Beauchamp Alaina M, Shen Gordon C, Hussain Syed H, Adam Atif, Highfield Linda, Zhang Kai
The University of Texas Health Science Center at Houston School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Dallas, TX, USA.
UT Southwestern Medical Center, O'Donnell School of Public Health, Dallas, TX, USA.
SSM Popul Health. 2023 Dec 29;25:101591. doi: 10.1016/j.ssmph.2023.101591. eCollection 2024 Mar.
Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot and cold spots that are the highest and lowest CCI quintile, respectively. Hot spots census tracts were mostly located in metropolitan areas (84.8%), in the Southern census region (41.5%), and also had larger Black and Hispanic populations. The census tracts with the greatest need for culturally competent health care also had the sickest populations. Census tracts with a CCI rank of 5 ('greatest need') had higher prevalences of self-reported poor physical health (17.2%) and poor mental health (17.4%), compared to either the general population (13.9% and 14.5%) or to CCI rank of 1 ('lowest need') (11.9% and 10.8%). The CCI can pinpoint census tracts with a need for culturally competent health care and inform supply-side policy planning as healthcare and social service providers will inevitably come in contact with consumers from different backgrounds.
美国少数族裔人口将持续增长。这种多元化使得对文化背景进行反复的地理空间测量成为必要。我们这项研究的目的是在美国不同种族、语言和宗教多样性的地理区域创建一种衡量健康社会决定因素的方法。我们根据2015年至2019年与人群健康差异已知相关的社区特征提取了地理信息系统数据。我们使用主成分分析构建了一个文化背景指数（CCI）。我们为美国50个州和5个有人居住的领地的73682个普查区创建了CCI。我们分别确定了CCI五分位数最高和最低的热点和冷点地区。热点普查区大多位于大都市地区（84.8%）、南部普查区（41.5%），并且黑人及西班牙裔人口较多。对具有文化能力的医疗保健需求最大的普查区，其人口健康状况也最差。与普通人群（13.9%和14.5%）或CCI排名为1（“需求最低”）的普查区（11.9%和10.8%）相比，CCI排名为5（“需求最大”）的普查区自我报告的身体健康不佳（17.2%）和心理健康不佳（17.4%）的患病率更高。CCI可以确定需要具有文化能力的医疗保健的普查区，并为供应方政策规划提供信息，因为医疗保健和社会服务提供者将不可避免地接触到来自不同背景的消费者。
