Cohen Steven A, Broccoli Julia R, Greaney Mary L
Department of Health Studies, University of Rhode Island, 25 West Independence Way Suite P, Kingston, Rhode Island 02881 USA.
Arch Public Health. 2020 Jun 15;78:56. doi: 10.1186/s13690-020-00438-7. eCollection 2020.
Efforts to understand and address the causes of place-based health disparities have focused primarily on understanding the social determinants of health on a large geographic level, such as the region, state, or county. However, there is a growing need to assess and understand how place-based characteristics at smaller geographic areas relate to of local place-based neighborhood characteristics on population health. Therefore, the objective of this study was to evaluate the magnitude of the associations between social determinants of health and life expectancy (LE) and related measures on the community level.
LE at birth (LE0), remaining LE at age 65 (LE65), and age-specific mortality rates (ASMR) were calculated from mortality data (2009-2011) collected by the Rhode Island Department of Health (RIDoH) using abridged life table methods for each RI city/town. The city/town-specific LE and ASMR were linked to data collected by the US Census, RIDoH, the Federal Bureau of Investigation, and other databases that include information about multiple social, environmental, and demographic determinants of health. Bivariate correlations between city/town-level LE0, LE65, and ASMR and social determinants: demographics, household composition, income and poverty, education, environment, food insecurity, crime, transportation, and rural-urban status were examined.
LE0 (range: 75.9-83.3 years) was strongly associated with the percent of the population with a graduate/professional degree ( = 0.687, < 0.001), violent crime rate ( - 0.598, 0.001), and per capita income ( 0.553, < 0.001). Similar results were observed for ASMR: ASMR was associated with the percent of the population with a graduate/professional degree ( - 0.596, 0.001), violent crime rate ( 0.450, = 0.005), and per capita income ( - 0.533, < 0.001). The associations between LE65 and social determinants were more attenuated. Of note, none of the measures (LE0, LE65, or ASMR) were associated with any of the race/ethnicity variables.
There are several important place-based characteristics associated with mortality (LE and ASMR) among RI cities/towns. Additionally, some communities had unexpectedly high LE and low ASMR, despite poor social indicators.
为了解和解决基于地域的健康差异问题，人们主要致力于从较大的地理层面，如地区、州或县，去理解健康的社会决定因素。然而，对于较小地理区域内基于地域的特征如何与当地基于邻里的特征对人群健康的影响相关联的评估和理解需求日益增长。因此，本研究的目的是评估社区层面健康的社会决定因素与预期寿命（LE）及相关指标之间关联的强度。
使用简略寿命表方法，根据罗德岛州卫生部（RIDoH）收集的死亡率数据（2009 - 2011年），计算罗德岛州每个城市/城镇的出生时预期寿命（LE0）、65岁时剩余预期寿命（LE65）以及特定年龄死亡率（ASMR）。将城市/城镇特定的LE和ASMR与美国人口普查局、RIDoH、联邦调查局以及其他包含多种健康的社会、环境和人口决定因素信息的数据库收集的数据相链接。检验了城市/城镇层面的LE0、LE65和ASMR与社会决定因素（人口统计学、家庭构成、收入与贫困、教育、环境、粮食不安全、犯罪、交通以及城乡地位）之间的双变量相关性。
LE0（范围：75.9 - 83.3岁）与拥有研究生/专业学位人口的百分比（r = 0.687，p < 0.001）、暴力犯罪率（r = - 0.598，p < 0.001）以及人均收入（r = 0.553，p < 0.001）密切相关。ASMR也有类似结果：ASMR与拥有研究生/专业学位人口的百分比（r = - 0.596，p < 0.001）、暴力犯罪率（r = 0.450，p = 0.005）以及人均收入（r = - 0.533，p < 0.001）相关。LE65与社会决定因素之间的关联更为减弱。值得注意的是，所有指标（LE0、LE65或ASMR）均与任何种族/族裔变量无关。
罗德岛州各城市/城镇中，有几个重要的基于地域的特征与死亡率（LE和ASMR）相关。此外，尽管社会指标不佳，但一些社区的预期寿命意外地高，特定年龄死亡率意外地低。
