Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures--the public health disparities geocoding project (US)

Public Health Rep. 2003 May-Jun;118(3):240-60. doi: 10.1093/phr/118.3.240.


Objectives: To determine which area-based socioeconomic measures, at which level of geography, are suitable for monitoring socioeconomic inequalities in sexually transmitted infections (STIs), tuberculosis (TB), and violence in the United States.

Methods: Cross-sectional analysis of public health surveillance data, geocoded and linked to area-based socioeconomic measures generated from 1990 census tract, block group, and ZIP Code data. We included all incident cases among residents of either Massachusetts (MA; 1990 population = 6016425) or Rhode Island (RI; 1990 population = 1003464) for: STIs (MA: 1994-1998, n = 26535 chlamydia, 7464 gonorrhea, 2619 syphilis; RI: 1994-1996, n = 4473 chlamydia, 1256 gonorrhea, 305 syphilis); TB (MA: 1993-1998, n = 1793; RI: 1985-1994, n = 576), and non-fatal weapons related injuries (MA: 1995-1997, n = 6628).

Results: Analyses indicated that: (a). block group and tract socioeconomic measures performed similarly within and across both states, with results more variable for the ZIP Code level measures; (b). measures of economic deprivation consistently detected the steepest socioeconomic gradients, considered across all outcomes (incidence rate ratios on the order of 10 or higher for syphilis, gonorrhea, and non-fatal intentional weapons-related injuries, and 7 or higher for chlamydia and TB); and (c). results were similar for categories generated by quintiles and by a priori categorical cut-points.

Conclusions: Supplementing U.S. public health surveillance systems with census tract or block group area-based socioeconomic measures of economic deprivation could greatly enhance monitoring and analysis of social inequalities in health in the United States.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Censuses
  • Cross-Sectional Studies
  • Female
  • Geography
  • Humans
  • Incidence
  • Male
  • Massachusetts / epidemiology
  • Middle Aged
  • Population Surveillance / methods*
  • Postal Service
  • Poverty
  • Rhode Island / epidemiology
  • Sexually Transmitted Diseases / classification
  • Sexually Transmitted Diseases / economics
  • Sexually Transmitted Diseases / epidemiology*
  • Socioeconomic Factors*
  • Tuberculosis / economics
  • Tuberculosis / epidemiology*
  • Violence / classification
  • Violence / economics
  • Violence / statistics & numerical data*
  • Wounds, Gunshot / economics
  • Wounds, Gunshot / epidemiology*
  • Wounds, Stab / economics
  • Wounds, Stab / epidemiology*