Dataset Information

Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: results from a primary care network.

ABSTRACT: To determine which area-based socioeconomic status (SES) indicator is best suited to monitor health care disparities from a delivery system perspective.142,659 adults seen in a primary care network from January 1, 2009 to December 31, 2011.Cross-sectional, comparing associations between area-based SES indicators and patient outcomes.Address data were geocoded to construct area-based SES indicators at block group (BG), census tract (CT), and ZIP code (ZIP) levels. Data on health outcomes were abstracted from electronic records. Relative indices of inequality (RIIs) were calculated to quantify disparities detected by area-based SES indicators and compared to RIIs from self-reported educational attainment.ZIP indicators had less missing data than BG or CT indicators (p < .0001). Area-based SES indicators were strongly associated with self-report educational attainment (p < .0001). ZIP, BG, and CT indicators all detected expected SES gradients in health outcomes similarly. Single-item, cut point defined indicators performed as well as multidimensional indices and quantile indicators.Area-based SES indicators detected health outcome differences well and may be useful for monitoring disparities within health care systems. Our preferred indicator was ZIP-level median household income or percent poverty, using cut points.

SUBMITTER: Berkowitz SA

PROVIDER: S-EPMC4369215 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: results from a primary care network.

Berkowitz Seth A SA Traore Carine Y CY Singer Daniel E DE Atlas Steven J SJ

Health services research 20140915 2

<h4>Objective</h4>To determine which area-based socioeconomic status (SES) indicator is best suited to monitor health care disparities from a delivery system perspective.<h4>Data sources/study setting</h4>142,659 adults seen in a primary care network from January 1, 2009 to December 31, 2011.<h4>Study design</h4>Cross-sectional, comparing associations between area-based SES indicators and patient outcomes.<h4>Data collection</h4>Address data were geocoded to construct area-based SES indicators a ...[more]

PMID: 25219917

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Project description:BackgroundGiving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these SES disparities. Drawing on the Disparities in Skilled Birth Attendance (DiSBA) framework, we examined the contribution of three proximal factors-perceived need, accessibility, and quality of care-that influence the use of SBAs.MethodsWe used data from a survey conducted in Migori County, Kenya in 2016, among women aged 15-49 years who gave birth nine weeks before the survey (N = 1020). The primary outcome is facility-based childbirth. The primary predictors are wealth, measured in quintiles calculated from a wealth index based on principal component analysis of household assets, and highest education level attained. Proposed mediating variables include maternal perceptions of need, accessibility (physical and financial), and quality of care (antenatal services received and experience of care). Logistic regression with mediation analysis was used to investigate the mediating effects.ResultsOverall, 85% of women in the sample gave birth in a health facility. Women in the highest wealth quintile were more likely to give birth in a facility than women in the lowest quintile, controlling for demographic factors (adjusted odds ratio [aOR]: 2.97, 95% CI: 1.69-5.22). College-educated women were five times more likely than women with no formal education or primary education to give birth in a health facility (aOR: 4.96; 95% CI: 1.43-17.3). Women who gave birth in health facilities had higher perceived accessibility and quality of care than those who gave birth at home. The five mediators were estimated to account for between 15% and 48% of the differences in facility births between women in the lowest and higher wealth quintiles.ConclusionOur results confirm SES disparities in facility-based childbirth, with the proximal factors accounting for some of these differences. These proximal factors - particularly perceived accessibility and quality of care - warrant attention due to their relationship with facility-birth overall, and their impact on inequities in this care.

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Dataset Information

Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: results from a primary care network.

Publications

Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: results from a primary care network.

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