Background

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.

Methods

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.

Findings

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.

Interpretation

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.

Funding

State of Washington and National Institute on Minority Health and Health Disparities.

中文翻译：

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2008-21 年美国按种族和民族、年龄、性别和地点划分的福祉差异：使用人类发展指数的分析

 背景

人类发展指数 （HDI） 是一种包含人口预期寿命、教育和收入的综合指标，广泛用于评估和比较国家层面的人类发展和福祉，但不考虑国内不平等。在这项对美国的研究中，我们旨在调整 HDI 框架以衡量个人层面的 HDI，以检查按种族和民族、性别、年龄和地理位置划分的幸福感分布差异。

 方法

我们使用了 2008-21 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人水平数据。我们提取了有关种族和民族、年龄、性别、位置（公共使用微数据区域）、教育程度以及家庭收入和规模的信息。我们将这些数据与按种族和民族、性别、年龄、位置（县）和年份划分的估计寿命表合并，这些表使用应用于国家生命统计系统死亡证明数据的贝叶斯小面积估计模型生成。对于 ACS 中的每个人，我们使用这些综合数据来估计受教育年限、家庭消费和预期寿命;使用百分位分数将这三个特征中的每一个都转换为指数;并将 HDI 计算为这三个指数的几何平均值。最后，我们将个体分为年度 HDI 十分位数。

 发现

在 2008-21 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 HDI）差异很大。对于大多数种族、民族和性别群体，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 按种族、民族和性别的分布存在系统性差异。在人类发展指数最低的十分位数中，美洲印第安人和阿拉斯加原住民 （AIAN） 男性（十分位数为 50% [SE 0·2]，十分位数为平均年人口 0·37 万 [SE 0·002]）、黑人男性（40% [<0·1]，4·67 百万 [0·006]）、 AIAN 女性（23% [0·1]，0·1900 万 [0·001]）、拉丁裔男性（21% [<0·1]，3·27 百万 [0·006]）、黑人女性（14% [<0·1]，1·86 万 [0·004]）和拉丁裔女性（13% [<0·1]，2·07 万 [0·006]）。然而，鉴于总人口规模的差异，白人男性是最低十分位数中最大的人口群体（最低十分位数的 27% [<0·1]，即 5.87 万 [0·012]），其次是黑人男性（22% [<0·1]）和拉丁裔男性（15% [<0·1]）。这些模式按年龄组存在显着差异：例如，对于 25-44 岁年龄组，最低的 HDI 十分位数的 AIAN 男性（66% [0·2] 十分位数，0·22 百万 [0·001]）和黑人男性（46% [<0·1]，2·52 万 [0·005]）比 85 岁及以上年龄组（22% [1·1]）（22% [1·1]） <0·01 百万 [<0·001];和 20% [0·3]、0.03 万 [<0·001]）。 相比之下，最低的十分位数在 25-44 岁年龄组中的亚洲女性代表性不足（2% [<0·1]，0.06 万 [<0·001]），但在 85 岁及以上年龄组中代表性过高（25% [0·3]，0.03 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]，6·44 百万 [0·009]），而 85 岁及以上的人群主要是女性（71% [0·1]，0·42 万 [0·002]）。在 HDI 最高的十分位数中，白人男性按年龄划分的人口构成变化特别大，在 25-44 岁年龄组中，他们占该十分位数的 5%（0·1;0·39 万 [0·001]），但在 85 岁及以上年龄组中占 49%（0·2;0·2900 [0·001]）。从 2012 年到 2021 年，生活在 HDI 最低十分位数的人口比例因地点而异，居住在美国南半部大部分地区、阿巴拉契亚和铁锈地带各州的人口比例过高，处于 HDI 最低的十分位数。

 解释

美国国内的幸福感存在巨大差异，并且在很大程度上受到种族和民族（由于种族主义）、性别、年龄和地理位置的影响。这些差距不是一成不变的，但改进不是必然的，面对 COVID-19 大流行等危机，收益可能是转瞬即逝的。需要采取持续行动，确保每个人都能有意义地获得高质量的教育，获得足够的收入，并有机会过上健康长寿的生活，以减少这些差距，并应关注最贫困的人群和地区。

 资金

华盛顿州和国家少数族裔健康和健康差异研究所。