An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health
Abstract Background Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-09-01
|
| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12939-023-01984-6 |
| _version_ | 1797453477088067584 |
|---|---|
| author | William B Weeks Ji E Chang José A Pagán Ann Aerts James N Weinstein Juan Lavista Ferres |
| author_facet | William B Weeks Ji E Chang José A Pagán Ann Aerts James N Weinstein Juan Lavista Ferres |
| author_sort | William B Weeks |
| collection | DOAJ |
| description | Abstract Background Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. Methods For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group’s 2015–2019 Distressed Community Index Scores. Results With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. Conclusions In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities. |
| first_indexed | 2024-03-09T15:23:24Z |
| format | Article |
| id | doaj.art-6acd7cea434a46a7a8940f923e954deb |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-03-09T15:23:24Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-6acd7cea434a46a7a8940f923e954deb2023-11-26T12:39:17ZengBMCInternational Journal for Equity in Health1475-92762023-09-0122111010.1186/s12939-023-01984-6An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of healthWilliam B Weeks0Ji E Chang1José A Pagán2Ann Aerts3James N Weinstein4Juan Lavista Ferres5AI for Good LabNYU School of Global Public HealthNYU School of Global Public HealthNovartis FoundationMicrosoft ResearchAI for Good LabAbstract Background Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. Methods For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group’s 2015–2019 Distressed Community Index Scores. Results With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. Conclusions In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.https://doi.org/10.1186/s12939-023-01984-6Population healthHealth equitySocio-economic statusSocial determinants of health |
| spellingShingle | William B Weeks Ji E Chang José A Pagán Ann Aerts James N Weinstein Juan Lavista Ferres An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health International Journal for Equity in Health Population health Health equity Socio-economic status Social determinants of health |
| title | An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health |
| title_full | An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health |
| title_fullStr | An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health |
| title_full_unstemmed | An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health |
| title_short | An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health |
| title_sort | observational sequential analysis of the relationship between local economic distress and inequities in health outcomes clinical care health behaviors and social determinants of health |
| topic | Population health Health equity Socio-economic status Social determinants of health |
| url | https://doi.org/10.1186/s12939-023-01984-6 |
| work_keys_str_mv | AT williambweeks anobservationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT jiechang anobservationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT joseapagan anobservationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT annaerts anobservationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT jamesnweinstein anobservationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT juanlavistaferres anobservationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT williambweeks observationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT jiechang observationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT joseapagan observationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT annaerts observationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT jamesnweinstein observationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth AT juanlavistaferres observationalsequentialanalysisoftherelationshipbetweenlocaleconomicdistressandinequitiesinhealthoutcomesclinicalcarehealthbehaviorsandsocialdeterminantsofhealth |