indicators of socioeconomic position course on social determinants of health parvin tajik, md phd...
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Indicators of Socioeconomic Position
Course on Social Determinants of Health
Parvin Tajik, MD
PhD candidate of Epidemiology,
Tehran University of Medical Sciences
SEPWidely used in epidemiological
research:◦Socioeconomic Position (SEP)◦Socioeconomic Status (SES)
Definitions vary but incorporate:◦Physical resources◦Social resources◦Status with the social hierarchy
Its measurement is crucial
Indicators of SEPA multi-dimentional construct
with diverse factors:◦Education◦Occupation◦Economical status
Moderately correlated, but not interchangeable
EducationOne of the most widely used Can be easily determined for all
individualsHealth impairments
that emerge in adulthood rarely affect educational attainment => Avoids the potential contamination of reverse causation
EducationCan reflect a range of non-
economical social characteristics:◦General knowledge◦Health-related knowledge◦Literacy◦Problem-solving skills◦Prestige◦Influence over others & one’s own life
Affects Health
Measurement approaches
)اداره ي طبقه بندي سطح سواد آمار ايران(
بي سواد ابتدايیراهنمايی متوسطه پيش دانشگاهیعالی سوادآموزی بزرگساالن سايردوره های تحصيلی
ComparisonBoth 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
Advantages
Fairly stable beyond early adulthood
Its measurement is practical and convenient in many contexts
One of the SEP indicators especially likely to capture aspects of lifestyle and behavior
Limitations (1)Varies by birth cohort Relative to income, there is
decreasing variance => may minimize estimates of social inequalities in health
Lack of volatility => precludes the opportunity to assess how health status is affected by changes in SEP
Individualistic, separate from other members of the household
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
OccupationSummarizes:
◦Power◦Income ◦educational requirements
associated with various positions in the occupational structure
Several advantages:the outcome of educational attainment
likely to be a better indicator of income over the long term than is income
a promising measure of social position & job characteristics:◦environmental and working conditions, d◦decision-making latitude◦psychological demands of the job.
CODE DESC1 قانونگذاران ، مقامات عاليرتبه ومديران11 قانونگذاران و مقامات عاليرتبه111 قانونگذاران1110 قانونگذاران1110 استاندار1110 بخشدار1110 دادستان كل كشور1110 دبيركل سازمان امورادارئ واستخدامي كشور1110 رهبر1110 رييس جمهور1110 رييس ديوانعالي كشور1110 رييس سازمان انرژئ اتمي1110 رييس سازمان برنامه وبودجه1110 رييس سازمان تربيت بدني1110 رييس سازمان حفاظت محيط زيست1110 رييس شوراعالي قضايي1110 رييس شورائ شهر1110 رييس مجلس شورائ اسالمي1110 رييس مجمع تشخيص مصلحت نظام
تكنسين شنوايي سنجي تكنسين فوريتهائ پزشكي تكنسين كالبدشكافي تكنسين نوارنگارئ تكنسين هوش برئ راديوگراف راديولوژيست - كارشناس ياتكنسين سونوگراف - كارشناس ياتكنسين شنوايي سنجي كارشناس اموربهداشتي ودرماني روستا كارشناس راديولوژئ كمك تكنسين استريل كمك تكنسين راديولوژئ كمك تكنسين نوارنگارئ متخصص اديومترئ متصدئ اتاق عمل
)اداره طبقه بندي گروه شغلی ي آمار ايران(
قانونگذاران، مقامات عالي رتبه ومديران ابتدايی متخصصان تكنسين ها ودستياران كارمندان اموراداري ودفتريکاركنان خدماتي وفروشندگانكاركنان ماهركشاورزي، جنگلداري و ماهيگيريصنعتگران وكاركنان مشاغل مربوط متصديان، مونتاژكاران ماشين آالت و دستگاه ها و
رانندگان وسايل نقليهكارگران ساده
Economical statusDirect measures
◦Income◦Consumption
Indirect measures◦Household assets (Wealth)
Direct measuresIncome:
◦Earnings from productive activities + transfers
Consumption:◦Resources actually consumed
Moderately correlated, but not interchangeable
Correlation between indices
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
02
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0 1.000e+09 2.000e+09 3.000e+09daramad
ConsumptionPreferred measure by manyDifferent questionnaires with
different items4 main classes of consumption:
◦Food items◦Non-food items◦Consumer durables◦Housing
Consumption expenditure
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nsity
0 200000000 400000000 600000000 800000000 1000000000Impure consumption expenditure
3 steps in construction
1. Constructing an aggregate of different components of consumption
2. Making adjustment for cost of living differences
3. Making adjustment for household size and composition
In developing countries Consumption is preferred:
1. Income is received intermittently, consumption smoothed over time => more directly related to current living standards
2. 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
Proxy measures (wealth)Using household assets & other
characteristics
Data easily collected on a single household interview or observation
Less recall bias & more reliable
Constructing a proxy wealth index
◦3 methods: ◦differ in how household assets &
characteristics are weighted in overall index:
1. Arbitrary2. Predicting consumption3. Principal component analysis
1. Arbitrary approachSum of indicatorsEqual weightsConvenient proxy
Index = asset1 + asset2 + ….+ assetn
Each asset is a dichotomous (0, 1) variable
Very simple wealth index =Very simple wealth index = Vacuum + Kitchen + Computer + Washing + Vacuum + Kitchen + Computer + Washing + Bathroom + FreezerBathroom + Freezer
2. Predicting consumptionWhere complementary data are
availableDeriving weights for index through a
consumption regression => coefficients are used as weights
It has considerable predictive powerCan include Indicators & determinants
Y = w1asset1 + w2asset2 + + wnassetn
Each asset is a dichotomous (0, 1) variable
3. Principal components analysisUsing statistical techniques to
determine the weights in the indexTo 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
id VariableScoring
Coefficients1 Vacuum cleaner 0.274872 Washing machine 0.255673 Bathroom 0.240784 Kitchen 0.235155 Heating fuel 0.231186 Color TV 0.22117 Telephone 0.220978 Gas 0.215269 Area 0.2093210 Rooms 0.2072211 Housing 0.2039412 Freezer 0.1994513 Mobile 0.1975314 Sewing machine 0.1961315 Computer 0.1867716 Car 0.1837117 Cooler 0.1758618 Recorder 0.1751519 Oven 0.1669720 Video 0.1654921 Cooking fuel 0.1436522 Piped water 0.1427123 Internet 0.1393924 Bicycle 0.1016825 Central heating 0.0926326 Fan 0.0900227 electricity 0.0897728 Mobile cooler 0.0498129 Radio 0.0424830 Motorcycle 0.0323331 Central cooler 0.0302632 Refrigerator 0.0086733 BWTV -0.12393
Constructed WI distribution
0.0
5.1
.15
De
nsity
-10 -5 0 5 10wealth
Advantages of incomeCaptures the dynamic component of
SEP Income is the component of SEP 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)
Limitations of incomeReverse causation problemMore unstable measure than education or
occupationSensitive to changes in life circumstances Age dependentSensitive for some people => greater
errors in reporting and non-responseCostly and time consuming measurement Varies within occupations and is only
moderately correlated with education Measures fail to include all income earned
Past SE experiences:Effect of childhood SEP on health,
Independent of adult SEP.Importance varies with health
outcomesSEP measurement at only one stage of
life is inadequate for full evaluationCan act as confounder or effect-
modifierChanges of SEP over time can affect
healthPoverty can have cumulative health
effect
Neighborhood SE conditionsCould affect health through
features of the environment:◦Physical◦Social◦Service
% of poor household or Unemployed adults in the region
or physical environment