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Abstract: Area-level socioeconomic status (SES) measures have been used as a proxy in child health research when individual SES measures are lacking, yet little is known about their validity in an urban setting. We assessed agreement between census block-group and individual-level SES measures obtained from a caregiver telephone survey in Jackson County, Missouri. Associations with prevalence of childhood overweight (OW), low birth weight (LBW), and household smoking exposure were examined using logistic regression models. Seven hundred eighty-one households were surveyed: 49% male, 76% White, mean child age 9.4 years. We found misclassification rates of 20-35% between individual vs. area-level measures of education and income; Kappa indices ranged from 0.26-0.36 indicating poor agreement. Both SES measures showed an inverse association with LBW and smoking exposure. Area-level SES measures may reflect a construct inclusive of neighborhood resources; routine substitution of these measures should be interpreted with caution, despite similar correlations with health outcomes.
Key words: Birth weight, smoking, socioeconomic status, research methods.
Oakes and Rossi defined socioeconomic status (SES) as a construct that reflects one's access to collectively desired resources (e.g., material goods, money, power, friendship networks, health care, leisure time, or educational opportunities).1 We postulate that the definition of SES may go beyond access to resources as it also affects effective utilization and recycling of such resources. There is substantial evidence in the literature that SES is an important predictor of health outcomes.2- 10 For example, low birth weight, overweight, and smoking exposure have significant public health implications, particularly among children, and these three health outcomes have been previously reported to be associated with individual SES measures.11- 14 While the mechanism of influence has not yet been elucidated, biological and behavioral interactions with environmental stimuli likely play a role in determination of disease and health status, particularly as implicated in health outcomes for children.15- 18 In fact, both environmental triggers and psychosocial factors at birth and SES in childhood may affect subsequent adult health status through biological alterations including epigenetic modifications.19,20
Despite the important role of SES measures, the use of SES data in health research is inconsistent. Commonly-collected SES measures such as income, education, and occupation may be difficult to ascertain at the individual level, and are thus often unavailable in datasets used by...