Comparison of individual-level versus area-level socioeconomic measures in assessing health outcomes of children in Olmsted County, Minnesota
- Maria R Pardo-Crespo1,7,
- Nirmala Priya Narla2,
- Arthur R Williams3,
- Timothy J Beebe4,
- Jeff Sloan4,
- Barbara P Yawn5,
- Philip H Wheeler6,
- Young J Juhn1
- 1Division of Community Paediatric and Adolescent Medicine, Department of Paediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- 2Mayo Medical School, Mayo Clinic, Rochester, Minnesota, USA
- 3Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, Florida, USA
- 4Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- 5Department of Research, Olmsted Medical Center, Rochester, Minnesota, USA
- 6Rochester Olmsted Planning Department, Olmsted County, Rochester, Minnesota, USA
- 7Servicio Cantabro de Salud, Santander, Cantabria, Spain
- Correspondence to Dr Young J Juhn, Division of Community Paediatric and Adolescent Medicine, Department of Paediatric and Adolescent Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA;
- Received 12 July 2012
- Revised 20 November 2012
- Accepted 7 December 2012
- Published Online First 15 January 2013
Background Socioeconomic status (SES) is an important determinant of health, but SES measures are frequently unavailable in commonly used datasets. Area-level SES measures are used as proxy measures of individual SES when the individual measures are lacking. Little is known about the agreement between individual-level versus area-level SES measures in mixed urban–rural settings.
Methods We identified SES agreement by comparing information from telephone self-reported SES levels and SES calculated from area-level SES measures. We assessed the impact of this agreement on reported associations between SES and rates of childhood obesity, low birth weight <2500 g and smoking within the household in a mixed urban–rural setting.
Results 750 households were surveyed with a response rate of 62%: 51% male, 89% Caucasian; mean child age 9.5 years. Individual-level self-reported income was more strongly associated with all three childhood health outcomes compared to area-level SES. We found significant disagreement rates of 22–31%. The weighted Cohen's κ indices ranged from 0.15 to 0.22, suggesting poor agreement between individual-level and area-level measures.
Conclusion In a mixed urban–rural setting comprised of both rural and urbanised areas, area-level SES proxy measures significantly disagree with individual SES measures, and have different patterns of association with health outcomes from individual-level SES measures. Area-level SES may be an unsuitable proxy for SES when individual rather than community characteristics are of primary concern.