come does not fully account for economic differences between the groups (Kaufman, Cooper, and McGee, 1997). For example, Schoendorf and colleagues (1992), in a study among college-educated parents, showed that racial disparities in infant mortality rates persisted despite accounting for the SEP indicator of education. Findings from this study show an IMR of 10.2 per 1,000 live births for black infants and a rate of 5.4 per 1,000 live births for white infants. The likelihood of death for a black infant was thus 1.82 times that of a white infant even after controlling for age and parity (Schoendorf et al., 1992). In the article’s conclusion, the authors acknowledge that the persistent gap in IMR may be attributable to economic and social differences between the black and white samples that were not addressed.
There are several problems inherent in the use of single indicators or crude measures to control or adjust for the impact of socioeconomic position that make it less than the ideal approach when studying racial inequalities in health (Kaufman, Cooper, and McGee, 1997). The concept of SEP is complex, and one-dimensional measures (e.g., education) do not fully capture it. In addition, the experiences associated with standard SEP indicators (income, education, and occupation) are not the same among different racial groups. For example, whites have approximately twice the income, four times the net financial assets, and a staggering nine times the net worth of blacks (Oliver and Shapiro, 1997). In addition, black men are more likely than white men to be employed in jobs that expose them to hazards and carcinogens (Robinson, 1984). In the few studies that have adjusted for a fuller range of socioeconomic position indicators, a gap in health between racial and ethnic groups often remains. For example, data from the National Longitudinal Mortality Survey (Muntaner, Sorlie, and O’Campo, 2001) showed unadjusted odds ratios for cardiovascular disease mortality for black men and women compared to whites to be 1.5 for men and 2.0, for women. Adjustment for several socioeconomic indicators, such as education, income, and occupational status, resulted in a reduction of those odds ratios to 1.3 and 1.8. Still, an unexplained gap in cardiovascular disease mortality for blacks compared to whites remained after accounting for numerous indicators of social class.
Adjustment using a single or crude indicator of socioeconomic position results in problems of residual confounding for economic position when comparing health status or health care utilization between racial or ethnic groups. Use of multiple indicators will minimize the degree to which residual confounding is a problem. However, as noted earlier, some reports of health status or health care utilization do not adjust for any SEP indicators (e.g., NCHS reports of U.S. live births or infant deaths). The reporting of health status by only racial or ethnic group gives the erroneous impression that the within-group heterogeneity may be less than the between-