Zhang Xue, Monnat Shannon M
Lerner Center for Public Health Promotion and Population Health, Syracuse University, NY, 13244, USA.
Center for Policy Research, Syracuse University, NY, 13244, USA.
SSM Popul Health. 2024 Jan 2;25:101595. doi: 10.1016/j.ssmph.2023.101595. eCollection 2024 Mar.
Mortality rates from drug poisoning, suicide, alcohol, and homicide vary significantly across the United States. This study explores localized relationships (i.e., geographically specific associations) between county-level economic and household distress and mortality rates from these causes among working-age adults (25-64).
Mortality data were from the National Vital Statistics System for 2014-2019. County-level socioeconomic distress (poverty, employment, income, education, disability, insurance) and household distress (single-parent, no vehicle, crowded housing, renter occupied) were from the 2009-2013 American Community Survey. We conducted Ordinary Least Squares (OLS) regression to estimate average associations and Geographically Weighted Regression (GWR) to estimate localized spatial associations between county-level distress and working-age mortality.
In terms of national average associations, OLS results indicate that a one standard deviation increase in socioeconomic distress was associated with an average of 6.1 additional drug poisoning deaths, 3.0 suicides, 2.1 alcohol-induced deaths, and 2.0 homicides per 100,000 population. A one standard deviation increase in household distress was associated with an average of 1.4 additional drug poisonings, 4.7 alcohol-induced deaths, and 1.1 homicides per 100,000 population. However, the GWR results showed that these associations vary substantially across the U.S., with socioeconomic and household distress associated with significantly higher mortality rates in some parts of the U.S than others, significantly lower rates in other parts of the U.S., and no significant associations in others. There were also some areas where distress overlapped to influence multiple causes of death, in a type of compounded disadvantage.
Socioeconomic and household distress are significant and substantial predictors of higher rates of drug poisoning mortality, suicide, alcohol-induced deaths, and homicide in specific regions of the U.S. However, these associations are not universal. Understanding the place-level factors that contribute to them can inform geographically tailored strategies to reduce rates from these preventable causes of death in different places.
药物中毒、自杀、酒精和凶杀导致的死亡率在美国各地差异显著。本研究探讨了县级经济和家庭困境与工作年龄成年人（25 - 64岁）因这些原因导致的死亡率之间的局部关系（即地理上特定的关联）。
死亡率数据来自2014 - 2019年国家生命统计系统。县级社会经济困境（贫困、就业、收入、教育、残疾、保险）和家庭困境（单亲家庭、无车辆、住房拥挤、租房居住）来自2009 - 2013年美国社区调查。我们进行了普通最小二乘法（OLS）回归以估计平均关联，并进行地理加权回归（GWR）以估计县级困境与工作年龄死亡率之间的局部空间关联。
就全国平均关联而言，OLS结果表明，社会经济困境每增加一个标准差，每10万人中平均额外增加6.1例药物中毒死亡、3.0例自杀、2.1例酒精导致的死亡和2.0例凶杀。家庭困境每增加一个标准差，每10万人中平均额外增加1.4例药物中毒、4.7例酒精导致的死亡和1.1例凶杀。然而，GWR结果显示，这些关联在美国各地差异很大，社会经济和家庭困境在美国某些地区与显著更高的死亡率相关，在其他地区则显著更低，在其他地区则无显著关联。也有一些地区困境相互重叠，以一种复合劣势的形式影响多种死因。
社会经济和家庭困境是美国特定地区药物中毒死亡率、自杀率、酒精导致的死亡率和凶杀率较高的重要且显著的预测因素。然而，这些关联并非普遍存在。了解导致这些现象的地方层面因素可以为制定因地制宜的策略提供依据，以降低不同地区这些可预防死因导致的死亡率。
