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. 1992 May;82(5):703–710. doi: 10.2105/ajph.82.5.703

Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology.

N Krieger 1
PMCID: PMC1694121  PMID: 1566949

Abstract

BACKGROUND. Most US medical records lack socioeconomic data, hindering studies of social gradients in health and ascertainment of whether study samples are representative of the general population. This study assessed the validity of a census-based approach in addressing these problems. METHODS. Socioeconomic data from 1980 census tracts and block groups were matched to the 1985 membership records of a large prepaid health plan (n = 1.9 million), with the link provided by each individual's residential address. Among a subset of 14,420 Black and White members, comparisons were made of the association of individual, census tract, and census block-group socioeconomic measures with hypertension, height, smoking, and reproductive history. RESULTS. Census-level and individual-level socioeconomic measures were similarly associated with the selected health outcomes. Census data permitted assessing response bias due to missing individual-level socioeconomic data and also contextual effects involving the interaction of individual- and neighborhood-level socioeconomic traits. On the basis of block-group characteristics, health plan members generally were representative of the total population; persons in impoverished neighborhoods, however, were underrepresented. CONCLUSIONS. This census-based methodology offers a valid and useful approach to overcoming the absence of socioeconomic data in most US medical records.

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Selected References

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  1. Alexander F. E., O'Brien F., Hepburn W., Miller M. Association between mortality among women and socioeconomic factors in general practices in Edinburgh: an application of small area statistics. Br Med J (Clin Res Ed) 1987 Sep 26;295(6601):754–756. doi: 10.1136/bmj.295.6601.754. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Arber S. Social class, non-employment, and chronic illness: continuing the inequalities in health debate. Br Med J (Clin Res Ed) 1987 Apr 25;294(6579):1069–1073. doi: 10.1136/bmj.294.6579.1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bassett M. T., Krieger N. Social class and black-white differences in breast cancer survival. Am J Public Health. 1986 Dec;76(12):1400–1403. doi: 10.2105/ajph.76.12.1400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Carstairs V., Morris R. Deprivation and mortality: an alternative to social class? Community Med. 1989 Aug;11(3):210–219. doi: 10.1093/oxfordjournals.pubmed.a042469. [DOI] [PubMed] [Google Scholar]
  5. Carstairs V., Morris R. Deprivation: explaining differences in mortality between Scotland and England and Wales. BMJ. 1989 Oct 7;299(6704):886–889. doi: 10.1136/bmj.299.6704.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Centerwall B. S. Race, socioeconomic status, and domestic homicide, Atlanta, 1971-72. Am J Public Health. 1984 Aug;74(8):813–815. doi: 10.2105/ajph.74.8.813. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Curtis S. E. Use of survey data and small area statistics to assess the link between individual morbidity and neighbourhood deprivation. J Epidemiol Community Health. 1990 Mar;44(1):62–68. doi: 10.1136/jech.44.1.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dayal H. H., Power R. N., Chiu C. Race and socio-economic status in survival from breast cancer. J Chronic Dis. 1982;35(8):675–683. doi: 10.1016/0021-9681(82)90020-0. [DOI] [PubMed] [Google Scholar]
  9. Devesa S. S., Diamond E. L. Association of breast cancer and cervical cancer incidence with income and education among whites and blacks. J Natl Cancer Inst. 1980 Sep;65(3):515–528. [PubMed] [Google Scholar]
  10. Devesa S. S., Diamond E. L. Socioeconomic and racial differences in lung cancer incidence. Am J Epidemiol. 1983 Dec;118(6):818–831. doi: 10.1093/oxfordjournals.aje.a113700. [DOI] [PubMed] [Google Scholar]
