title: Comparison of individual-level versus area-level socioeconomic measures in assessing health outcomes of children in Olmsted County, Minnesota.
abstract: BACKGROUND
  Socioeconomic status (SES) is an important determinant of health, but SES measures are frequently unavailable in commonly used datasets. Area-level SES measures are used as proxy measures of individual SES when the individual measures are lacking. Little is known about the agreement between individual-level versus area-level SES measures in mixed urban-rural settings.
  
  
  METHODS
  We identified SES agreement by comparing information from telephone self-reported SES levels and SES calculated from area-level SES measures. We assessed the impact of this agreement on reported associations between SES and rates of childhood obesity, low birth weight <2500 g and smoking within the household in a mixed urban-rural setting.
  
  
  RESULTS
  750 households were surveyed with a response rate of 62%: 51% male, 89% Caucasian; mean child age 9.5 years. Individual-level self-reported income was more strongly associated with all three childhood health outcomes compared to area-level SES. We found significant disagreement rates of 22-31%. The weighted Cohen's κ indices ranged from 0.15 to 0.22, suggesting poor agreement between individual-level and area-level measures.
  
  
  CONCLUSIONS
  In a mixed urban-rural setting comprised of both rural and urbanised areas, area-level SES proxy measures significantly disagree with individual SES measures, and have different patterns of association with health outcomes from individual-level SES measures. Area-level SES may be an unsuitable proxy for SES when individual rather than community characteristics are of primary concern.
authors: Division of Community Paediatric and Adolescent Medicine, Department of Paediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors: Maria R
authors: MR
authors: Pardo-Crespo
authors: Nirmala Priya
authors: NP
authors: Narla
authors: Arthur R
authors: AR
authors: Williams
authors: Timothy J
authors: TJ
authors: Beebe
authors: Jeff
authors: J
authors: Sloan
authors: Barbara P
authors: BP
authors: Yawn
authors: Philip H
authors: PH
authors: Wheeler
authors: Young J
authors: YJ
authors: Juhn
mesh_terms: D000293:Adolescent; D017028:Caregivers / Q000523:psychology; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight / Q000502:physiology; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012424:Rural Population / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D014505:Urban Population / Q000706:statistics & numerical data