan areas. Place-based variations in mortality rates and disparities may reflect resource, and access inequities that are often greater and have greater health consequences for some racial/ethnic populations than others. Tailored, systems level actions may help eliminate mortality disparities existing at intersections between race/ethnicity and place.
将非都市区和都市区的死亡人数进行细分，以说明基于地点的健康影响的价值是显而易见的。然而，地点与种族/族裔等特征的相互作用还没有得到充分确立。本研究比较了六个农村指定地区的社会经济特征和按种族/族裔划分的年龄调整死亡率，并评估了每个指定地区非西班牙裔黑人（NHB）和非西班牙裔白人（NHW）之间的死亡率差异对全国差异的贡献。与 NHW 相比，年龄调整后的死亡率为：（1）NHB 因所有原因（合并）、心脏病、恶性肿瘤和脑血管疾病而更高；（2）美洲印第安人和阿拉斯加原住民在农村地区因所有原因的死亡率显著更高；（3）所有地区的所有原因和所有主要死因的亚太岛民和西班牙裔的死亡率要么更低，要么没有显著差异。美国 NHB 和 NHW 之间的死亡率差异的最大贡献来自大型中心大都市地区。死亡率和差异的基于地点的变化可能反映了资源和机会不平等，这些不平等对某些种族/族裔群体的影响往往更大，对健康的影响也更大。有针对性的、系统层面的行动可能有助于消除在种族/族裔和地点交叉点存在的死亡率差异。
