Grobman Benjamin, Bondarchuk Connor P, Mansur Arian, Lu Christine Y
Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA.
J Racial Ethn Health Disparities. 2025 Aug 8. doi: 10.1007/s40615-025-02595-3.
People living in areas of lower socioeconomic status experience worse health outcomes. Less is known about how specific measures of area-level socioeconomic influence mortality, and how these effects are modified by race, geography, and gender in the United States.
We obtained data on deaths from all causes in the United States from 1999 to 2020 from the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research database. We combined county-level age-adjusted mortality rates (AAMRs) and population counts from the CDC WONDER database with the overall SVI score, both for the overall population and for sociodemographic subgroups. We divided the SVI into quartiles and compared death rates across groups by SVI quartile.
Higher SVI scores were significantly associated with higher all-cause mortality rates in the overall population (p < 0.001) and across all sociodemographic subgroups. Significant mortality disparities were observed across all subgroups. Notably, Black-White disparities were not significant in the least vulnerable quartile (AAMR ratio = 1.10, 95% CI: 0.96-1.25, p = 0.16) but remained significant in all other quartiles and for the overall population.
In this national analysis, higher SVI was consistently linked to increased mortality across all population subgroups. While sociodemographic disparities were significant across SVI quartiles, they tended to widen with increasing SVI. The lack of significant Black-White disparities in the least vulnerable quartile suggests that reducing social vulnerability may help mitigate racial health disparities, though it alone may not be sufficient. These findings highlight the potential for targeted interventions to reduce social deprivation, particularly to benefit Black Americans.
生活在社会经济地位较低地区的人群健康状况较差。关于地区层面社会经济的具体衡量指标如何影响死亡率，以及在美国这些影响如何因种族、地理位置和性别而改变，我们所知甚少。
我们从疾病控制中心的广泛在线流行病学研究数据库中获取了1999年至2020年美国所有原因导致的死亡数据。我们将疾病预防控制中心WONDER数据库中的县级年龄调整死亡率（AAMR）和人口计数与总体社会脆弱性指数（SVI）得分相结合，包括总体人群和社会人口亚组的得分。我们将SVI分为四分位数，并按SVI四分位数比较各组的死亡率。
在总体人群（p < 0.001）和所有社会人口亚组中，较高的SVI得分与较高的全因死亡率显著相关。在所有亚组中均观察到显著的死亡率差异。值得注意的是，在最不易受影响的四分位数中，黑人和白人之间的差异不显著（AAMR比值 = 1.10，95%置信区间：0.96 - 1.25，p = 0.16），但在所有其他四分位数以及总体人群中仍然显著。
在这项全国性分析中，较高的SVI始终与所有人群亚组的死亡率增加相关。虽然社会人口差异在SVI四分位数中很显著，但它们往往随着SVI的增加而扩大。在最不易受影响的四分位数中缺乏显著的黑人和白人差异表明，减少社会脆弱性可能有助于减轻种族健康差异，尽管仅靠这一点可能还不够。这些发现凸显了有针对性的干预措施减少社会剥夺的潜力，特别是对美国黑人有益。
