Lee Hyunjung, Singh Gopal K
Department of Public Policy and Public Affairs, John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, 100 William T Morrissey Blvd. Boston, MA 02125, United States.
The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., Riverdale, MD 20738, United States.
Int J MCH AIDS. 2022;11(1):e533. doi: 10.21106/ijma.533. Epub 2022 Apr 5.
Previous research has shown a significant association between psychological distress (PD) and all-cause mortality. However, there is a dearth of studies quantifying the contributions of sociodemographic and behavioral characteristics to group differences in mortality. In this study, we identify factors of mortality differences by PD.
The Blinder-Oaxaca decomposition analysis was used to quantify the contributions of individual sociodemographic and behavioral characteristics to the observed mortality differences between United States (US) adults with no PD and those with serious psychological distress (SPD), using the pooled data from the 1997-2014 National Health Interview Survey prospectively linked to the 1997-2015 National Death Index (N = 263,825).
Low educational level, low household income, and high proportions of current smokers, renters, former drinkers, and adults experiencing marital dissolution contributed to high all-cause mortality among adults with SPD. The relative percentage of all-cause mortality disparity explained by socioeconomic and demographic factors was 38.86%. Approximately 47% of the mortality disparity was attributed to both sociodemographic and behavioral risk factors. Lower educational level (21.13%) was the top contributor to higher all-cause mortality among adults with SPD, followed by smoking status (13.51%), poverty status (11.77%), housing tenure (5.11%), alcohol consumption (4.82%), marital status (3.61%), and nativity/immigrant status (1.95%). Age, sex, and body mass index alleviated all-cause mortality risk among adults with SPD.
Improved education and higher income levels, and reduced smoking among US adults with SPD might eliminate around half of the all-cause mortality disparity by SPD. Such a policy strategy might lead to reductions in mental health disparities and adverse health impacts both in the US and globally.
先前的研究表明，心理困扰（PD）与全因死亡率之间存在显著关联。然而，缺乏量化社会人口学和行为特征对死亡率群体差异贡献的研究。在本研究中，我们确定了按PD划分的死亡率差异因素。
使用1997 - 2014年全国健康访谈调查与1997 - 2015年全国死亡指数前瞻性关联的汇总数据（N = 263,825），采用布林德 - 奥克分解分析来量化个体社会人口学和行为特征对美国无PD的成年人与有严重心理困扰（SPD）的成年人之间观察到的死亡率差异的贡献。
教育水平低、家庭收入低以及当前吸烟者、租房者、既往饮酒者和经历婚姻解体的成年人比例高，导致SPD成年人的全因死亡率较高。社会经济和人口因素解释的全因死亡率差异的相对百分比为38.86%。约47%的死亡率差异归因于社会人口学和行为风险因素。教育水平较低（21.13%）是SPD成年人全因死亡率较高的首要因素，其次是吸烟状况（13.51%）、贫困状况（11.77%）、住房保有情况（5.11%）、饮酒情况（4.82%）、婚姻状况（3.61%）以及出生地/移民身份（1.95%）。年龄、性别和体重指数降低了SPD成年人的全因死亡风险。
改善美国SPD成年人的教育和提高收入水平，并减少吸烟，可能消除约一半由SPD导致的全因死亡率差异。这样的政策策略可能会减少美国乃至全球的心理健康差距和不良健康影响。
