Abstract
OBJECTIVE: To evaluate the potential for and obstacles to routine monitoring of socioeconomic inequalities in health using U.S. vital statistics and disease registry data, the authors surveyed current data collection and reporting practices for specific socioeconomic variables. METHODS: In 1996 the authors mailed a self-administered survey to all of the 55 health department vital statistics offices reporting data to the National Center for Health Statistics (NCHS) to determine what kinds of socioeconomic data they collected on birth and death certificates and in cancer, AIDS, and tuberculosis (TB) registries and what kinds of socioeconomic data were routinely reported in health department publications. RESULTS: Health departments routinely obtained data on occupation on death certificates and in most cancer registries. They collected data on educational level for both birth and death certificates. None of the databases collected information on income, and few obtained data on employment status, health insurance carrier, or receipt of public assistance. When socioeconomic data were collected, they were usually not included in published reports (except for mothers educational level in birth certificate data). Obstacles cited to collecting and reporting socioeconomic data included lack of resources and concerns about the confidentiality and accuracy of data. All databases, however, included residential addresses, suggesting records could be geocoded and linked to Census-based socioeconomic data. CONCLUSIONS: U.S. state and Federal vital statistics and disease registries should routinely collect and publish socioeconomic data to improve efforts to monitor trends in and reduce social inequalities in health.
Full text
PDF










Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Antonovsky A. Social class, life expectancy and overall mortality. Milbank Mem Fund Q. 1967 Apr;45(2):31–73. [PubMed] [Google Scholar]
- Antonovsky A. Social class, life expectancy and overall mortality. Milbank Mem Fund Q. 1967 Apr;45(2):31–73. [PubMed] [Google Scholar]
- Cherkin D. C., Grothaus L., Wagner E. H. Is magnitude of co-payment effect related to income? Using census data for health services research. Soc Sci Med. 1992 Jan;34(1):33–41. doi: 10.1016/0277-9536(92)90064-w. [DOI] [PubMed] [Google Scholar]
- Diaz T., Chu S. Y., Frederick M., Hermann P., Levy A., Mokotoff E., Whyte B., Conti L., Herr M., Checko P. J. Sociodemographics and HIV risk behaviors of bisexual men with AIDS: results from a multistate interview project. AIDS. 1993 Sep;7(9):1227–1232. doi: 10.1097/00002030-199309000-00012. [DOI] [PubMed] [Google Scholar]
- Duleep H. O. Mortality and income inequality among economically developed countries. Soc Secur Bull. 1995 Summer;58(2):34–50. [PubMed] [Google Scholar]
- Feldman J. J., Makuc D. M., Kleinman J. C., Cornoni-Huntley J. National trends in educational differentials in mortality. Am J Epidemiol. 1989 May;129(5):919–933. doi: 10.1093/oxfordjournals.aje.a115225. [DOI] [PubMed] [Google Scholar]
- GUTMAN R. Birth and death registration in Massachusetts. II. The inauguration of a modern system, 1800-1849. Milbank Mem Fund Q. 1958 Oct;36(4):373–402. [PubMed] [Google Scholar]
- GUTMAN R. Birth and death registration in Massachusetts. II. The inauguration of a modern system, 1800-1849. Milbank Mem Fund Q. 1958 Oct;36(4):373–402. [PubMed] [Google Scholar]
- Greenwald H. P., Polissar N. L., Borgatta E. F., McCorkle R. Detecting survival effects of socioeconomic status: problems in the use of aggregate measures. J Clin Epidemiol. 1994 Aug;47(8):903–909. doi: 10.1016/0895-4356(94)90194-5. [DOI] [PubMed] [Google Scholar]
- Hahn R. A., Eaker E. D., Barker N. D., Teutsch S. M., Sosniak W. A., Krieger N. Poverty and death in the United States. Int J Health Serv. 1996;26(4):673–690. doi: 10.2190/967K-LC4F-DU66-W5P9. [DOI] [PubMed] [Google Scholar]
- Hyndman J. C., Holman C. D., Hockey R. L., Donovan R. J., Corti B., Rivera J. Misclassification of social disadvantage based on geographical areas: comparison of postcode and collector's district analyses. Int J Epidemiol. 1995 Feb;24(1):165–176. doi: 10.1093/ije/24.1.165. [DOI] [PubMed] [Google Scholar]
