Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper

Abstract

Much has been written about the measurement of socio-economic position (SEP) in high-income countries (HIC). Less has been written for an epidemiology, health systems and public health audience about the measurement of SEP in low- and middle-income countries (LMIC). The social stratification processes in many LMIC—and therefore the appropriate measurement tools—differ considerably from those in HIC. Many measures of SEP have been utilized in epidemiological studies; the aspects of SEP captured by these measures and the pathways through which they may affect health are likely to be slightly different but overlapping. No single measure of SEP will be ideal for all studies and contexts; the strengths and limitations of a given indicator are likely to vary according to the specific research question. Understanding the general properties of different indicators, however, is essential for all those involved in the design or interpretation of epidemiological studies. In this article, we describe the measures of SEP used in LMIC. We concentrate on measures of individual or household-level SEP rather than area-based or ecological measures such as gross domestic product. We describe each indicator in terms of its theoretical basis, interpretation, measurement, strengths and limitations. We also provide brief comparisons between LMIC and HIC for each measure.

Association between depression and glycemic control among type 2 diabetes patients in Lima, Peru

“…Third, although our models included a large list of confounders, variables such as socioeconomic status or overweight/obesity were not included. However, education has been suggested as a good form to assess socioeconomic status (Howe et al., 2012). Fourth, patients enrolled in the study were drawn from hospital clinical settings instead from the general population; hence, some selection bias might arise, especially in the case of depression rates.…”

Wealth index and risk of childhood overweight and obesity: evidence from four prospective cohorts in Peru and Vietnam

“…A wealth index approach has become a common assessment method regarding socioeconomic status in developing countries and it is a useful measure of the household socioeconomic status. (Howe et al 2012) This variable was assessed with a face-to-face questionnaire answered by the household head or the mother.…”

“…Moreover, we used a comprehensive method to assess socioeconomic status -wealth index-, as previous reports used characteristics such as household size and parental education (Zadzinska et al 2012), or type school and assets (Wrotniak et al 2012). The wealth index approach is commonly used in developing countries and it has some strengths: it is less prone to change according to seasonality patterns of consumption, and it does assess the socioeconomic status at the household level (Howe et al 2012). …”

“…Furthermore, previous studies have included surrogates to assess socioeconomic status such as parental educational attainment or household size (Wrotniak et al 2012;Zadzinska et al 2012). Thus, there is need to explore the risk of childhood obesity according to socioeconomic status with a more comprehensive definition of socioeconomic status for developing countries, such as wealth index, which also has other strengths in comparison to other methods to assess socioeconomic status (Howe et al 2012). Data to calculate wealth index is available for many countries as much of the work on this indicator has been developed with Demographic and Health Surveys.…”

“…Data to calculate wealth index is available for many countries as much of the work on this indicator has been developed with Demographic and Health Surveys. In addition, it is less susceptible to changes in income and expenditure (Howe et al 2012).…”