American Journal of Epidemiology Advance Access originally published online on September 8, 2008
American Journal of Epidemiology 2008 168(8):906-914; doi:10.1093/aje/kwn207
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PRACTICE OF EPIDEMIOLOGY |
Methods and Software for Estimating Health Disparities: The Case of Children's Oral Health
Correspondence to Dr. Stuart A. Gansky, Division of Oral Epidemiology and Dental Public Health, University of California, San Francisco, 3333 California Street, Suite 495, San Francisco, CA 94143-1361 (e-mail: stuart.gansky{at}ucsf.edu).
Received for publication December 7, 2007. Accepted for publication June 12, 2008.
The National Center for Health Statistics recently issued a monograph with 11 guidelines for reporting health disparities. However, guidelines on confidence intervals (CIs) cannot be readily implemented with the complex sample surveys often used for disease surveillance. In the United States, dental caries (decay) is the most common chronic childhood disease—5 times more common than asthma. Racial/ethnic minorities, immigrants, and persons of lower socioeconomic position (SEP) have a greater prevalence of caries. The authors provide methods for applying National Center for Health Statistics guidelines to complex sample surveys (health disparity indices and absolute and relative difference measures assessing associations of race/ethnicity and SEP to health outcomes with CIs); illustrate the application of those methods to children's untreated caries; provide relevant software; and report results from a simulation varying prevalence. They use data on untreated caries from the California Oral Health Needs Assessment of Children 2004–2005 and school percentage of participation in free/reduced-price lunch programs to illustrate the methods. Absolute and relative measures, the Slope Index of Inequality, the Relative Index of Inequality (mean and ratio), and the Health Concentration Index were estimated. Taylor series linearization and rescaling bootstrap methods were used to estimate CIs. Oral health differed significantly between White children and all non-White children and was significantly related to SEP.
confidence intervals; dental health surveys; epidemiologic methods; health status disparities; oral health; socioeconomic factors; software
Abbreviations: COHNAC, California Oral Health Needs Assessment of Children; FRL, free/reduced-price lunch; RII, Relative Index of Inequality; RSE, relative standard error; SE, standard error; SEP, socioeconomic position; SII, Slope Index of Inequality