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Is the wealth index a proxy for consumption expenditure? A systematic review
  1. L D Howe1,2,
  2. J R Hargreaves1,
  3. S Gabrysch1,
  4. S R A Huttly1
  1. 1
    Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London UK
  2. 2
    Department of Social Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr L D Howe, Department of Social Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK; laura.howe{at}


Background: Many epidemiological studies require a measure of socioeconomic position. The monetary measure preferred by economists is consumption expenditure; the wealth index has been proposed as a reliable, simple alternative to expenditure and is extensively used.

Methods: A systematic review was conducted of the agreement between wealth indices and consumption expenditure, summarising the agreement and exploring factors affecting agreement.

Results: Seventeen studies using 36 datasets met the inclusion criteria. Of these, 22 demonstrated weak agreement, 10 moderate agreement, and four strong agreement. There was some evidence that agreement is higher: in middle-income settings; in urban areas; for wealth indices with a greater number of indicators; and for wealth indices including a wider range of indicators.

Conclusions: The wealth index is mostly a poor proxy for consumption expenditure.

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  • Funding LH was supported by an Economic & Social Research Council/Medical Research Council Interdisciplinary PhD Studentship; JH is supported by an Economic & Social Research Council/Medical Research Council Post-doctoral Fellowship.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.