文章基本信息

标题：Assessing Alternative Measures of Wealth in Health Research
本地全文：下载
作者：Catherine Cubbin ; Craig Pollack ; Brian Flaherty 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：5
页码：939-947
DOI：10.2105/AJPH.2010.194175
语种：English
出版社：American Public Health Association
摘要：Objectives . We assessed whether it would be feasible to replace the standard measure of net worth with simpler measures of wealth in population-based studies examining associations between wealth and health. Methods. We used data from the 2004 Survey of Consumer Finances (respondents aged 25–64 years) and the 2004 Health and Retirement Survey (respondents aged 50 years or older) to construct logistic regression models relating wealth to health status and smoking. For our wealth measure, we used the standard measure of net worth as well as 9 simpler measures of wealth, and we compared results among the 10 models. Results. In both data sets and for both health indicators, models using simpler wealth measures generated conclusions about the association between wealth and health that were similar to the conclusions generated by models using net worth. The magnitude and significance of the odds ratios were similar for the covariates in multivariate models, and the model-fit statistics for models using these simpler measures were similar to those for models using net worth. Conclusions. Our findings suggest that simpler measures of wealth may be acceptable in population-based studies of health. In health research, the term “wealth” refers to total financial resources amassed over a lifetime, as opposed to “income,” which refers to the capital obtained during a specified period of time (e.g., annual earnings in dollars).¹ Wealth may buffer the effects of temporary low income, as in the event of illness or unemployment. Compared with income, wealth may better reflect long-term family resources and hence resources available across an individual's lifetime.² Wealth may be particularly important for the health of the elderly, whose incomes typically drop dramatically following retirement,³ and for racial/ethnic disparities in health, because differences in wealth by racial/ethnic group are far greater than are the corresponding differences in income.² A systematic review of the literature has found that greater wealth is associated with better health, even after adjustment for other socioeconomic factors, such as income and educational attainment.^{1 , 4 – 11} Moreover, these findings of positive correlations between wealth and health were most consistent when studies used detailed wealth measures based on multiple questions on assets (e.g., savings, home, retirement) and debts (e.g., mortgage, loans) instead of single questions on wealth (e.g., home ownership). The review also found that racial/ethnic disparities in health generally decreased after adjustment for wealth. Despite the conceptual and empirical rationales for including wealth in research on health, population-based health surveys (such as the National Health Interview Survey) and vital statistics data generally have either poor measures of wealth or none at all. This deficiency is not surprising, given the difficulty of collecting wealth data. The topic of wealth is considered to be sensitive, collection of reliable information is laborious, and the values of assets and debts vary over time and may require professional appraisal. Conversely, population-based surveys with detailed wealth measures typically contain little information on health. Thus, current population-based data sources present significant barriers to studies of the relationships between wealth and health. Standard wealth measures are based on multiple detailed questions; for example, the Survey of Consumer Finances (SCF) assesses 25 different classes of assets and debts that measure net worth. Simpler approaches to wealth measurement could benefit population-based health research by making it more feasible to include such measures in important public health surveys. Building on earlier work on the measurement of socioeconomic status and position,^{1 , 2 , 12 , 13} we assessed whether simplified measures of wealth could be used in health research to reasonably approximate standard wealth measures. We used population-based data from the SCF and the Health and Retirement Survey (HRS) to assess (1) correlations between 9 simpler measures of wealth and the standard wealth measure net worth, which requires multiple detailed questions on assets and debts; and (2) the results of models relating wealth to self-reported health status and cigarette smoking, with comparisons between models that measured wealth as net worth and models using simpler measures of wealth.