Eliminating health disparities is a fundamental, though not always explicit, goal of public health research and practice. There is a burgeoning literature in this area, but a number of unresolved issues remain. These include the definition of what constitutes a disparity, the relationship of different bases of disadvantage, the ability to attribute cause from association, and the establishment of the mechanisms by which social disadvantage affects biological processes that get into the body, resulting in disease. We examine current definitions and empirical research on health disparities, particularly disparities associated with race/ethnicity and socioeconomic status, and discuss data structures and analytic strategies that allow causal inference about the health impacts of these and associated factors. We show that although health is consistently worse for individuals with few resources and for blacks as compared with whites, the extent of health disparities varies by outcome, time, and geographic location within the United States. Empirical work also demonstrates the importance of a joint consideration of race/ethnicity and social class. Finally, we discuss potential pathways, including exposure to chronic stress and resulting psychosocial and physiological responses to stress, that serve as mechanisms by which social disadvantage results in health disparities.

中文翻译：

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美国的健康差异：描述，原因和机制。

消除卫生差距是公共卫生研究和实践的基本目标，尽管并非总是明确的。这个领域的文学正在蓬勃发展，但是仍有许多未解决的问题。这些包括对构成差异的定义，不利因素的不同基础之间的关系，从关联中归因的能力以及建立社会不利因素影响进入人体的生物过程并导致疾病的机制的建立。我们研究了当前关于健康差异的定义和实证研究，特别是与种族/民族和社会经济地位有关的差异，并讨论了可以对这些健康影响及相关因素进行因果推断的数据结构和分析策略。我们显示，尽管与白人相比，资源匮乏的人和黑人的健康状况始终较差，但健康差异的程度因结果，时间和地理位置在美国境内而异。实证研究还证明了种族/民族和社会阶层共同考虑的重要性。最后，我们讨论了潜在的途径，包括暴露于慢性压力以及由此产生的对压力的社会心理和生理反应，它们是社会不利因素导致健康差异的机制。实证研究还证明了种族/民族和社会阶层共同考虑的重要性。最后，我们讨论了潜在的途径，包括暴露于慢性压力以及由此产生的对压力的社会心理和生理反应，它们是社会不利因素导致健康差异的机制。实证研究还证明了种族/民族和社会阶层共同考虑的重要性。最后，我们讨论了潜在的途径，包括暴露于慢性压力以及由此产生的对压力的社会心理和生理反应，它们是社会不利因素导致健康差异的机制。