Wami Welcome, Walsh David, Hennig Benjamin D, McCartney Gerry, Dorling Danny, Galea Sandro, Sampson Laura, Dundas Ruth
MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, Scotland, United Kingdom; Amsterdam Institute for Global Health and Development, AHTC, Tower C4, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands.
Glasgow Centre for Population Health, Olympia Building, 2-16 Orr Street, Bridgeton Cross, Glasgow G40 2QH, Scotland, United Kingdom.
Health Place. 2021 Jul;70:102586. doi: 10.1016/j.healthplace.2021.102586. Epub 2021 May 16.
Previous UK and European research has highlighted important variations in mortality between populations after adjustment for key determinants such as poverty and deprivation. The aim here was to establish whether similar populations could be identified in the US, and to examine changes over time. We employed Poisson regression models to compare county-level mortality with national rates between 1968 and 2016, adjusting for poverty, education, race (a proxy for exposure to racism), population change and deindustrialisation. Results are presented by means of population-weighted cartograms, and highlight widening spatial inequalities in mortality over time, including an urban to rural, and south-westward, shift in areas with the highest levels of such unexplained 'excess' mortality. There is a need to understand the causes of the excess in affected communities, given that it persists after adjustment for such a broad range of important health determinants.
英国和欧洲此前的研究强调，在对贫困和匮乏等关键决定因素进行调整后，不同人群之间的死亡率存在重要差异。本文旨在确定美国是否能识别出类似的人群，并研究随时间的变化情况。我们采用泊松回归模型，比较了1968年至2016年间县级死亡率与全国死亡率，并对贫困、教育、种族（种族主义暴露的替代指标）、人口变化和去工业化进行了调整。结果通过人口加权统计图呈现，突出了死亡率方面空间不平等随时间的扩大，包括此类无法解释的“超额”死亡率最高地区从城市向农村以及向西南方向的转移。鉴于在对如此广泛的重要健康决定因素进行调整后这种情况仍然存在，有必要了解受影响社区超额死亡率的原因。
