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An Approach to Studying Social Disparities in Health and Health Care

 Paula A. Braveman, Susan A. Egerter, Catherine Cubbin, Kristen S. Marchi
 Center on Social Disparities in Health and the Department of Family and
Community Medicine, University of California, San Francisco. Catherine
Cubbin is also with the Stanford Prevention Research Center, Stanford
University, Stanford, CA.

December 2004, Vol 94, No. 12 - American Journal of Public Health 2139-2148

 Abstract:  http://www.ajph.org/cgi/content/abstract/94/12/2139?etoc

 Requests for reprints could be sent to Paula A. Braveman
 Director Center on Social Disparities in Health, Department of Family and
Community Medicine,
University of California, San Francisco - 500 Parnassus Avenue, MU 3-E, San
Francisco, CA 9414351;0900
 email:  [log in to unmask]

With this article, the authors propose an approach to studying and
monitoring social disparities in health and health care, using prenatal
care as an example. They use the term "social disparities in health"
broadly here to refer to differences in health;or likely determinants of
health;that are systematically associated with different levels of
underlying social advantage or position in a social hierarchy.

 Social advantage or position is reflected by economic resources,
occupation, education, racial/ethnic group, gender, sexual orientation, and
other characteristics associated with greater resources, influence,
prestige, and social inclusion

 The authors explored methods and potential applications of a systematic
approach to studying and monitoring social disparities in health and health
care.

Using delayed or no prenatal care as an example indicator:
 (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: The authors identified at-risk groups and relevant factors and
suggest ways to direct efforts for reducing prenatal care disparities.

This systematic approach should be useful for studying and monitoring
disparities in other indicators of health and health

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