159284 Measuring wealth in health research: A systematic review

Sunday, November 4, 2007

Craig Pollack, MD, MHS , Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
Sekai Chideya, MD, MPH , Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA
Catherine Cubbin, PhD , School of Social Work, University of Texas at Austin, Austin, TX
Brie Williams, MD , Dvision of Geriatrics, University of California-San Francisco, San Francisco, CA
Mercedes Dekker, MPH , Center on Social Disparities in Health, University of California San Francisco, San Francisco, CA
Paula A. Braveman, MD, MPH , Family and Community Medicine, University of California, San Francisco, San Francisco, CA
BACKGROUND: Measures of socioeconomic status/position (SES) are not interchangeable. Different SES factors, such as education, income, occupational status, and wealth, may influence health through various mechanisms at different stages of the lifespan. Wealth may be particularly important for elderly and retired persons, may buffer the effects of lost income, and may vary tremendously by different racial/ethnic groups. This study reviews the U.S.-based health literature to describe how wealth has been measured and to determine whether empiric evidence supports including measures of wealth in health research.

METHODS: We systematically reviewed studies published between 1990 and 2006 that included wealth as an independent variable and a health-related indicator as a dependent variable. Included studies controlled for least one other measure of SES.

RESULTS: Twenty-nine studies met inclusion criteria. Measures of wealth varied greatly in detail and length. Significant associations between wealth and health appeared most consistent when wealth measures relied on detailed questions about specific assets and debts as opposed to employing a single question measuring wealth. Higher levels of wealth were associated with decreased mortality and better health status. Controlling for wealth tended to reduce or eliminate black/white differences in many of the studies. For older and elderly persons, the correlation between wealth and health was particularly strong.

CONCLUSIONS: Health studies should include wealth as an important SES indicator. Failure to measure wealth may result in underestimating the contribution of SES to health, e.g., when studying the etiology of racial/ethnic disparities.

Learning Objectives:
1. To review the ways in which wealth has been measured in public health research. 2. To summarize the evidence to date which links wealth and health outcomes. 3. To recognize the potential impact of wealth on health disparities.

Keywords: Social Inequalities, Epidemiology

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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