Indicators of Socioeconomic Status

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Indicators of Socioeconomic Status

• Course on Social Determinants of Health

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SES

• Widely used in health research
• Socioeconomic Status (SES)
• Socioeconomic Position (SEP)
• Social Class
• Studies treat SES as
• Potential confounder
• Main exposure

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Indicators of SES

• A multidimentional construct with diverse
  factors
• Education
• Economical status
• Occupational status
• Moderately correlated, but not interchangeable

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Education

• One of the most widely used
• Can be easily determined for all individuals

• Health impairments that emerge in adulthood
  rarely affect educational attainment gt Avoids
  the potential contamination of reverse causation

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Education

• Can reflect a range of noneconomical social
  characteristics
• General knowledge
• Health-related knowledge
• Literacy
• Problem-solving skills
• Prestige
• Influence over others ones own life
• Affect Health

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Measurement approaches
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Comparison

• Both approaches are common
• More meaningful to measure educational level in
  terms of credentials rather than simply years of
  education more influential in determining
  occupational prestige
• Discontinuities when years of education is used
  as a continuous variable

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Advantages

• Fairly stable beyond early adulthood
• Its measurement is practical and convenient in
  many contexts
• One of the SE indicators especially likely to
  capture aspects of lifestyle and behavior

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Limitations (1)

• Varies by birth cohort
• Relative to income, there is decreasing variance
  gt may minimize estimates of social inequalities
  in health
• Lack of volatility gt precludes the opportunity
  to assess how health status is affected by
  changes in SES
• Individualistic, separate from other members of
  the household

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Limitations (2)

• The economic return for a given level of
  education varies importantly by race and gender
• The economic and social return for a given level
  of education may vary importantly by the prestige
  of the educational institution attended

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Economical status

• Direct measures
• Income
• Consumption
• Indirect measures
• Household assets (Wealth)

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Direct measures

• Income
• Earnings from productive activities transfers
• Consumption
• Resources actually consumed
• Moderately correlated, but not interchangeable

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Income

• Have 4 main components
• Wage income from labor services
• Rental income from land, capital or assets
• Self-employment income
• Current transfer from government or
  non-governmental agencies or other households

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• Which of these categories best describes your
  total combined family income for the past 12
  months? This should include income (before taxes)
  from all sources, wages, rent from properties,
  social security, disability and/or veteran's
  benefits, unemployment benefits, workman's
  compensation, help from relatives (including
  child payments and alimony), and so on.
  _____Less than 5,000_____5,000 through
  11,999_____12,000 through 15,999_____16,000
  through 24,999_____25,000 through
  34,999_____35,000 through 49,999_____50,000
  through 74,999_____75,000 and
  greater_____Don't know_____No response

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Consumption

• Preferred measure by many
• Different questionnaires with different items
• 4 main classes of consumption
• Food items
• Non-food items
• Consumer durables
• Housing

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3 steps in construction

• Constructing an aggregate of different components
  of consumption
• Making adjustment for cost of living differences
• Making adjustment for household size and
  composition

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Relationship between income consumption
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In developing countries

• Consumption is preferred
• Income is received intermittently, consumption
  smoothed over time gt more directly related to
  current living standards
• Income data is more difficult to collect.
• Self-employment
• Multiple continually changing sources of income
• Informal economic activities
• Widespread reluctance to disclose information on
  income

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Proxy measures (wealth)

• Using household assets other characteristics
• Data easily collected on a single household
  interview
• Constructing an index
• 3 methods differ in how household assets
  characteristics are weighted in overall index.

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1. Arbitrary approach

• Sum of indicators
• Equal weights
• Convenient proxy
• Index asset1 asset2 . assetn
• Each asset is a dichotomous (0, 1) variable

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2. Principal components analysis

• Using statistical techniques to determine the
  weights in the index
• To describe as much as possible of the variation
  in the original data set.
• Asset index is the first linear combination
• Y w1asset1 w2asset2 wnassetn
• Each asset is a dichotomous (0, 1) variable

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3. Predicting consumption

• Where complementary data are available
• Deriving weights for index through a consumption
  regression gt coefficients are used as weights
• It has considerable predictive power
• Can include Indicators determinants
• Y w1asset1 w2asset2 wnassetn
• Each asset is a dichotomous (0, 1) variable

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Advantages of income

• Captures the dynamic component of SES
• Income is the component of SES that is most
  amenable to change through redistributive
  policies such as tax credits or direct income
  supplementation
• Has psychometric properties of being continuous
  and spread along a very broad range from low (the
  depths of poverty) to high (extreme wealth)

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Limitations of income

• Reverse causation problem
• More unstable measure than education or
  occupation
• Sensitive to changes in life circumstances
• Age dependent
• Sensitive for some people gt greater errors in
  reporting and non-response
• Costly and time consuming measurement
• Varies within occupations and is only moderately
  correlated with education
• Measures fail to include all income earned

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Past SE experiences

• Effect of childhood SES on health, Independent of
  adult SES.
• Importance varies with health outcomes
• SES measurement at only one stage of life is
  inadequate for full evaluation
• Can act as confounder or effect-modifier
• Changes of SES over time can affect health
• Poverty can have cumulative health effect

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Neighborhood SE conditions

• Could affect health through features of the
  environment
• Physical
• Social
• Service
• of poor household or
• Unemployed adults in the region or physical
  environment