Painting a Truer Picture of US Socioeconomic and Racial/Ethnic Health Inequalities: The Public Health Disparities Geocoding Project

• Published in: American journal of public health (1971) Vol. 95; no. 2; pp. 312 - 323
• Main Authors: Krieger, Nancy, Chen, Jarvis T, Waterman, Pamela D, Rehkopf, David H, Subramanian, S.V
• Format: Journal Article
• Language: English
• Published: Washington, DC Am Public Health Assoc 01-02-2005; American Public Health Association; American Journal of Public Health 2005
• Subjects: Biological and medical sciences; Censuses; Family Characteristics - ethnology; Female; Geography; Health disparities; Healthy People Programs; Humans; Inequality; Male; Massachusetts - epidemiology; Medical sciences; Minority & ethnic groups; Miscellaneous; Morbidity; Population Surveillance - methods; Poverty - ethnology; Poverty - statistics & numerical data; Program Evaluation; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Racial discrimination; Research and Practice; Rhode Island - epidemiology; Risk Assessment; Social Class; Socioeconomic Factors; Rhode Island; United States; North America; Massachusetts; America; USA, Rhode Island; USA, Massachusetts; Socioeconomic status; Race; Economic aspect; Measurement method; Sanitary surveillance; Socioeconomics; Social aspect; Ethnic group; Public health; Geographical variation; Inequality
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2003.032482

We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States.
We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island.
For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead.
Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.