The ADI-3: a revised neighborhood risk index of the social determinants of health over time and place

• Published in: Health services and outcomes research methodology Vol. 21; no. 4; pp. 486 - 509
• Main Authors: Berg, Kristen A., Dalton, Jarrod E., Gunzler, Douglas D., Coulton, Claudia J., Freedman, Darcy A., Krieger, Nikolas I., Dawson, Neal V., Perzynski, Adam T.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2021; Springer Nature B.V
• Subjects: Economics; Health Administration; Medicine; Medicine & Public Health; Methodology of the Social Sciences; Neighborhoods; Public Health; Socioeconomic factors; Statistics; Measurement validity; Clinical care; Area deprivation index; Socioeconomic disadvantage; Health
• ISSN: 1387-3741; 1572-9400
• DOI: 10.1007/s10742-021-00248-6

Since its development, Singh’s 2003 Area Deprivation Index (ADI) has been routinely used by researchers to measure a global construct of neighborhood socioeconomic deprivation and to investigate how living in neighborhoods of different levels of socioeconomic deprivation affects individuals’ health. We empirically tested the ADI’s dimensionality, using 2013–2017 American Community Survey tract-level estimates (
N
 = 73,056), and the stability of its performance across time and place. Factor analysis findings illuminated three distinct dimensions, the ADI-3, consisting of neighborhood financial strength, economic hardship and inequality, and educational attainment. The prior-assumed unidimensional ADI measure fails standard tests of construct validity. Findings from multigroup structural equation modeling across 2009 and 2017 and between New York and Minnesota suggest that the ADI performs with only partial stability across time and place. In order to most precisely understand the complex role of neighborhood socioeconomic position in health, public health researchers must integrate construct-valid and regionally and temporally relevant measures.