Journal Article

Geocoding and Monitoring of US Socioeconomic Inequalities in Mortality and Cancer Incidence: Does the Choice of Area-based Measure and Geographic Level Matter?

Nancy Krieger, Jarvis T. Chen, Pamela D. Waterman, Mah-Jabeen Soobader, S. V. Subramanian and Rosa Carson

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 156, issue 5, pages 471-482
Published in print September 2002 | ISSN: 0002-9262
Published online September 2002 | e-ISSN: 1476-6256 | DOI: http://dx.doi.org/10.1093/aje/kwf068
Geocoding and Monitoring of US Socioeconomic Inequalities in Mortality and Cancer Incidence: Does the Choice of Area-based Measure and Geographic Level Matter?

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Despite the promise of geocoding and use of area-based socioeconomic measures to overcome the paucity of socioeconomic data in US public health surveillance systems, no consensus exists as to which measures should be used or at which level of geography. The authors generated diverse single-variable and composite area-based socioeconomic measures at the census tract, block group, and zip code level for Massachusetts (1990 population: 6,016,425) and Rhode Island (1990 population: 1,003,464) to investigate their associations with mortality rates (1989–1991: 156,366 resident deaths in Massachusetts and 27,291 in Rhode Island) and incidence of primary invasive cancer (1988–1992: 140,610 resident cases in Massachusetts; 1989–1992: 19,808 resident cases in Rhode Island). Analyses of all-cause and cause-specific mortality rates and all-cause and site-specific cancer incidence rates indicated that: 1) block group and tract socioeconomic measures performed comparably within and across both states, but zip code measures for several outcomes detected no gradients or gradients contrary to those observed with tract and block group measures; 2) similar gradients were detected with categories generated by quintiles and by a priori categorical cutpoints; and 3) measures including data on economic poverty were most robust and detected gradients that were unobserved using measures of only education and wealth.

Keywords: censuses; geographic information system; geostatistics; mortality; neoplasms; population surveillance; poverty; socioeconomic factors; Abbreviations: IRR, incidence rate ratio; RII, relative index of inequality; SEP, socioeconomic position.

Journal Article.  8129 words.  Illustrated.

Subjects: Public Health and Epidemiology

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