Monitoring Socioeconomic Inequalities in Sexually Transmitted Infections,Tuberculosis,and Violence: Geocoding and Choice of Area-Based Socioeconomic Measures—The Public Health Disparities Geocoding Project (US)
Free accessResearch articleFirst published online May, 2003
Monitoring Socioeconomic Inequalities in Sexually Transmitted Infections,Tuberculosis,and Violence: Geocoding and Choice of Area-Based Socioeconomic Measures—The Public Health Disparities Geocoding Project (US)
To determine which area-based socioeconomic measures, at which level of geography, are suitable for monitoring socioeconomic inequalities in sexually transmitted infections (STIs), tuberculosis (TB), and violence in the United States.
Methods.
Cross-sectional analysis of public health surveillance data, geocoded and linked to area-based socioeconomic measures generated from 1990 census tract, block group, and ZIP Code data. We included all incident cases among residents of either Massachusetts (MA; 1990 population = 6,016,425) or Rhode Island (RI; 1990 population = 1,003,464) for: STIs (MA: 1994–1998, n = 26,535 chlamydia, 7,464 gonorrhea, 2,619 syphilis; RI: 1994–1996, n = 4,473 chlamydia, 1,256 gonorrhea, 305 syphilis); TB (MA: 1993–1998, n = 1,793; RI: 1985–1994, n = 576), and non-fatal weapons related injuries (MA: 1995–1997, n = 6,628).
Results.
Analyses indicated that: (a) block group and tract socioeconomic measures performed similarly within and across both states, with results more variable for the ZIP Code level measures; (b) measures of economic deprivation consistently detected the steepest socioeconomic gradients, considered across all outcomes (incidence rate ratios on the order of 10 or higher for syphilis, gonorrhea, and non-fatal intentional weapons-related injuries, and 7 or higher for chlamydia and TB); and (c) results were similar for categories generated by quintiles and by a priori categorical cut-points.
Conclusions.
Supplementing U.S. public health surveillance systems with census tract or block group area-based socioeconomic measures of economic deprivation could greatly enhance monitoring and analysis of social inequalities in health in the United States.
References
1.
KriegerNChenJTEbelG.Can we monitor socioeconomic inequalities in health? A survey of U.S. health departments’ data collection and reporting practices. Public Health Rep1997; 112:481–91.
2.
National Center for Health Statistics (US). Health, United States, 1998 with socioeconomic status and health chartbook. Hyattsville (MD): National Center for Health Statistics; 1998.
ThomasJCClarkMRobinsonJMonnettMKilmarxPHPetermanTA. The social ecology of syphilis. Soc Sci Med1999; 48:1081–94.
5.
AralSO. The social context of syphilis persistence in the southeastern United States. Sex Transm Dis1996; 23:9–15.
6.
AndersonJEMcCormickLFichtnerR.Factors associated with self-reported STDs: Data from a national survey. Sex Transm Dis1994; 21:303–8.
7.
Acevedo-GarciaD. ZIP Code-level risk factors for tuberculosis: Neighborhood environment and residential segregation in New Jersey, 1985–1992. Am J Public Health2001; 91:734–41.
8.
MillarMI. Genital chlamydial infection: A role for social scientists. Soc Sci Med1987; 25:1289–99.
9.
LienhardtC. From exposure to disease: The role of environmental factors in susceptibility to and development of tuberculosis. Epidemiol Rev2001; 23:288–301.
10.
HarriesK. Social stress and trauma: Synthesis and spatial analysis. Soc Sci Med1997; 45:1251–64.
11.
DahlbergLL. Youth violence in the United States: Major trends, risk factors, and prevention approaches. Am J Prev Med1998; 14:259–72.
12.
CubbinCLeClereFBSmithGS. Socioeconomic status and the occurrence of fatal and nonfatal injury in the United States. Am J Public Health2000; 90:70–7.
13.
JadackRAPareBKachurSPZenilmanJM. Self-reported weapon ownership, use, and violence experience among clients accessing an inner-city sexually transmitted disease clinic. Res Nurs Health2000; 23:213–21.
14.
PeekMZenilmanJM. Sexually transmitted diseases in patients attending a Baltimore tuberculosis clinic: Assessment of use of multiple categoric services. Sex Transm Dis1997; 24:8–10.
15.
MartinSLMatzaLSKupperLLThomasJCDalyMCloutierS.Domestic violence and sexually transmitted diseases: The experience of prenatal care patients. Public Health Rep1999; 114:262–8.
16.
KriegerN. Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology. Am J Public Health1992; 82:703–10.
17.
KriegerNWilliamsDMossN.Measuring social class in U.S. public health research: Concepts, methodologies and guidelines. Annu Rev Public Health1997; 18:341–78.
18.
