Comparisons of individual- and area-level socioeconomic status as proxies for individual-level measures: evidence from the Mortality Disparities in American Communities study

被引：99

作者：

Moss, Jennifer L. ^{[1
,2
]}

Johnson, Norman J. ^{[3
]}

Yu, Mandi ^{[4
]}

Altekruse, Sean F. ^{[5
]}

Cronin, Kathleen A. ^{[6
]}

机构：

[1] NCI, Div Canc Control & Populat Sci, Canc Prevent Fellowship Program, Surveillance Res Program, Bethesda, MD 20892 USA

[2] Penn State Univ, Penn State Coll Med, Dept Family & Community Med, 134 Sipe Ave 205,POB 850,MC HS72, Hershey, PA 17033 USA

[3] US Bur Census, Ctr Adm Records Res & Applicat, Res & Methodol Directorate, Suitland, MD USA

[4] NCI, Stat Res & Applicat Branch, Surveillance Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA

[5] NHLBI, Cardiovasc Epidemiol Branch, Bldg 10, Bethesda, MD 20892 USA

[6] NCI, Off Associate Director, Surveillance Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA

来源：

POPULATION HEALTH METRICS | 2021年 / 19卷 / 01期

关键词：

Socioeconomic status; Individuals; Census tracts; Counties; Mortality; Social epidemiology; CANCER INCIDENCE; HEALTH RESEARCH; INCOME; INEQUALITIES; VALIDITY; CONTEXT; IMPACT; RISK;

D O I：

10.1186/s12963-020-00244-x

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background Area-level measures are often used to approximate socioeconomic status (SES) when individual-level data are not available. However, no national studies have examined the validity of these measures in approximating individual-level SES. Methods Data came from similar to 3,471,000 participants in the Mortality Disparities in American Communities study, which links data from 2008 American Community Survey to National Death Index (through 2015). We calculated correlations, specificity, sensitivity, and odds ratios to summarize the concordance between individual-, census tract-, and county-level SES indicators (e.g., household income, college degree, unemployment). We estimated the association between each SES measure and mortality to illustrate the implications of misclassification for estimates of the SES-mortality association. Results Participants with high individual-level SES were more likely than other participants to live in high-SES areas. For example, individuals with high household incomes were more likely to live in census tracts (r = 0.232; odds ratio [OR] = 2.284) or counties (r = 0.157; OR = 1.325) whose median household income was above the US median. Across indicators, mortality was higher among low-SES groups (all p < .0001). Compared to county-level, census tract-level measures more closely approximated individual-level associations with mortality. Conclusions Moderate agreement emerged among binary indicators of SES across individual, census tract, and county levels, with increased precision for census tract compared to county measures when approximating individual-level values. When area level measures were used as proxies for individual SES, the SES-mortality associations were systematically underestimated. Studies using area-level SES proxies should use caution when selecting, analyzing, and interpreting associations with health outcomes.

引用

页数：10