Eliminating Health Disparities Measurement and Data Needs (2004) / Chapter Skim
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3 Measuring Race, Ethnicity, Socioeconomic Position, and Acculturation
3 Measuring Race, Ethnicity, Socioeconomic Position, and Acculturation
Pages 41-61
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From page 41... ...
data systems and then describes measures of SEP and acculturation and language use. We then discuss some data collection issues that apply to the measurement of each of these concepts.
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From page 42... ...
. Self-report was established as the preferred method of collecting data, and respondents were instructed to choose only one race and one ethnicity.1 1Because Hispanic origin is given special priority, equal to basic racial categories, in the OMB standards, the term ethnicity is often used to refer solely to the response to the question on Hispanic or non-Hispanic origin.
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1990 White, Black, Indian (American) , Eskimo, Aleut, Chinese, Filipino, Hawaiian, Korean, Vietnamese, Japanese, Asian Indian, Samoan, Guamanian, Other Asian Pacific Islander, Other race 2000 White; Black, African American, or Negro; American Indian or Alaska Native (specify tribe)
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As with the 1977 guidelines, these minimum standards apply to all federal data collection activities but not to state or private-sector data collection, except when required for federally sponsored statistical data collections, including all federal administrative and grant reporting (OMB, 1997) .2 OMB emphasized "The categories represent a social-political con struct designed for collecting data on the race and ethnicity of broad popu lation groups in this country, and are not anthropologically or scientifically based" (OMB, 1997, p.
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showed that infant mor tality rates varied by the infant's mother's Hispanic ethnicity: infants of Puerto Rican descent had the lowest birth weights and the highest infant mortality rates of all Hispanic groups, while infants of Cuban descent had the lowest infant mortality rate. Thus, especially for more localized use of data, it is important to distinguish among ethnic groups within a racial category (e.g., between Filipinos and Japanese)
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The federal government currently has no standard way of measuring educational at tainment in its data collection efforts, but a Federal Interagency Committee on Measures of Educational Attainment recommended that the measure of education used on the 2000 census long form should be the model for measuring education in all federal surveys and administrative data collec tions. This measure, shown in Box 3-1, combines years of schooling com pleted through high school with detailed categories for college and ad vanced degrees (Federal Interagency Committee on Measures of Educational Attainment, 2000)
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No schooling completed Nursery school to 4th grade 5th grade or 6th grade 7th grade or 8th grade 9th grade 10th grade 11th grade 12th grade, NO DIPLOMA HIGH SCHOOL GRADUATE -- high school DIPLOMA or the equivalent (for ex ample: GED) Some college credit, but less than 1 year 1 or more years of college, no degree Associate's degree (for example: AA, AS)
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Since wealth is transferable from generation 4For example, elderly people often have little current income but significant wealth, and so wealth may be more important than income when assessing their SEP. In contrast, younger people may have high current income, but lower levels of accumulated wealth.
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review how wealth is measured in health and health care data collection systems. Lifetime Income and Wealth History While wealth and current income measure current economic resources, lifetime income and wealth and their dynamics can also be important di mensions of SEP.
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The Panel Study of In come Dynamics is unique in that this longitudinal survey has followed the same families since 1968 and has collected extensive income and wealth data on these families. Another possible source of lifetime income measure ment is from earnings records reported to the Social Security Administra tion (SSA)
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For example, income information is collected to determine eligibility for the Medicaid program and some states with assets tests collect information on household assets such as savings accounts, investments, and automobiles.6 Some surveys collect information about participation in low-income programs such as Medicaid, State Children's Health Insurance Program (SCHIP) , the Women, Infants, and Children (WIC)
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An individual's degree of acculturation can be measured by cultural characteristics, such as language preference and English proficiency or cultural practices, or by other variables that measure status, such as place of birth or years or generations living in the United States. These variables may yield more information useful for studying health and health care because they are closer proxies to factors that tend to vary across cultures that may affect 7In the context of this broad review of data systems and their collection of SEP, the panel cannot specify which measures of SEP should be collected in every data system.
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But often only one question is asked about the respondent's pre ferred or primary language. These simple scales of acculturation based on language proficiency, either combined or as a single question, have proven to be good and reliable indicators for health care research among immi 9Acculturation scales for Asian subpopulations have also been developed and are being used to assess variations in health and health care among these groups (Anderson et al., 1993)
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Such information is likely to be useful to improve program administration, to target language -- appropriate educa tional materials and information, to suggest providers, or to allocate trans lation services. Generational status and time in the United States are addi tional indicators of the acculturation experience and can provide pertinent information about health care access and utilization of health services in addition to differences in health outcomes among immigrant populations living in the United States.
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Data collected in the application process for health insurance are used to underwrite policies. Data on race and ethnicity are sometimes used to enforce civil rights laws.
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Some surveys ask specifically about health status, such as the National Health Interview Survey, while others focus on other topics such as medical expenditures (the Medical Expenditure Panel Study) and collect only limited information on health status.
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Examples of administrative data systems include the Medicare Enrollment Database, which represents enrollees since 1966, and the federal Healthcare Cost Utilization Project, which collects hospital discharge abstracts in a uniform way from 28 state data organizations. These administrative data sets are more often used for their information on health care utilization rather than on health status, as measures of the latter are not usually collected as part of the administrative process.
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These inferences may be descriptive -- describing health status, disease prevalence, and health care outcomes for a population of interest -- or they may be used to draw causal conclusions about why an outcome or a difference in outcomes between groups is observed. While information at the individual level is needed in order to make these infer ences, the specific identities of individuals are irrelevant and inferences are always drawn at an aggregate level.
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For example, a health insurance plan might collect ethnicity and language data on enrollees to target culturally appropriate information or program interventions to individuals in their primary language. Or a plan may want to target information on disease prevention to enrollees who belong to racial or ethnic groups with higher prevalences of certain diseases.
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(2003) found that census tract- and census block-level measures of SEP gave consistent parameter estimates of the effects of these SEP measures on outcomes across different racial, ethnic, and gender groups, while Zip Code level measures were less consistent.
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Linking across data sets has great potential payoff in terms of increased content coverage over a single source of data. For example, SEP and lan guage data from other data sources could be linked to a data set that does not cover these items, or demographic information or information on health outcomes could be linked to information about health care received.
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