Dwyer-Lindgren Laura, Kendrick Parkes, Baumann Mathew M, Li Zhuochen, Schmidt Chris, Sylte Dillon O, Daoud Farah, La Motte-Kerr Wichada, Aldridge Robert W, Bisignano Catherine, Hay Simon I, Mokdad Ali H, Murray Christopher J L
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Lancet. 2024 Dec 7;404(10469):2261-2277. doi: 10.1016/S0140-6736(24)01757-4. Epub 2024 Nov 7.
The Human Development Index (HDI)-a composite metric encompassing a population's life expectancy, education, and income-is used widely for assessing and comparing human development and wellbeing at the country level, but does not account for within-country inequality. In this study of the USA, we aimed to adapt the HDI framework to measure the HDI at an individual level to examine disparities in the distribution of wellbeing by race and ethnicity, sex, age, and geographical location.
We used individual-level data on adults aged 25 years and older from the 2008-21 American Community Survey (ACS) Public Use Microdata Sample. We extracted information on race and ethnicity, age, sex, location (Public Use Microdata Areas), educational attainment, and household income and size. We merged these data with estimated life tables by race and ethnicity, sex, age, location (county), and year, generated using Bayesian small-area estimation models applied to death certificate data from the National Vital Statistics System. For each individual in the ACS, we used these combined data to estimate years of education, household consumption, and expected lifespan; converted each of these three features into an index using a percentile score; and calculated the HDI as the geometric mean of these three indices. Finally, we grouped individuals into yearly HDI deciles.
Years of education, household consumption, and expected lifespan-and thus the HDI-varied considerably among adults in the USA during the 2008-21 period. For most race and ethnicity and sex groups, the mean HDI increased gradually from 2008 to 2019, then declined in 2020 due to declines in expected lifespan, although there were systematic differences in the distribution of the HDI by race and ethnicity and sex. In the lowest HDI decile, there was over-representation (ie, >10% of the total population of a given race and ethnicity and sex group) of American Indian and Alaska Native (AIAN) males (50% [SE 0·2] in decile, mean annual population in decile 0·37 million [SE 0·002]), Black males (40% [<0·1], 4·67 million [0·006]), AIAN females (23% [0·1], 0·19 million [0·001]), Latino males (21% [<0·1], 3·27 million [0·006]), Black females (14% [<0·1], 1·86 million [0·004]), and Latina females (13% [<0·1], 2·07 million [0·006]). Given differences in total population size, however, White males were the largest population group in the lowest decile (27% [<0·1] of the lowest decile, 5·87 million [0·012]), followed by Black males (22% [<0·1]) and Latino males (15% [<0·1]). There were notable differences in these patterns by age group: for example, for the 25-44 years age group, the lowest HDI decile had even greater over-representation of AIAN males (66% [0·2] in decile, 0·22 million [0·001]) and Black males (46% [<0·1], 2·52 million [0·005]) than the 85 years and older age group (22% [1·1], <0·01 million [<0·001]; and 20% [0·3], 0·03 million [<0·001]). By contrast, the lowest decile had an under-representation of Asian females (2% [<0·1], 0·06 million [<0·001]) in the 25-44 years age group, but an over-representation in the 85 years and older age group (25% [0·3], 0·03 million [<0·001]). The lowest HDI decile for the 25-44 years age group was primarily male (76% [<0·1], 6·44 million [0·009]) whereas for age 85 years and older it was predominantly female (71% [0·1], 0·42 million [0·002]). In the highest HDI decile, shifts in the composition of the population by age were particularly large for White males, who made up 5% (0·1; 0·39 million [0·001]) of this decile in the 25-44 years age group, but 49% (0·2; 0·29 million [0·001]) in the 85 years and older age group. From 2012 to 2021, the proportion of the population living in the lowest HDI decile varied substantially by location, and a disproportionately high share of the population living in locations in much of the southern half of the USA, Appalachia, and Rust Belt states were in the lowest HDI decile.
Substantial disparities in wellbeing exist within the USA and are heavily influenced by race and ethnicity (due to racism), sex, age, and geographical location. These disparities are not immutable, but improvement is not a given, and gains can be fleeting in the face of a crisis such as the COVID-19 pandemic. Sustained action to ensure that everyone has meaningful access to a high-quality education, the means to earn a sufficient income, and the opportunity to live a long and healthy life is needed to reduce these disparities and should focus on the populations and locations that are worst off.
