What is a good surrogate measure for socioeconomic status (created 2010-05-03).

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I received a question, indirectly, about what might be a good surrogate measure for socioeconomic status (SES). That raises two questions, actually. What is SES, and how can we tell if a surrogate is a good surrogate for SES.

First, it helps to recognize that there is no single thing that is considered SES. Instead, SES is an aggregate measure of an individual or family that incorporates three major factors:

Typically, these three factors are all indicating roughly the same thing, but in today's economy, you may see someone with a PhD serving up fries at McDonald's.

Other items might be an indirect indicator of SES. A person's insurance status, for example, could be used with no insurance or government subsidized insurance being a marker of lower SES. Home ownership could be an indicator of higher SES. Geographic location could also be an indirect indicator of SES, as certain areas tend to have a higher concentration of well paid, highly educated individuals.

SES is an important variable in many health research studies, because SES is strongly associated with many health outcomes. If you fail to account for SES properly in these studies, then effects due to differences in SES may be falsely attributed to other factors.

There is no single measure of SES, but a commonly used measure is Hollingshead. There are variations on the Hollingshead scale, but the original scale separated occupation into 9 categories from farm laborer, day laborer (lowest) to senior manager, professional, or owner/CEO of a large business (highest).

J. Michael Oakes, Peter H. Rossi. The measurement of SES in health research: current practice and steps toward a new approach. Social Science & Medicine. 2003;56(4):769-784. Abstract: "The resurgence of social epidemiology has yet to induce corresponding research into basic measurement issues. This paper aims to motivate investigators to refocus attention on the measurement of socioeconomic status (SES). With a primarily American focus, we document striking paucity of basic research in SES, review the history of SES measurement, highlight the central limitations of current measurement approaches, sketch a new theoretical perspective, present new pilot results, and outline areas for future research. We argue (1) that lack of conceptual clarity and the bypassing of standard psychometric techniques have retarded SES measurement. And (2) social epidemiologists should revisit the measurement of SES and consider whether a richer, psychometrically induced, approach would be more useful. Our pilot study suggests a great deal of uniformity between existing SES measures and that a new approach may be worthy of pursuit." [Accessed May 29, 2010]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12560010.

Agency for Healthcare Research and Quality. Creation of New Race-Ethnicity Codes and Socioeconomic Status (SES) Indicators for Medicare Beneficiaries. Excerpt: "This project continued an earlier one in order to identify disparities in the use of Medicare services. This project created and validated a measure of socioeconomic status (SES) and compiled tabulations in the use of selected Medicare services by race and ethnicity and SES nationally and within the largest metropolitan statistical areas (MSAs) in which elderly Hispanics and Asians reside." [Accessed May 29, 2010]. Available at: http://www.ahrq.gov/qual/medicareindicators/.