TReND: Measuring Wealth in Health Disparities Research: Practical Recommendations
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Rationale: Wealth is a complex construct, referring not only to material resources, but also to potential access to different lifestyles, and a sense of security, power and control. In survey research, the standard method to measure wealth is by accumulated economic resources offset by accumulated debt, or “net worth.” Strong empirical and conceptual grounds exist for measuring wealth in health disparities studies.  A given level of income or education reflects dramatically different levels of wealth for people in different racial/ethnic groups. Failure to measure wealth, then, may under-estimate the contribution of SES/position (SES) to health, such as when studying the etiology of racial/ethnic disparities. Further, wealth may be more relevant for health than income because it can buffer against effects of temporary low income (e.g., due to unemployment, illness) and it reflects power and influence over others more so than income. However, wealth measures are rarely included in health research, in part because questions on net worth are considered to be intrusive and burdensome (collecting acceptable measures involves a lengthy set of questions and advanced preparation by participants). A recent systematic review of studies that examined the relationship between wealth and health found that wealth was significantly associated with health after adjusting for at least one other SES measure, but that more consistent associations between wealth and health were observed when using multiple, detailed questions rather than simple measures, e.g., home ownership.  In addition, racial/ethnic disparities generally decreased when wealth was included in models compared with models without wealth; however, few studies investigated how wealth was related to health within social groups, defined by race/ethnicity, SES, or gender. The study’s main recommendation called for validation of simpler approaches to measuring wealth that are feasible in health studies. Also of note is that no studies were identified that examined tobacco-related indicators.
Purpose: The purpose of this study is to identify and recommend feasible measures of wealth based on current questions asked in the following two population-based health surveys: The Health and Retirement Survey (HRS) , which uses “bracketing” in the survey administration to reduce missing data on wealth; and the Survey of Consumer Finances (SCF), which is considered to contain the most comprehensive distribution of wealth data in the U.S. TReND investigators will conduct analyses to assess correlations between nine different simpler measures of wealth and the standard measure, “net worth.” The investigators will then compare whether results would be similar in models relating wealth to health status and smoking, depending on whether wealth was measured by net worth or a simpler measure. Comparisons will be primarily based upon the magnitude of effects and model fit. This information will be used to select optimal subsets of items to measure wealth. Items will be tested in the overall samples, as well as within social groups based on race/ethnicity. HRS and SCF both sample Black, Hispanic, and White women and men, and collect data on income and education. Health indicators will include smoking status and fair/poor health.
Impact: Racial/ethnic disparities are often interpreted to reflect biological or cultural differences without adequately considering the role of SES influences, such as wealth. This project will inform the nature of racial/ethnic--and other social--disparities in health, as well as increase our understanding of wealth disparities in smoking. We will also gain knowledge of how wealth measures operate within social groups. The increased use of wealth measures in health/tobacco disparities research may inform the development of more effective policy and programmatic interventions to reduce disparities.
- Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S (2005). Socioeconomic status in health research: One size does not fit all. Journal of the American Medical Association; 294(22):2879-2888.
- Pollack CE, Chideya S, Cubbin C, Williams B, Dekker M, Braveman P (2007). Should health studies measure wealth? A systematic review. American Journal of Preventive Medicine; 33(3):250-264.
Catherine Cubbin, Ph.D. (Principal Investigator)
University of Texas at Austin
Paula Braveman, MD, M.P.H.
University of California, San Francisco
Brian Flaherty, Ph.D.
University of Washington
Mark Hayward, Ph.D.
University of Texas at Austin
Craig Pollack, MD, MHS
RAND Corporation/George Washington University
Ayesha Sania, M.P.H.
Harvard School of Public Health
Donna Vallone, Ph.D., M.P.H.
American Legacy Foundation
Catherine Cubbin, Ph.D.
Associate Professor, School of Social Work
Faculty Research Associate, Population Research Center
University of Texas at Austin
Health and Retirement Study, University of Michigan
Survey of Consumer Finances, Federal Reserve Board
Cubbin C, Pollack C, Flaherty B, Hayward M, Sania A, Vallone D, Braveman PA (2011). Recommending feasible measures of wealth in health research. AJPH; 101: e1-e9.
Cubbin C (November 2010). Developing feasible measures of wealth in studies of health. Oral presentation at the 138th American Public Health Association Annual Meeting and Expo, Denver, CO.
Cubbin C (April 2010). Recommending feasible measures of wealth in health research. Oral presentation at the Population Association of America Annual Meeting, Dallas, TX.
Cubbin C (March 2010). Recommending feasible measures of wealth for health research: Findings from two nationally-representative surveys. Oral presentation at the Center for Studies in Demography and Ecology, University of Washington, Seattle, WA.
Cubbin C (February 2010). Recommending feasible measures of wealth for health research: Findings from two nationally-representative surveys. Population Research Center Brown Bag seminar, University of Texas Austin, Austin, TX.
Cubbin C (June 2009). Developing feasible measures of wealth in health research. Oral presentation at the Tobacco Research Network on Disparities (TReND) Meeting, National Cancer Institute, Bethesda, MD.
Cubbin C (June 2009). Developing feasible measures of wealth in health research. Oral presentation at the Society for Epidemiologic Research Annual Meeting, Anaheim, CA.
Cubbin C (May 2009). Developing feasible measures of wealth in health research. Oral presentation at the California Center for Population Research, UCLA, Los Angeles, CA.
Pollack C (April 2010). Simplified measures of wealth for health research. Oral presentation at the Society of General Internal Medicine Annual Meeting, Minneapolis, MN.
Pollack CE, Chideya S, Cubbin C, Williams B, Dekker M, Braveman P (2007). Should health studies measure wealth? A systematic review. Am J of Prev Med; 33(3):250-264.
Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S (2005). Socioeconomic status in health research: One size does not fit all. JAMA; 294(22):2879-2888.
Scholz JK, Levine K (2004). U.S. Black-White Wealth Inequality. In Social Inequality, ed. K. Neckerman, 895-929. New York: Russell Sage Foundation.
Braveman PA, Cubbin C, Marchi KS, Egerter S, Chavez GF (2001). Measuring socioeconomic status/position in studies of racial/ethnic disparities: Maternal and infant health. Public Health Reports; 116:449-463.
Oliver ML, Shapiro TM (2006). Black Wealth, White Wealth: A New Perspective on Racial Inequality, 2nd edition. New York, NY: Routledge.
The National Cancer Institute (NCI) and American Legacy Foundation are proud to fund the Tobacco Research Network on Disparities (TReND). Previous support has also been provided by the Department of Health and Human Services (DHHS) Office on Women’s Health, NCI Office of Women’s Health, and the NCI Center to Reduce Cancer Health Disparities.