KriegerNZierlerSHoganJW, Geocoding and measurement of neighborhood socioeconomic position. In: KawachiAMBerkmanLF, editors. Neighborhoods and health. New York: Oxford University Press, 2003 p. 147–78.
19.
NathanWB. Health conditions in North Harlem 1923–1927. New York: National Tuberculosis Association; 1932.
GreenHW. The use of census tracts in analyzing the population of a metropolitan community. JASA1933; 28:147–53.
22.
TerrisM. Relation of economic status to tuberculosis mortality by age and sex. Am J Public Health1948; 38:1061–70.
23.
WatkinsRJ. Introduction. In: WatkinsAMSwiftALJrGreenHWEcklerAR. Golden anniversary of census tracts, 1956Washington: American Statistical Association; 1956 p. 1–2.
24.
CoulterEJGuralnickL.Analysis of vital statistics by census tract. JASA1959; 54:730–40.
25.
LynchJKaplanG.Socioeconomic position. In: BerkmanAMKawachiI, editors. Social epidemiology. Oxford (UK): Oxford University Press; 2000 p. 13–35.
26.
RouxAV Diez. Investigating neighborhood and area effects on health. Am J Public Health2001; 91:1783–9.
27.
FriedmanDJAnderkaMKriegerJWLandGSoletD.Accessing population health information through interactive systems: Lessons learned and future directions. Public Health Rep2001; 116:132–47.
28.
EllenJMKohnRPBolanGAShiboskiSKriegerN.Socioeconomic differences in sexually transmitted disease rates among black and white adolescents in San Francisco, 1990 to 1992. Am J Public Health1995; 85:1546–8.
29.
CohenDSpearSScribnerRKissingerPMasonKWildgenJ.Broken windows and the risk of gonorrhea. Am J Public Health2000; 90:230–6.
30.
BarrRGDiez-RouxAKnirschCAPablos-MéndezA.Neighborhood poverty and the resurgence of tuberculosis in New York City, 1984–1992. Am J Public Health2001; 91:1487–93.
31.
MortonWEHortonHBBakerHW. Effects of socioeconomic status on incidences of three sexually transmitted diseases. Sex Transm Dis1979; 6:206–10.
32.
PotteratJJRothenbergRBWoodhouseDEMuthJBPrattsCIFogleJSII. Gonorrhea as a social disease. Sex Transm Dis1985; 12:25–32.
33.
RothenbergRB. The geography of gonorrhea. Empirical demonstration of core group transmission. Am J Epidemiol1983; 117:688–94.
34.
HinmanAR. Disease prevention programs for racial and ethnic minorities. Ann Epidemiol1993; 3:185–92.
35.
RiceRJRobertsPLHandsfieldHHHolmesKK. Sociodemographic distribution of gonorrhea incidence: Implications for prevention and behavioral research. Am J Public Health1991; 81:1252–8.
36.
DurkinMSDavidsonLLKuhnLO'ConnorPBarlowB.Low-income neighborhoods and the risk of severe pediatric injury: A small-area analysis in northern Manhattan. Am J Public Health1994; 84:587–92.
37.
CubbinCLeClereFBSmithGS. Socioeconomic status and injury mortality: Individual and neighbourhood determinants. J Epidemiol Community Health2000; 54:517–24.
38.
ChaulkCPKhooLMatuszakDLIsraelE.Case characteristics and trends in pediatric tuberculosis, Maryland, 1986–1993. Public Health Rep1997; 112:146–52.
39.
CantwellMFSniderDEJrCauthenGMOnoratoI.Epidemiology of tuberculosis in the United States, 1985 through 1992. JAMA1994; 272:535–9.
40.
CantwellMFMcKennaMTMcCrayEOnoratoIM. Tuberculosis and race/ethnicity in the United States: Impact of socioeconomic status. Am J Respir Crit Care Med1997; 157:1016–20.
41.
ReichmanLBO'DayR.Tuberculosis infection in a large urban population. Am Rev Respir Dis1978; 117:705–12.
42.
WagnerAKSasserHCHammondFMWiercisiewskiDAlexanderJ.Intentional traumatic brain injury: Epidemiology, risk factors, and associations with injury severity and mortality. [published erratum appears in J Trauma2000; 49:982]. J Trauma2000;49:404–10.
43.
ReihardCPaulWSMcAuleyJB. Epidemiology of pediatric tuberculosis in Chicago, 1974 to 1994: A continuing public health problem. Am J Med Sci1997; 313:336–40.
44.
WallaceDWallaceR.Scales of geography, time, and population: The study of violence as a public health problem. Am J Public Health1988; 88:1853–8.
45.
FeeroSHedgesJRSimmonsEIrwinL.Intracity regional demographics of major trauma. Ann Emerg Med1995; 25:788–93.
46.
