Can we monitor socioeconomic inequalities in health? A survey of U.S. health departments' data collection and reporting practices.
OBJECTIVE
To evaluate the potential for and obstacles to routine monitoring of socioeconomic inequalities in health using U.S. vital statistics and disease registry data, the authors surveyed current data collection and reporting practices for specific socioeconomic variables.


METHODS
In 1996 the authors mailed a self-administered survey to all of the 55 health department vital statistics offices reporting data to the National Center for Health Statistics (NCHS) to determine what kinds of socioeconomic data they collected on birth and death certificates and in cancer, AIDS, and tuberculosis (TB) registries and what kinds of socioeconomic data were routinely reported in health department publications.


RESULTS
Health departments routinely obtained data on occupation on death certificates and in most cancer registries. They collected data on educational level for both birth and death certificates. None of the databases collected information on income, and few obtained data on employment status, health insurance carrier, or receipt of public assistance. When socioeconomic data were collected, they were usually not included in published reports (except for mothers educational level in birth certificate data). Obstacles cited to collecting and reporting socioeconomic data included lack of resources and concerns about the confidentiality and accuracy of data. All databases, however, included residential addresses, suggesting records could be geocoded and linked to Census-based socioeconomic data.


CONCLUSIONS
U.S. state and Federal vital statistics and disease registries should routinely collect and publish socioeconomic data to improve efforts to monitor trends in and reduce social inequalities in health.
Krieger
N
N
Harvard School of Public Health, Boston, MA 02115, USA. nkrieger@hsph.harvard.edu
Chen
J T
JT
Ebel
G
G
D001719:Birth Certificates; D003625:Data Collection / Q000379:methods* / Q000592:standards; D016208:Databases, Factual / Q000592:standards; D003644:Death Certificates; D006302:Health Services Research / Q000379:methods* / Q000592:standards; D006801:Humans; D007348:Insurance, Health; D009309:National Center for Health Statistics, U.S.; D012042:Registries; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D014798:Vital Statistics