University of Southern Mississippi, Hattiesburg, USA.
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.
J Gen Intern Med. 2023 Sep;38(12):2686-2694. doi: 10.1007/s11606-023-08062-1. Epub 2023 Mar 27.
Race and ethnicity, socioeconomic class, and geographic location are well-known social determinants of health in the US. Studies of population mortality often consider two, but not all three of these risk factors.
To disarticulate the associations of race (whiteness), class (socioeconomic status), and place (county) with risk of cause-specific death in the US.
We conducted a retrospective analysis of death certificate data. Bayesian regression models, adjusted for age and race/ethnicity from the American Community Survey and the county Area Deprivation Index, were used for inference.
County-level mortality for 11 leading causes of death (1999-2019) and COVID-19 (2020-2021).
County "whiteness" and socioeconomic status modified death rates; geospatial effects differed by cause of death. Other factors equal, a 20% increase in county whiteness was associated with 5-8% increase in death from three causes and 4-15% reduction in death from others, including COVID-19. Other factors equal, advantaged counties had significantly lower death rates, even when juxtaposed with disadvantaged ones. Patterns of residual risk, measured by spatial county effects, varied by cause of death; for example: cancer and heart disease death rates were better explained by age, socioeconomic status, and county whiteness than were COVID-19 and suicide deaths.
There are important independent contributions from race, class, and geography to risk of death in the US.
在美国，种族和民族、社会经济阶层和地理位置是众所周知的健康社会决定因素。研究人口死亡率的研究通常考虑这三个风险因素中的两个，但不是全部。
阐明种族（白人）、阶层（社会经济地位）和地点（县）与美国特定原因死亡风险的关联。
我们对死亡证明数据进行了回顾性分析。使用贝叶斯回归模型，根据美国社区调查和县区域剥夺指数中的年龄和种族/民族进行调整，进行推断。
1999-2019 年 11 种主要死因和 2020-2021 年 COVID-19 的县死亡率。
县“白人”和社会经济地位改变了死亡率；地理空间效应因死因而异。在其他因素相等的情况下，县白人比例增加 20%，与三种死因的死亡率增加 5-8%，与其他死因（包括 COVID-19）的死亡率降低 4-15%相关。在其他因素相等的情况下，即使与劣势县并列，优势县的死亡率也明显较低。以空间县效应衡量的剩余风险模式因死因而异；例如：癌症和心脏病的死亡率比 COVID-19 和自杀死亡率更能通过年龄、社会经济地位和县白人比例来解释。
在美国，种族、阶层和地理环境对死亡风险有重要的独立贡献。
