title: Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: results from a primary care network.
abstract: OBJECTIVE
  To determine which area-based socioeconomic status (SES) indicator is best suited to monitor health care disparities from a delivery system perspective.
  
  
  METHODS
  142,659 adults seen in a primary care network from January 1, 2009 to December 31, 2011.
  
  
  METHODS
  Cross-sectional, comparing associations between area-based SES indicators and patient outcomes.
  
  
  METHODS
  Address data were geocoded to construct area-based SES indicators at block group (BG), census tract (CT), and ZIP code (ZIP) levels. Data on health outcomes were abstracted from electronic records. Relative indices of inequality (RIIs) were calculated to quantify disparities detected by area-based SES indicators and compared to RIIs from self-reported educational attainment.
  
  
  RESULTS
  ZIP indicators had less missing data than BG or CT indicators (p < .0001). Area-based SES indicators were strongly associated with self-report educational attainment (p < .0001). ZIP, BG, and CT indicators all detected expected SES gradients in health outcomes similarly. Single-item, cut point defined indicators performed as well as multidimensional indices and quantile indicators.
  
  
  CONCLUSIONS
  Area-based SES indicators detected health outcome differences well and may be useful for monitoring disparities within health care systems. Our preferred indicator was ZIP-level median household income or percent poverty, using cut points.
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Berkowitz
authors.forename: Carine Y
authors.initials: CY
authors.lastname: Traore
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data*; D017062:Small-Area Analysis; D012959:Socioeconomic Factors
keywords: Socioeconomic status; delivery of health care; geographic mapping; health care disparities; quality of health care