An approach to studying social disparities in health and health care

Am J Public Health. 2004 Dec;94(12):2139-48. doi: 10.2105/ajph.94.12.2139.


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.

Publication types

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

MeSH terms

  • California
  • Cross-Sectional Studies
  • Ethnicity
  • Female
  • Health Services Research*
  • Humans
  • Pregnancy
  • Prenatal Care*
  • Quality of Health Care*
  • Racial Groups
  • Socioeconomic Factors