Eliminating Health Disparities Measurement and Data Needs (2004) / Chapter Skim
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Appendix C Recommendations on the Use of Socioeconomic Position Indicators to Better Understand Racial Inequalities in Health
Appendix C Recommendations on the Use of Socioeconomic Position Indicators to Better Understand Racial Inequalities in Health
Pages 184-201
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From page 184... ...
Substantial research documents racial and ethnic disparities in health status and health care access. Racial disparities in disease incidence have been demonstrated for many health outcomes including cardiovascular disease, HIV/AIDS, diabetes, and infant morality (U.S.
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From page 185... ...
Socioeconomic position is often not taken into account at all. National Vital Statistics Reports produced by the Centers for Disease Control and Prevention are just one example of multiple official health reports that present data only on the racial distribution of health outcomes and fail to simultaneously address SEP issues (e.g., Anderson, 2002)
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Adjustment using a single or crude indicator of socioeconomic position results in problems of residual confounding for economic position when comparing health status or health care utilization between racial or ethnic groups. Use of multiple indicators will minimize the degree to which residual confounding is a problem.
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discussion of social and economic inequalities as the fundamental causes of racial disparities in health draws attention to our limited understanding of these causal relationships and points out the limited availability of SEP data in large routine administrative data sets, he too fails to offer insight into which existing measures of SEP might best be incorporated in studies of racial health disparities. General SEP research has found that economic measures (i.e., income and wealth)
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Only three of the sources reviewed address issues of wealth, and none utilize individual-level indices of socioeconomic position or indicators of social class. Among the administrative and survey sources presented in Table C-1, the use of multiple SEP indicators varies dramatically.
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Detailed set of questions: income from all sources including wages and salary; investment income; government program participation; rental property income; business income (Duncan et al., 2002)
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Indices Townsend index: a combination of unemployment among those 16 64; proportion of households with no car; proportion of households who do not own their dwellings; overcrowding as measured by more than one person per room. Other indices might include the Socioeconomic Status Index, which combines information on education and income of an area, and Stockwell, which differentially weights information on occupation, education, income, housing values, and overcrowding (see Liberatos, Link, and Kelsey, 1988; or Krieger, 1999; Krieger, Williams, and Moss, 1997, for overviews of various composite measures)
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, a residential Zip Code is provided for each respondent and can be used in a similar fashion to tie individual records to area-level information. REVIEW OF INDICATORS OF SOCIOECONOMIC POSITION We describe here the specific indicators of socioeconomic position and how they might be used to increase our understanding of racial inequalities in health.
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However, among those administrative sources that do collect information on income, another question on housing ownership and value might be considered. When possible, to promote a better understanding of the interaction of class and racial inequalities in health, information on wealth should be collected in future surveys and in administrative sources of data.
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Poverty can be determined using information on salary and wages and household size. The advantage of using poverty indicators is that, when expressed in relation to the official poverty line, they provide a measure of whether the household has the minimum resources for basic necessities.
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Because of this explicit link to mechanisms by which class processes can create inequalities, these social class indicators yield information that is different from the usual stratification measures (Muntaner, Eaton, and Diala, 2000)
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Government Program Participation Government program participation information, typically collected in administrative sources, is useful for the study of lower-income populations as, for program eligibility, there are often income cutoffs (e.g., Temporary Assistance for Needy Families, Food Stamps, Medicaid) , not though for all assistance programs (e.g., Medicare, unemployment benefits)
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USING SEP INDICATORS TO UNDERSTAND RACIAL INEQUALITIES IN HEALTH STATUS AND USE OF HEALTH CARE SERVICES To fully understand racial inequalities in health, we must begin to do a better job of untangling SEP from racial group membership. Thus far, few studies or reports have adequately accounted for SEP in a way that makes
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From page 197... ...
While education is the most common SEP indicator collected in these administrative data sets, some sources also contained information on critical economic indicators such as income and even wealth. For the data sets that contain only education, additional collection of a more direct indicator of economic standing (e.g., income or wealth)
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From page 198... ...
Given that research surveys often have the most flexibility for including questions on SEP we suggest that, when possible, multiple indicators be collected, with data on wealth receiving the highest priority. This approach of collecting multiple indicators allows for residual confounding to be addressed in the analyses of survey data on racial and ethnic differences in health.
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Williams 2002 Optimal indicators of socioeconomic status for health research. American Journal of Public Health 92(6)
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Wolfson 1999 Assessing ecologic proxies for household income: A comparison of household and neighborhood level income measures in the study of population and health status. Health and Place 5:157-171.
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Fortmann 1992 Socioeconomic status and health: How education, income, and occupation contrib ute to risk factors for cardiovascular disease. American Journal of Public Health 82(6)
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