Guidance for the National Healthcare Disparities Report (2002) / Chapter Skim
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2 Measuring the Effects of Socioeconomic Status on Health Care
2 Measuring the Effects of Socioeconomic Status on Health Care
Pages 45-74
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From page 45... ...
Part 2-3 presents an overview of the current methods that health services researchers use in studying disparities in health care. ~ Instead of socioeconomic status, some social scientists use the concept of socioeconomic position, which they believe takes into account more of the social and economic factors that influence health.
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From page 46... ...
Above the poverty threshold, the level of health was constant as income increased. At a ~ 987 conference sponsored by the Kaiser Family Foundation, leading social scientists from the U.S.
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From page 47... ...
Cross-fertilization of knowledge between social scientists and health services research promises to be beneficial all around. The dissemination of information about disparities in the use of Medicare services has helped to change the perception that health insurance by itself assures equal access and use of health care (Robert and House, 2000~.
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From page 48... ...
The link between socioeconomic status and health is not well understood. Among social scientists there is a consensus that there are many different pathways connecting socioeconomic status and health.
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From page 49... ...
A different formulation of a composite index (named CAPSES) has been developed based on the theory that socioeconomic status is a function of three domains of capital: material capital (such as incomes, homes, and stocks)
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These problems include: 1. The lack of precision and reliability of various measures as well as difficulties in generating measures of socioeconomic status; Unresolved questions about how to measure the effects of socioeconomic status over the life course that would reflect change in social and economic factors from birth to old age; 5 From personal participation in the Baltimore City Health Department study.
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From page 51... ...
The choice of a "right" measure depends upon the study. Table 2-1 briefly summarizes the advantages and disadvantages of using specific measures of socioeconomic status.
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From page 52... ...
-- most social scientists believe the direction of the relationship is the other way around. Among those who have studied disparities in health, there is a consensus that biological and genetic differences account for a relatively small proportion of the disparities in health.
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From page 53... ...
Income, from U.S. Census Data Median household income in ZIP code a generally accepted measure.
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From page 54... ...
Social scientists ceased using socioeconomic status as a control variable when they recognized that health was affected not only by poverty, but also by a much broader set of variables including income, education, and occupation. Thus, if the intent is to understand factors that affect disparities in access, utilization, or quality of care, socioeconomic status should not be used as a control variable.
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From page 55... ...
2-3. REVIEW OF METHODS USED IN STUDYING DISPARITIES IN HEALTH CARE Disparities in health care have been studied for many years.
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From page 56... ...
The first approach uses information about health care collected in nationally representative household surveys. The second draws from administrative databases from such sources as the Medicare and Medicaid programs, the Veterans Administration, and hospital discharges.
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From page 57... ...
The sample size of household surveys is generally large enough to generate utilization rates for frequently used services, such as influenza immunization and mammography, but not for less frequently used services such as CABG surgery. Data sources that collect information for a large number of people such as administrative data, surveys of hospital discharges, or statewide hospital discharge systems are needed to generate utilization rates for the majority of medical and surgical services.
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The MOBS was used to validate this approach (Gornick et al., 1996~. It was intended that the ZIP code analyses would be refined in future studies by using census tracts aggregations.
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Therefore, analysts need to be aware of the design features as well as the limitations and strengths of their data sources. The following tables illustrate the types of data available from household surveys and administrative data.
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The rates differ because the number of women in the income and education groups changes somewhat. For example, among White women, the
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From page 61... ...
TABLE 2-3 Percent of Women Receiving Mammography, Flu Shots, and Pap Smears, 65 Years of Age and Over, 1998 WOMEN SERVICES Race, Income, and Number % with % with % with Education (in 1000s) Mammo- Flu Shot Pap gram Smear By Income Total-White 16,059 100.0 47.5 69.7 $25,001 and over 4,625 28.8 60.0 74.4 $25,000 or less 11,434 71.2 42.3 67.8 Total-Black 1,538 100.0 43.7 51.4 $25,001 arid over 111 7.2 54.8 62.1 $25,000 or less 1,427 92.8 42.9 50.6 _ Black/White Ratio, .92 .
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From page 62... ...
80 Income % with Pap Smear 35.6 45.8 29.1 38.5 38.1 37.1 33.4 55.7 30.8 .94 1.07 SOURCE: Unpublished tabulations from the 2000 Medicare Current Beneficiary Survey (MCBS) provided by Gerald Adler, Centers for Medicare and Medicaid Services (CMS)
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From page 63... ...
Any Revascularization ~ 4,455 406 15.3 9.0 SOURCE: (Peterson et al., 19944. Tables 2-2 through 2-6 illustrate the ways that household surveys, administrative databases, and patient records can be used to analyze patterns of health care for various types of services by race, ethnicity, and socioeconomic status.
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From page 64... ...
2-4. METHODOLOGICAL ISSUES IN STUDIES OF HEALTH CARE DISPARITIES In addition to the advantages and disadvantages of specific measures of socioeconomic status, certain other data issues must also be considered.
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From page 65... ...
Databases that lack information on socioeconomic status have been linked with U.S. census data at the census tract or ZIP code area level to assign an individual in the database the median income and educational attainment corresponding to his or her area of residence.
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2-5. CONCLUSION incorporating knowledge from the social sciences about methods for studying socioeconomic status will help to put the NHDR on a sounder scientific footing and expand the perspective of its audiences.
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From page 69... ...
In the example showing White, Black, and Hispanic rates of mammography, flu shots, and Pap smears by income groups, the rates for Hispanic women in the higher income groups differed substantially not only from White women but from Black women as well. Thus, studies of disparities in health care that aggregate data for all minority persons and present an overall measure of access and utilization are likely to obscure the fact that barriers to health care can differ for population subgroups.
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From page 70... ...
70 GUIDANCE FOR THE NATIONAE HEAETHCARE DISPARITIES REPORT function not only in reporting disparities in health care, but in stimulating questions about why disparities exist. Thus, the report can serve as a foundation for conceptualizing a framework for testing hypotheses about pathways that lead to disparities in health and health care and ways of effecting a change.
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From page 71... ...
1993. On The Validity of Using Census Geocode Characteristics to Proxy Economic Status (Research Reports No.
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From page 72... ...
Baltimore MD: Health Care Financing Administration. Krieger, N
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From page 73... ...
1993. Racial differences in the use of invasive cardiovascular procedures in Veterans Affairs medical system.
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