KriegerNChenJTWatermanPDSoobaderMJSubramanianSVCarsonR.Geocoding and monitoring U.S. socioeconomic inequalities in mortality and cancer incidence: Does choice of area-based measure and geographic level matter?—the Public Health Disparities Geocoding Project. Am J Epidemiol2002; 156:471–82.
47.
KriegerNChenJTWatermanPDSoobaderM-JSubramanianSVCarsonR.Choosing area-based socioeconomic measures to monitor social inequalities in low birthweight and childhood lead poisoning—The Public Health Disparities Geocoding Project (US). J Epidemiol Community Health2003; 57:186–99.
48.
KriegerN. Theories for social epidemiology for the 21st century: An ecosocial perspective. Int J Epidemiol2001; 30:668–77.
Massachusetts Department of Public Health. 1998 Annual STD Report. Bureau of Communicable Disease Control, Division of Sexually Transmitted Disease Prevention [cited 29 Mar 2002]. Available from: URL: http://www.state.ma.us/dph/cdc/std/divstd.htm
51.
Massachusetts Department of Public Health. 2000 Tuberculosis overview. Bureau of Communicable Disease Control, Division of Tuberculosis Prevention and Control [cited 29 Mar 2002]. Available from: URL: http://www.state.ma.us/dph/cdc/tb/INDEX.HTM
Census Bureau (US). Census of population and housing, 1990: Summary Tape File 3 technical documentation. Washington: Census Bureau (US); 1991.
56.
Census Bureau (US). Geographical areas reference manual. Washington: Department of Commerce (US); 1994 Available from: URL: http://www.census.gov/geo/www/garm.html [cited 28 Jun 2001].
Post Office (US). Address Information Products Technical Guide. Memphis: Postal Service National Customer Support Center (US); 2001.
59.
Office of Social and Economic Data Analysis (US). The ZIP Code resource page: Tools and resources related to U.S. ZIP Codes. Columbia (MO): University of Missouri; 2000 Available from: URL: http://www.oseda.missouri.edu/ [cited 24 Feb 2002].
60.
KriegerNWatermanPChenJTSoobaderMJSubramanianSVCarsonR.ZIP Code caveat: Bias due to spatiotemporal mismatches between ZIP Codes and U.S. census-defined areas—the Public Health Disparities Geocoding Project. Am J Public Health2002; 92:1100–2.
61.
KriegerNWatermanPLemieuxKZierlerSHoganJW. On the wrong side of the tracts? Evaluating accuracy of geocoding in public health research. Am J Public Health2001; 91:1114–6.
62.
ShawMDorlingDGordonDSmithG. DaveyThe widening gap: Health inequalities and policy in Britain. Bristol (UK): Policy Press; 1999.
63.
EvansTWhiteheadMDiderichsenFBhuiyaAWirthM.Challenging inequities in health: From ethics to action. New York: Oxford University Press; 2001.
64.
LeonDWaltG, editors. Poverty, inequality, and health: An international perspective. Oxford (UK): Oxford University Press; 2001.
65.
BerkmanLKawachiI, editors. Social epidemiology. Oxford (UK): Oxford University Press; 2000.
66.
CarstairsVMorrisR.Deprivation and mortality: An alternative to social class?Community Med1989; 11:210–9.
67.
LeePMurieAGordonD.Area measures of deprivation: A study of current methods and best practices in the identification of poor areas in Great Britain. Birmingham (UK): Centre for Urban and Regional Studies, University of Birmingham; 1995.
68.
GordonD. Census based deprivation indices: Their weighting and validation. J Epidemiol Community Health1995; 49(suppl 2):39–44.
69.
TownsendPPhillimorePBeattieA.Health and deprivation: Inequality and the North. London: Croom Helm; 1988.
70.
CarstairsV. Deprivation indices: Their interpretation and use in relation to health. J Epidemiol Community Health1995; 49(suppl 2):3–8.
71.
CasperMLBarnettEHalversonJAElmesGABrahamVEMajeedZA, Women and heart disease: An atlas of racial and ethnic disparities in mortality. Atlanta: CDC; 1999.
72.
LawleyDNMaxwellAE. Factor analysis as a statistical method. New York: American Elsevier Pub.; 1972.
73.
BartholomewDJKnottM.Latent variable models and factor analysis. London: Charles Griffin & Co.; 1987.
74.
BreslowNEDayNE, editors. Statistical methods in cancer research, vol. II: The design and analysis of cohort studies. Oxford (UK): Oxford University Press; 1987.
AndersonRNRosenbergHM. Age standardization of death rates: Implementation of the year 2000 standard. Natl Vital Stat Rep 1998 Oct 7;47:1–16.
77.
BreslowNEDayNE. Statistical methods in cancer research: Vol. I. The analysis of case-control studies. Lyon: International Agency for Research on Cancer; 1980 p. 47. IARC Scientific Pub. No. 32.
