一个基于社会决定因素的县级心血管死亡指数,以确定美国高风险县
Anqi Zhu1, Bibhas Chakraborty1,2,3,4, Tazeen H Jafar5,6
1Program in Health Services Research & Population Health, Duke-NUS Medical School, Singapore, Singapore.
一个新的社会心血管死亡率指数 (SCMI) 有效地确定了美国心血管疾病 (CVD) 死亡率高风险的县. 这一指数基于健康的社会决定因素 (SDOH),在预测心血管疾病死亡方面表现优于现有的工具.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 健康差异 在健康上的差异
背景情况:
- 健康的社会决定因素 (SDOH) 显著影响美国心血管疾病 (CVD) 死亡率的地理差异.
- 识别风险县对于公共卫生监测和规划至关重要.
研究的目的:
- 开发和评估与SDOH相关的社会心血管死亡率指数 (SCMI) 用于人口级心血管疾病死亡风险评估.
- 确定与美国各县心血管疾病死亡率相关的关键SDOH变量.
主要方法:
- 在3141个美国县的158个SDOH变量上利用机器学习来确定心血管疾病死亡率的15个关键决定因素.
- 开发了SCMI (0-100) 并使用启动样本与社会脆弱性指数 (SVI) 验证了其预测性能.
- 采用地理随机森林模型,确定与县级心血管疾病死亡率相关的主要SDOH因素.
主要成果:
- 在最高SCMI五分位数的县,与最低五分位数相比,每10万人口预测的心血管疾病死亡人数显著增加.
- SCMI对未来心血管疾病死亡率的预测准确度高于SVI,由较高的R2和较低的RMSE和MAE证明.
- 频繁的精神困扰,SNAP参与和较低的家庭收入中位数成为SDOH导致心血管疾病死亡率的主要决定因素.
结论:
- 基于SDOH的新型SCMI有效地预测了美国高风险心血管疾病死亡率的县,其表现优于SVI.
- 确定了领先的县级SDOH变量,为社区干预减少心血管疾病死亡率提供了潜在的目标.
- 这些发现可以提高县级心血管风险分层,并减轻心血管疾病死亡率的地理差异.
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