Comparing individual- and area-based socioeconomic measures for the surveillance of health disparities: A multilevel analysis of Massachusetts births, 1989-1991
Comparing individual- and area-based socioeconomic measures for the surveillance of health disparities: A multilevel analysis of Massachusetts births, 1989-1991
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DOI：
10.1093/aje/kwj313
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发表时间：
2006-11-01
影响因子：
5
通讯作者：
Krieger, N.
中科院分区：
文献类型：
--
作者：
Subramanian, S. V.;Chen, J. T.;Krieger, N.
由于美国大部分健康监测数据中缺乏个人层面的社会经济信息，因此需要使用基于区域的社会经济指标（ABSMs）来监测健康不平等。使用1989-1991年出生体重数据从马萨诸塞州，作者比较了估计的健康差距检测与人口普查区和街区组水平的ABSM有关的贫困和教育，以及父母的教育，独立和一起。在单独的模型中，调整了婴儿的性别，母亲的年龄和父母的种族/民族，人口普查区ABSM和父母教育的最差类别有一个类似的出生体重不足70克。低出生体重（< 2,500 g）也观察到类似的结果，人口普查区ABSM和父母教育的最差类别的比值比接近1.37（p < 0.001）。在相互调整模型的出生体重和低出生体重，人口普查区ABSMs仍然检测到的效果估计近50%的父母教育。此外，人口普查区ABSM检测到出生体重的社会经济梯度的母亲年龄小于25岁，在这个年龄组中，教育程度是不可能完成的。这些结果表明，适当选择ABSM可以用来监测社会经济不平等的健康。在缺乏个人一级社会经济信息的情况下，如果存在任何风险，也只是对健康方面社会经济不平等的保守估计。
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 similar to 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 similar to 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.