78.
BoylePParkinDM, Statistical methods for registries. In: JensenAMParkinDMMacLennanR, editors. Cancer registration: Principles and methods. Lyon: International Agency for Research on Cancer; 1991 p. 126–58. IARC Scientific Pub. No. 95.
JargowskyPA. Poverty and place: Ghettos, barrios, and the American city. New York: Russell Sage Foundation; 1997.
81.
PamukER. Social class inequality in mortality from 1921 to 1972 in England and Wales. Popul Stud1985; 39:17–31.
82.
WagstaffAPaciPvan DoorslaerE.On the measurement of inequalities in health. Soc Sci Med1991; 33:545–57.
83.
SmithG DaveyHartCHoleDMacKinnonPGillisCWattG, Education and occupational social class: Which is the more important indicator of mortality risk?J Epidemiol Community Health1998; 52:153–60.
84.
SAS Institute, Inc.SAS software: Version 6.0 for Windows. Cary (NC): SAS Institute, Inc.; 1989.
85.
SubramanianSVDuncanCJonesK.Multilevel perspectives on modeling census data. Environ Planning A2001; 33:399–417.
86.
DuncanCJonesKMoonG.Context, composition, and heterogeneity: Using multilevel models in health research. Soc Sci Med1998; 46:97–117.
87.
SoobaderMLeClereFB. Aggregation and the measurement of income inequality: Effects on morbidity. Soc Sci Med1999; 48:733–44.
88.
AlkerHRJr., A typology of ecologic fallacies. In: DogganAMRokkanS, editors. Social ecology. Cambridge (MA): MIT Press; 1969 p. 69–86.
89.
Diez-RouxAV. Bringing context back into epidemiology: Variables and fallacies in multilevel analysis. Am J Public Health1998; 88:216–22.
90.
MacintyreSEllawayA.Ecological approaches: Rediscovering the role of the physical and social environment. In: BerkmanAMKawachiI, editors. Social epidemiology. Oxford (UK): Oxford University Press; 2000 p. 332–48.
91.
RobinsonWS. Ecological correlations and the behavior of individuals. Am Sociol Rev1950; 15:351–7.
92.
LangbeinLILichtmanAJ. Ecological inference. Beverly Hills: Sage Publications; 1978 p. 27–8.
93.
KriegerN. Women and social class: A methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J Epidemiol Comm Health1991; 45:35–42.
94.
GeronimusATBoundJ.Use of census-based aggregate variables to proxy for socioeconomic group: Evidence from national samples. Am J Epidemiol1998; 48:475–86.
95.
GeronimusATBoundJNeidertLJ. On the validity of using census characteristics to proxy individual socioeconomic characteristics. JASA1996;91:529–37.
96.
CherkinDCGrothausLWagnerEH. Is magnitude of co-payment effect related to income? Using census data for health services research. Soc Sci Med1992; 34:33–41.
97.
GreenwaldHPPolissarNLBorgattaEFMcCorkleR.Detecting survival effects of socioeconomic status: Problems in the use of aggregate measures. J Clin Epidemiol1994; 47:903–9.
98.
Carr-HillRRiceN.Is enumeration district level an improvement on ward level analysis in studies of deprivation and health?J Epidemiol Community Health1995; 49(suppl 2):S28–9.
99.
MustardCADerksenSBerthelotJMWolfsonM.Assessing ecologic proxies for household income: A comparison of household and neighbourhood level income measures in the study of population health status. Health Place1999; 5:157–71.
100.
ReijneveldSAVerheijRAde BakkerDH. The impact of area deprivation on differences in health: Does the choice of the geographical classification matter?J Epidemiol Community Health2000; 54:306–13.
101.
HyndmanJCHolmanCDHockeyRLDonovanRJCortiBRiveraJ.Misclassification of social disadvantage based on geographical areas: Comparison of postcode and collector's districts analyses. Int J Epidemiol1995; 24:165–76.
102.
RouxAV DiezKiefeCIJacobsDRJrHaanMJacksonSANietoFJ, Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies. Ann Epidemiol2001; 11:395–405.
RossiRJGilmartinKJ. The handbook of social indicators: Sources, characteristics, and analysis. New York: Garland STPM Press; 1980.
107.
KriegerNChenJTWatermanPDRehkopfDHSubramanianSV. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: A comparison of area-based socioeconomic measures—The Public Health Disparities Geocoding Project. Am J Public Health. In press2003.
108.
GordonDSpickerP, editors. The international glossary of poverty. CROP International Series on Poverty. London: Zed Books; 1999.
109.
KennedyBPKawachiIProthrow-StithD.Income distribution and mortality: Cross sectional ecological study of the Robin Hood index in the United States. Br Med J1996; 312:1004–7.