  11. Ernster V. L., Selvin S., Sacks S. T., Austin D. F., Brown S. M., Winkelstein W., Jr Prostatic cancer: mortality and incidence rates by race and social class. Am J Epidemiol. 1978 Apr;107(4):311–320. doi: 10.1093/oxfordjournals.aje.a112546. [DOI] [PubMed] [Google Scholar]
  12. Friedman G. D., Selby J. V., Quesenberry C. P., Jr, Armstrong M. A., Klatsky A. L. Precursors of essential hypertension: body weight, alcohol and salt use, and parental history of hypertension. Prev Med. 1988 Jul;17(4):387–402. doi: 10.1016/0091-7435(88)90038-2. [DOI] [PubMed] [Google Scholar]
  13. Haan M., Kaplan G. A., Camacho T. Poverty and health. Prospective evidence from the Alameda County Study. Am J Epidemiol. 1987 Jun;125(6):989–998. doi: 10.1093/oxfordjournals.aje.a114637. [DOI] [PubMed] [Google Scholar]
  14. Jenkins C. D., Tuthill R. W., Tannenbaum S. I., Kirby C. R. Zones of excess mortality in Massachusetts. N Engl J Med. 1977 Jun 9;296(23):1354–1356. doi: 10.1056/NEJM197706092962315. [DOI] [PubMed] [Google Scholar]
  15. Krieger N. Social class and the black/white crossover in the age-specific incidence of breast cancer: a study linking census-derived data to population-based registry records. Am J Epidemiol. 1990 May;131(5):804–814. doi: 10.1093/oxfordjournals.aje.a115571. [DOI] [PubMed] [Google Scholar]
  16. Krieger N. Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J Epidemiol Community Health. 1991 Mar;45(1):35–42. doi: 10.1136/jech.45.1.35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Liberatos P., Link B. G., Kelsey J. L. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121. doi: 10.1093/oxfordjournals.epirev.a036030. [DOI] [PubMed] [Google Scholar]
  18. Morgan M., Chinn S. ACORN group, social class, and child health. J Epidemiol Community Health. 1983 Sep;37(3):196–203. doi: 10.1136/jech.37.3.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Morgan M. Measuring social inequality: occupational classifications and their alternatives. Community Med. 1983 May;5(2):116–124. [PubMed] [Google Scholar]
  20. Rose G. Sick individuals and sick populations. Int J Epidemiol. 1985 Mar;14(1):32–38. doi: 10.1093/ije/14.1.32. [DOI] [PubMed] [Google Scholar]
  21. Savage D., Lindenbaum J., Van Ryzin J., Struening E., Garrett T. J. Race, poverty, and survival in multiple myeloma. Cancer. 1984 Dec 15;54(12):3085–3094. doi: 10.1002/1097-0142(19841215)54:12<3085::aid-cncr2820541246>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  22. Selvin S. Two issues concerning the analysis of grouped data. Eur J Epidemiol. 1987 Sep;3(3):284–287. doi: 10.1007/BF00149737. [DOI] [PubMed] [Google Scholar]
  23. Smith G. D., Bartley M., Blane D. The Black report on socioeconomic inequalities in health 10 years on. BMJ. 1990 Aug 18;301(6748):373–377. doi: 10.1136/bmj.301.6748.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Syme S. L., Oakes T. W., Friedman G. D., Feldman R., Siegelaub A. B., Collen M. Social class and racial differences in blood pressure. Am J Public Health. 1974 Jun;64(6):619–620. doi: 10.2105/ajph.64.6.619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Walker M., Shaper A. G., Wannamethee G. Height and social class in middle-aged British men. J Epidemiol Community Health. 1988 Sep;42(3):299–303. doi: 10.1136/jech.42.3.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. White E., Daling J. R., Norsted T. L., Chu J. Rising incidence of breast cancer among young women in Washington State. J Natl Cancer Inst. 1987 Aug;79(2):239–243. [PubMed] [Google Scholar]
  27. Wise P. H., Kotelchuck M., Wilson M. L., Mills M. Racial and socioeconomic disparities in childhood mortality in Boston. N Engl J Med. 1985 Aug 8;313(6):360–366. doi: 10.1056/NEJM198508083130605. [DOI] [PubMed] [Google Scholar]
  28. Yeracaris C. A., Kim J. H. Socioeconomic differentials in selected causes of death. Am J Public Health. 1978 Apr;68(4):342–351. doi: 10.2105/ajph.68.4.342. [DOI] [PMC free article] [PubMed] [Google Scholar]

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