An approach to studying social disparities in health and health care.
OBJECTIVE
We explored methods and potential applications of a systematic approach to studying and monitoring social disparities in health and health care.


METHODS
Using delayed or no prenatal care as an example indicator, we (1) categorized women into groups with different levels of underlying social advantage; (2) described and graphically displayed rates of the indicator and relative group size for each social group; (3) identified and measured disparities, calculating relative risks and rate differences to compare each group with its a priori most-advantaged counterpart; (4) examined changes in rates and disparities over time; and (5) conducted multivariate analyses for the overall sample and "at-risk" groups to identify particular factors warranting attention.


RESULTS
We identified at-risk groups and relevant factors and suggest ways to direct efforts for reducing prenatal care disparities.


CONCLUSIONS
This systematic approach should be useful for studying and monitoring disparities in other indicators of health and health care.
Braveman
Paula A
PA
Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, CA 94143-0900, USA. braveman@fcm.uscf.edu
Egerter
Susan A
SA
Cubbin
Catherine
C
Marchi
Kristen S
KS
D002140:California; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006302:Health Services Research; D006801:Humans; D011247:Pregnancy; D011295:Prenatal Care; D011787:Quality of Health Care; D044469:Racial Groups; D012959:Socioeconomic Factors