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February 2005, Vol 95, No. 2 | American Journal of Public Health 312-323
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2003.032482

RESEARCH AND PRACTICE

Painting a Truer Picture of US Socioeconomic and Racial/Ethnic Health Inequalities: The Public Health Disparities Geocoding Project

Nancy Krieger, PhD, Jarvis T. Chen, ScD, Pamela D. Waterman, MPH, David H. Rehkopf, MPH and S.V. Subramanian, PhD

The authors are with the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Mass.

Correspondence: Requests for reprints should be sent to Nancy Krieger, PhD, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Hunting-ton Ave, Boston, MA 02115 (e-mail: nkrieger{at}hsph.harvard.edu).

Objectives. We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States.

Methods. We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island.

Results. For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead.

Conclusions. Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.




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