This epidemiologic investigation will establish area-based measures of socioeconomic position appropriate for US public health surveillance systems and health research. To create these measures, we propose a cross-sectional study involving two US states, Massachusetts (MA) and Rhode Island (RI), using public health surveillance data from the mid-1980s to mid-1990s in conjunction with 1990 census tract, census block-group, and zip code socioeconomic data. We will: (1) geocode public health surveillance data bases containing individuals' residential addresses by appending codes for each address's census tract, block-group, and zip code; (2) create different area-based socioeconomic measures that we will apply to each geographic unit (census tract, block-group, zip code), following and extending approaches used in extant public health and social science literature; (3) link each geocoded record to the relevant census tract, block-group, and zipcode area-based socioeconomic measures; (4) investigate the comparability of the area-based socioeconomic measures, by state, with regard to both socioeconomic ranking of geographic units (centus tract, block-group, zip code) and sensitivity and specificity in predicting available individual-level socioeconomic data obtained in three public health data bases (birth and death certificates and the RI Health Interview Survey); (5) compare quantification of associations of the area-based socioeconomic measures with health outcomes, within and across geographic units (census tract, block-group, zip code), by state, for outcomes expected to exhibit socioeconomic gradients in health: birth rate, birth weight, gestational age, infant mortality, adult mortality (all-cause and cause-specific), cancer incidence, sexually transmitted diseases, tuberculosis domestic violence, gun shot and stab wounds, and childhood lead screening, as well as compare results to gradients in health detected with individual-level socioeconomic data, using the birth and death certificate and RI Health Interview Survey data, and (6) select the most valid, powerful, and easily understood area-based socioeconomic measure(s) and prepare a monograph explaining our methodology, to facilitate use of area-based socioeconomic measures by health agencies and researchers. In doing so, our project incorporates socioeconomic data, a powerful determinant of population health, disease, and well-being, into routinely collected public health data and greatly augments capacity to: (a) monitor socioeconomic inequalities in health in the United States, (b) analyze the contribution of socioeconomic inequality to racial/ethnic inequalities in health, and (c) guide allocation of resources and interventions to attain social equity in health.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Epidemiology and Disease Control Subcommittee 2 (EDC)
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Harvard University
Public Health & Prev Medicine
Schools of Public Health
United States
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Chen, Jarvis T; Rehkopf, David H; Waterman, Pamela D et al. (2006) Mapping and measuring social disparities in premature mortality: the impact of census tract poverty within and across Boston neighborhoods, 1999-2001. J Urban Health 83:1063-84
Subramanian, S V; Chen, J T; Rehkopf, D H et al. (2006) Comparing individual- and area-based socioeconomic measures for the surveillance of health disparities: A multilevel analysis of Massachusetts births, 1989-1991. Am J Epidemiol 164:823-34
Krieger, Nancy; Chen, Jarvis T; Waterman, Pamela D et al. (2005) Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. Am J Public Health 95:312-23
Subramanian, S V; Chen, Jarvis T; Rehkopf, David H et al. (2005) Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts. Am J Public Health 95:260-5
Gjelsvik, Annie; Zierler, Sally; Blume, Jeffery (2004) Homicide risk across race and class: a small-area analysis in Massachusetts and Rhode Island. J Urban Health 81:702-18
Krieger, Nancy; Waterman, Pamela D; Chen, Jarvis T et al. (2003) Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures--the public health disparities geocoding project (US). Public Health Rep 118:240-60
Krieger, Nancy; Chen, Jarvis T; Waterman, Pamela D et al. (2003) Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures--the public health disparities geocoding project. Am J Public Health 93:1655-71
Krieger, N; Chen, J T; Waterman, P D et al. (2003) Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US). J Epidemiol Community Health 57:186-99
Krieger, Nancy; Waterman, Pamela; Chen, Jarvis T et al. (2002) Zip code caveat: bias due to spatiotemporal mismatches between zip codes and US census-defined geographic areas--the Public Health Disparities Geocoding Project. Am J Public Health 92:1100-2
Krieger, Nancy; Chen, Jarvis T; Waterman, Pamela D et al. (2002) Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project. Am J Epidemiol 156:471-82

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