American Journal of Epidemiology Advance Access originally published online on September 12, 2006
American Journal of Epidemiology 2006 164(9):823-834; doi:10.1093/aje/kwj313
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Practice of Epidemiology |
Comparing Individual- and Area-based Socioeconomic Measures for the Surveillance of Health Disparities: A Multilevel Analysis of Massachusetts Births, 1989–1991
From the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA
Correspondence to Dr. S. V. Subramanian, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA 02115-6096 (e-mail: svsubram{at}hsph.harvard.edu).
The absence of individual-level socioeconomic information in most US health surveillance data necessitates using area-based socioeconomic measures (ABSMs) to monitor health inequalities. Using the 1989–1991 birth weight data from Massachusetts, the authors compared estimates of health disparities detected with census tract- and block group-level ABSMs pertaining to poverty and education, as well as parental education, both independently and together. In separate models, adjusted for infant's sex, mother's age, and parents' race/ethnicity, worst-off categories of census tract ABSMs and parental education had a comparable birth weight deficit of 
70 g. Similar results were observed for low birth weight (<2,500 g), with worst-off categories of census tract ABSMs and parental education having an odds ratio of 1.37 (p < 0.001). In mutually adjusted models for birth weight and low birth weight, census tract ABSMs still detected an effect estimate nearly 50% of that detected by parental education. Additionally, census tract ABSMs detected socioeconomic gradients in birth weight among births to mothers aged less than 25 years, an age group in which educational attainment is unlikely to be completed. These results suggest that aptly chosen ABSMs can be used to monitor socioeconomic inequalities in health. The risk, if any, in the absence of individual-level socioeconomic information is a conservative estimate of socioeconomic inequalities in health.
education; infant, low birth weight; multilevel model; poverty; socioeconomic factors; United States
Abbreviations: ABSM, area-based socioeconomic measure; CI, confidence interval
Editor's note: An invited commentary on this article appears on page 835, and the authors' response appears on page 841.
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Related articles in Am. J. Epidemiol.:
- Subramanian et al. Respond to "Think Conceptually, Act Cautiously"
- S. V. Subramanian, J. T. Chen, D. H. Rehkopf, P. D. Waterman, and N. Krieger
Am. J. Epidemiol. 2006 164: 841-844.[Extract] [FREE Full Text] - Invited Commentary: Using Area-based Socioeconomic Measures—Think Conceptually, Act Cautiously
- Arline T. Geronimus
Am. J. Epidemiol. 2006 164: 835-840.[Extract] [FREE Full Text]
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