1. Evaluating Area-Based Socioeconomic Status Indicators for Monitoring Disparities within Health Care Systems: Results from a Primary Care Network.
- Author
-
Berkowitz, Seth A., Traore, Carine Y., Singer, Daniel E., and Atlas, Steven J.
- Subjects
- *
SOCIAL status , *SOCIOECONOMICS , *MEDICAL care , *PRIMARY care , *HEALTH outcome assessment - Abstract
Objective To determine which area-based socioeconomic status ( SES) indicator is best suited to monitor health care disparities from a delivery system perspective. Data Sources/Study Setting 142,659 adults seen in a primary care network from January 1, 2009 to December 31, 2011. Study Design Cross-sectional, comparing associations between area-based SES indicators and patient outcomes. Data Collection Address data were geocoded to construct area-based SES indicators at block group ( BG), census tract ( CT), and ZIP code ( ZIP) levels. Data on health outcomes were abstracted from electronic records. Relative indices of inequality ( RIIs) were calculated to quantify disparities detected by area-based SES indicators and compared to RIIs from self-reported educational attainment. Principal Findings ZIP indicators had less missing data than BG or CT indicators ( p < .0001). Area-based SES indicators were strongly associated with self-report educational attainment ( p < .0001). ZIP, BG, and CT indicators all detected expected SES gradients in health outcomes similarly. Single-item, cut point defined indicators performed as well as multidimensional indices and quantile indicators. Conclusions Area-based SES indicators detected health outcome differences well and may be useful for monitoring disparities within health care systems. Our preferred indicator was ZIP-level median household income or percent poverty, using cut points. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF