Lines Lisa M, Fowler Christina I, Kaganova Yevgeniya, Peacock Karen
Center for the Health of Populations, RTI International, Research Triangle Park, NC 27709-2194, United States.
Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States.
Health Aff Sch. 2024 Jul 27;2(7):qxae048. doi: 10.1093/haschl/qxae048. eCollection 2024 Jul.
Equitable access to sexual and reproductive health (SRH) care is key to reducing inequities in SRH outcomes. Publicly funded family-planning services are an important source of SRH care for people with social risk factors that impede their access. This study aimed to create a new index (Local Social Inequity in SRH [LSI-SRH]) to measure community-level risk of adverse SRH outcomes based on social determinants of health (SDoH). We evaluated the validity of the LSI-SRH scores in predicting adverse SRH outcomes and the need for publicly funded services. The data were drawn from more than 200 publicly available SDoH and SRH measures, including availability and potential need for publicly supported family planning from the Guttmacher Institute. The sample included 72 999 Census tracts (99.9%) in the 50 states and the District of Columbia. We used random forest regression to predict the LSI-SRH scores; 42 indicators were retained in the final model. The LSI-SRH model explained 81% of variance in the composite SRH outcome, outperforming 3 general SDoH indices. LSI-SRH scores could be a useful for measuring community-level SRH risk and guiding site placement and resource allocation.
公平获得性与生殖健康（SRH）护理是减少SRH结果不平等的关键。由公共资金资助的计划生育服务是那些因社会风险因素而难以获得护理的人群获得SRH护理的重要来源。本研究旨在创建一个新的指数（性与生殖健康领域的地方社会不平等指数[LSI-SRH]），以基于健康的社会决定因素（SDoH）来衡量社区层面不良SRH结果的风险。我们评估了LSI-SRH分数在预测不良SRH结果及对公共资金资助服务需求方面的有效性。数据来源于200多项公开可用的SDoH和SRH指标，包括古特马赫研究所提供的公共支持计划生育的可及性和潜在需求。样本包括50个州和哥伦比亚特区的72999个普查区（占99.9%）。我们使用随机森林回归来预测LSI-SRH分数；最终模型保留了42个指标。LSI-SRH模型解释了综合SRH结果中81%的方差，优于3个一般的SDoH指数。LSI-SRH分数可能有助于衡量社区层面的SRH风险，并指导服务地点的设置和资源分配。