- Kaplan G. A., Pamuk E. R., Lynch J. W., Cohen R. D., Balfour J. L. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996 Apr 20;312(7037):999–1003. doi: 10.1136/bmj.312.7037.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kennedy B. P., Kawachi I., Prothrow-Stith D. Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. BMJ. 1996 Apr 20;312(7037):1004–1007. doi: 10.1136/bmj.312.7037.1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Krieger N., Fee E. Measuring social inequalities in health in the United States: a historical review, 1900-1950. Int J Health Serv. 1996;26(3):391–418. doi: 10.2190/B3AH-Q5KE-VBGF-NC74. [DOI] [PubMed] [Google Scholar]
- Krieger N., Fee E. Social class: the missing link in U.S. health data. Int J Health Serv. 1994;24(1):25–44. doi: 10.2190/2JG7-YMD5-WCP2-XXNT. [DOI] [PubMed] [Google Scholar]
- Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992 May;82(5):703–710. doi: 10.2105/ajph.82.5.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Krieger N., Rowley D. L., Herman A. A., Avery B., Phillips M. T. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993 Nov-Dec;9(6 Suppl):82–122. [PubMed] [Google Scholar]
- 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]
- 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]
- Kunst A. E., Looman C. W., Mackenbach J. P. Socio-economic mortality differences in The Netherlands in 1950-1984: a regional study of cause-specific mortality. Soc Sci Med. 1990;31(2):141–152. doi: 10.1016/0277-9536(90)90055-w. [DOI] [PubMed] [Google Scholar]
- La Veist T. A. Why we should continue to study race...but do a better job: an essay on race, racism and health. Ethn Dis. 1996 Winter-Spring;6(1-2):21–29. [PubMed] [Google Scholar]
- Lee P. R., Moss N., Krieger N. Measuring social inequalities in health. Report on the Conference of the National Institutes of Health. Public Health Rep. 1995 May-Jun;110(3):302–305. [PMC free article] [PubMed] [Google Scholar]
- Muldoon J. T., Wintermeyer L. A., Eure J. A., Fuortes L., Merchant J. A., Van Lier S. F., Richards T. B. Occupational disease surveillance data sources, 1985. Am J Public Health. 1987 Aug;77(8):1006–1008. doi: 10.2105/ajph.77.8.1006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Navarro V. Race or class versus race and class: mortality differentials in the United States. Lancet. 1990 Nov 17;336(8725):1238–1240. doi: 10.1016/0140-6736(90)92846-a. [DOI] [PubMed] [Google Scholar]
- Nolan L. J., Freeman W. L., D'Angelo A. J. Local research: needed guidance for the Indian Health Service's urban mission. Public Health Rep. 1996 Jul-Aug;111(4):320–320. [PMC free article] [PubMed] [Google Scholar]
- Pappas G., Queen S., Hadden W., Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. doi: 10.1056/NEJM199307083290207. [DOI] [PubMed] [Google Scholar]
- Phillimore P., Beattie A., Townsend P. Widening inequality of health in northern England, 1981-91. BMJ. 1994 Apr 30;308(6937):1125–1128. doi: 10.1136/bmj.308.6937.1125. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pollock A. M., Rice D. P. Monitoring health care in the United States--a challenging task. Public Health Rep. 1997 Mar-Apr;112(2):108–113. [PMC free article] [PubMed] [Google Scholar]
- Rep M. H., Hintzen R. Q., Polman C. H., van Lier R. A. Recombinant interferon-beta blocks proliferation but enhances interleukin-10 secretion by activated human T-cells. J Neuroimmunol. 1996 Jul;67(2):111–118. doi: 10.1016/0165-5728(96)00060-4. [DOI] [PubMed] [Google Scholar]
- 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]
- Sorvillo F., Kerndt P., Cheng K. J., Beall G., Turner P. A., Beer V. L., Kovacs A. Emerging patterns of HIV transmission: the value of alternative surveillance methods. AIDS. 1995 Jun;9(6):625–629. [PubMed] [Google Scholar]
- Starr P., Starr S. Reinventing vital statistics. The impact of changes in information technology, welfare policy, and health care. Public Health Rep. 1995 Sep-Oct;110(5):534–544. [PMC free article] [PubMed] [Google Scholar]
- Williams D. R., Lavizzo-Mourey R., Warren R. C. The concept of race and health status in America. Public Health Rep. 1994 Jan-Feb;109(1):26–41. [PMC free article] [PubMed] [Google Scholar]