Where you live is a good indicator of socioeconomic position

Life expectancy and disability-free life expectancy at birth, by neighborhood income level, England, 1999-2003.

Fair Society, Healthy Lives: The Marmot Review (www.ucl.ac.uk/marmotreview)

Inequality in early cognitive development of children in the 1970 British cohort study, at ages 22 months to 10 years.

Fair Society, Healthy Lives: The Marmot Review (www.ucl.ac.uk/marmotreview)

Populations living in areas the least favorable environmental conditions across various environmental categories.

Fair Society, Healthy Lives: The Marmot Review (www.ucl.ac.uk/marmotreview)

The Area Deprivation Index has its own web site (https://www.neighborhoodatlas.medicine.wisc.edu)

There are some problems with the ADI

• Missing observations are treated as having a value of zero

  • Rent: 18% missing
  • Mortgage: 13% missing
  • Median household income: 6% missing
  • Other variables: 1-2% missing

• Original factor loadings from 2000 are used

• Income disparity is not adjusted for inflation
• Variables are highly heteroscedastic
• Access to a phone means something different in 2020 than in 2000

Yost index vs. ADI (using 2011-2015 ACS data)

• Yost index vs. ADI as published: $$R^2 = 0.79$$

Where the two differ by >30 percentile points, Yost is higher over 90% of the time, because it used imputed rather than zero values missing data.

• Yost index vs. ADI calculated the same way: $$R^2 = 0.92$$

Differences are normally distributed and typically involve outliers in the variables unique to the ADI

Yost index vs. ADI (continued)

• Where ADI indicates a higher SES than Yost tend to be rural areas with low income but little income disparity, high rates of home ownership, few single-parent households, high vehicle ownership, and little crowding. (Examples in Arkansas, Alabama, Texas)

• Where ADI indicates a lower SES than Yost tend to be urban and suburban areas with high cost of living but high income disparity, low rates of home ownership, many single-parent households, low vehicle ownership, and high crowding (Examples in San Francisco, Los Angeles, Washington DC)

Conclusions

• No single SES index will ever be perfect, but the Yost index has a lot of positive qualities

• It is beyond time for socioeconomic measures to be a core element of population-based cancer surveillance