AI for Good Lab, Microsoft, Redmond, WA, USA.
NYU School of Global Public Health, New York, NY, USA.
Int J Equity Health. 2023 Sep 5;22(1):181. doi: 10.1186/s12939-023-01984-6.
Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level.
For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group's 2015-2019 Distressed Community Index Scores.
With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened.
In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.
社会经济地位长期以来一直与人口健康和健康结果相关联。虽然改善健康的社会决定因素可能会改善健康状况，但确定并针对可行干预措施最需要的领域将有助于提高健康公平性。我们试图确定与县级经济困境相关的健康和社会决定因素（SDOH）方面的不平等现象。
对于美国 50 个州和华盛顿特区的 3131 个县（2019 年约有 325711203 人居住），我们对两个时期（以 2015 年和 2019 年为中心）从县卫生排名中收集的县一级数据进行了回顾性分析。我们使用方差分析比较了五个健康和 SDOH 领域（健康结果、临床护理、健康行为、物理环境和社会经济因素）中 33 个指标，这些指标在两个时期都可用，以及两个时期之间指标的变化，以及根据经济创新集团 2015-2019 年受灾社区指数得分，在县一级繁荣五分位数中，最繁荣和最不繁荣县之间的指标比值。
除了七个例外，在两个时期，我们发现随着从较繁荣县到较不繁荣县的每一次进展，值都在恶化，最不繁荣县的情况最差（所有指标的方差分析 p < 0.001）。在 2015 年至 2019 年期间，当比较较高和较低繁荣五分位数时，除了六个指标之外，所有指标都逐渐恶化，而且最不繁荣县和最繁荣县之间的差距普遍扩大。
在 2010 年代后期，美国最不繁荣的县在健康结果、临床护理、健康行为、物理环境和社会经济因素方面的衡量指标中，其值明显比较繁荣的县更差。在 2015 年至 2019 年期间，对于大多数指标，最不繁荣县和最繁荣县之间的不平等现象加剧。我们的研究结果表明，当地经济繁荣程度可能是社区健康和 SDOH 状况的一个指标。公共和私营部门的政策制定者和领导人可以在经济欠发达的县长期、有针对性地实施经济刺激措施，为弱势人群带来当地的社区健康效益。这样做可以可持续地改善健康状况；不这样做将继续导致不良的健康结果和不断扩大的经济差距。
