TABLE 2–1, Summary of Measures of Socioeconomic Status: Methodological Advantages and Disadvantages - Guidance for the National Healthcare Disparities Report

ADVANTAGES	DISADVANTAGES
Income from Surveys
Household income a generally accepted measure. Three or more categories preferred, but cell sizes may permit only two.	May not be a fully logical measure for persons with insurance, especially if service does not require cost sharing. May not be able to adjust for family size.
Income, from U.S. Census Data
Median household income in ZIP code a generally accepted measure. Median income in ZIP code a proxy for individual income. Reflects characteristics of area of residence and may indicate availability of resources.	Smaller areas such as census tracts preferable, but only 70 percent of addresses in census tracts. Cannot be adjusted for family size.
Education
Comments about income generally apply to education. But education may be a more coherent measure, especially in assessing use of services such as preventive services, which are often self initiated.	Surveys that contain education for household head may not be valid measure for other members. From census data, education and income not statistically valid when used together in multivariate analyses because of multicollinearity.
Poverty Level
Can be a more sensitive economic measure than income, suggesting how Medicaid affects access and utilization.	Not as readily accepted by public because of concerns about what the levels mean.
Occupation
An important measure in U.K. because information collected about occupation.	Could be used in studies based on household surveys. In census data, summary measure of occupation not available.
Wealth
A useful measure for analyzing access to costly services not generally covered by insurance, such as nursing home care.	Not a commonly used measure for services covered by insurance.
Composite Indices
Composite indices may be useful, adding context. The CAPSES scale has been found consistent with other measures of socioeconomic status.	A summary measure must be used cautiously. Could be difficult to interpret because it combines several measures of socioeconomic status.

ADVANTAGES

DISADVANTAGES

Income from Surveys

Household income a generally accepted measure. Three or more categories preferred, but cell sizes may permit only two.

May not be a fully logical measure for persons with insurance, especially if service does not require cost sharing. May not be able to adjust for family size.

Income, from U.S. Census Data

Median household income in ZIP code a generally accepted measure. Median income in ZIP code a proxy for individual income. Reflects characteristics of area of residence and may indicate availability of resources.

Smaller areas such as census tracts preferable, but only 70 percent of addresses in census tracts. Cannot be adjusted for family size.

Education

Comments about income generally apply to education. But education may be a more coherent measure, especially in assessing use of services such as preventive services, which are often self initiated.

Surveys that contain education for household head may not be valid measure for other members. From census data, education and income not statistically valid when used together in multivariate analyses because of multicollinearity.

Poverty Level

Can be a more sensitive economic measure than income, suggesting how Medicaid affects access and utilization.

Not as readily accepted by public because of concerns about what the levels mean.

Occupation

An important measure in U.K. because information collected about occupation.

Could be used in studies based on household surveys. In census data, summary measure of occupation not available.

Wealth

A useful measure for analyzing access to costly services not generally covered by insurance, such as nursing home care.

Not a commonly used measure for services covered by insurance.

Composite Indices

Composite indices may be useful, adding context. The CAPSES scale has been found consistent with other measures of socioeconomic status.

A summary measure must be used cautiously. Could be difficult to interpret because it combines several measures of socioeconomic status.

From: 2, MEASURING THE EFFECTS OF SOCIOECONOMIC STATUS ON HEALTH CARE

Guidance for the National Healthcare Disparities Report.

Institute of Medicine (US) Committee on Guidance for Designing a National Healthcare Disparities Report; Swift EK, editor.

Washington (DC): National Academies Press (US); 2002.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

TABLE 2–1Summary of Measures of Socioeconomic Status: Methodological Advantages and Disadvantages