State of Washington and National Institute on Minority Health and Health Disparities.
人类发展指数（HDI）是一个综合指标，涵盖了人口的预期寿命、教育程度和收入，广泛用于在国家层面评估和比较人类发展与福祉，但未考虑国内不平等情况。在这项针对美国的研究中，我们旨在调整HDI框架，以在个体层面衡量HDI，从而研究福祉分配在种族和族裔、性别、年龄及地理位置方面的差异。
我们使用了2008 - 2021年美国社区调查（ACS）公共使用微观数据样本中25岁及以上成年人的个体层面数据。我们提取了关于种族和族裔、年龄、性别、地点（公共使用微观数据区域）、教育程度、家庭收入和规模的信息。我们将这些数据与根据种族和族裔、性别、年龄、地点（县）及年份生成的估计生命表合并，这些生命表是使用贝叶斯小区域估计模型应用于来自国家 Vital Statistics System的死亡证明数据生成的。对于ACS中的每个个体，我们使用这些合并数据来估计受教育年限、家庭消费和预期寿命；使用百分位数分数将这三个特征中的每一个转换为一个指数；并将HDI计算为这三个指数的几何平均值。最后，我们将个体分组为年度HDI十分位数。
在2008 - 2021年期间，美国成年人的受教育年限、家庭消费和预期寿命——以及因此的HDI——差异很大。对于大多数种族和族裔以及性别群体，平均HDI从2008年到2019年逐渐增加，然后在2020年由于预期寿命下降而下降，尽管HDI在种族和族裔以及性别方面的分布存在系统性差异。在最低HDI十分位数中，美国印第安人和阿拉斯加原住民（AIAN）男性（十分位数中占50% [标准误0·2]，十分位数中的平均年人口为0·37百万 [标准误0·002]）、黑人男性（40% [<0·1]，467万 [0·006]）、AIAN女性（23% [0·1]，0·19百万 [0·001]）、拉丁裔男性（21% [<0·1]，327万 [0·006]）、黑人女性（14% [<0·1]，186万 [0·004]）和拉丁裔女性（13% [<0·1]，207万 [0·006]）的占比过高（即占给定种族和族裔以及性别群体总人口的>10%）。然而，考虑到总人口规模的差异，白人男性是最低十分位数中最大的人口群体（占最低十分位数的27% [<0·1]，587万 [0·012]），其次是黑人男性（22% [<0·1]）和拉丁裔男性（15% [<0·1]）。这些模式在不同年龄组之间存在显著差异：例如，对于25 - 44岁年龄组，最低HDI十分位数中AIAN男性（十分位数中占66% [0·2]，0·22百万 [0·001]）和黑人男性（46% [<0·1]，252万 [0·005]）的占比甚至高于85岁及以上年龄组（22% [1·1]，<0·01百万 [<0·001]；和20% [0·3]，0·03百万 [<0·001]）。相比之下，最低十分位数在25 - 44岁年龄组中亚洲女性的占比过低（2% [<0·1]，0·06百万 [<0·001]），但在85岁及以上年龄组中占比过高（25% [0·3]，0·03百万 [<0·001]）。25 - 44岁年龄组的最低HDI十分位数主要是男性（76% [<0·1]，644万 [0·009]），而85岁及以上年龄组则主要是女性（71% [0·1]，0·42百万 [0·002]）。在最高HDI十分位数中，白人男性在不同年龄组的人口构成变化尤为显著，他们在25 - 44岁年龄组中占该十分位数的5%（0·1；0·39百万 [0·001]），但在85岁及以上年龄组中占49%（0·2；0·29百万 [0·001]）。从2012年到2021年，生活在最低HDI十分位数的人口比例在不同地点差异很大，美国南部一半地区、阿巴拉契亚地区和铁锈地带各州的许多地方，生活在最低HDI十分位数的人口比例过高。
美国国内存在巨大的福祉差异，并且受到种族和族裔（由于种族主义）、性别、年龄和地理位置的严重影响。这些差异并非不可改变，但改善并非必然，面对像COVID - 19大流行这样的危机，进展可能转瞬即逝。需要持续采取行动，确保每个人都能切实获得高质量教育、赚取足够收入的手段以及过上长寿健康生活的机会，以减少这些差异，并且应关注处境最差的人群和地区。
华盛顿州以及国家少数族裔健康与健康差异研究所。
