Ryu Euijung, Wi Chung-Il, Crow Sheri S, Armasu Sebastian M, Wheeler Philip H, Sloan Jeff A, Yawn Barbara P, Beebe Timothy J, Williams Arthur R, Juhn Young J
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Open. 2016 Jul 22;6(7):e011564. doi: 10.1136/bmjopen-2016-011564.
Socioeconomic status (SES) is a well-established risk factor for many health outcomes. Recently, we developed an SES measure based on 4 housing-related characteristics (termed HOUSES) and demonstrated its ability to assess health disparities. In this study, we aimed to evaluate whether fewer housing-related characteristics could be used to provide a similar representation of SES.
We performed a cross-sectional study using parents/guardians of children aged 1-17 years from 2 US Midwestern counties (n=728 in Olmsted County, Minnesota, and n=701 in Jackson County, Missouri).
For each participant, housing-related characteristics used in the formulation of HOUSES (assessed housing value, square footage, number of bedrooms and number of bathrooms) were obtained from the local government assessor's offices, and additional SES measures and health outcomes with known associations to SES (obesity, low birth weight and smoking exposure) were collected from a telephone survey. Housing characteristics with the greatest contribution for predicting the health outcomes were added to formulate a modified HOUSES index.
Among the 4 housing characteristics used in the original HOUSES, the strongest contributions for predicting health outcomes were observed from assessed housing value and square footage (combined contribution ranged between 89% and 96%). Based on this observation, these 2 were used to calculate a modified HOUSES index. Correlation between modified HOUSES and other SES measures was comparable to the original HOUSES for both locations. Consistent with the original HOUSES formula, the strongest association with modified HOUSES was observed with smoking exposure (OR=0.24 with 95% CI 0.11 to 0.49 for comparing participants in highest HOUSES vs lowest group; overall p<0.001).
The modified HOUSES requires only 2 readily available housing characteristics thereby improving the feasibility of using this index as a proxy for SES in multiple communities, especially in the US Midwestern region.
社会经济地位（SES）是许多健康结局公认的风险因素。最近，我们基于4个与住房相关的特征（称为HOUSES）开发了一种SES测量方法，并证明了其评估健康差异的能力。在本研究中，我们旨在评估是否可以使用更少的与住房相关的特征来提供类似的SES表征。
我们进行了一项横断面研究，使用来自美国中西部两个县1至17岁儿童的父母/监护人（明尼苏达州奥尔姆斯特德县n = 728，密苏里州杰克逊县n = 701）。
对于每位参与者，从当地政府评估办公室获取用于制定HOUSES的与住房相关的特征（评估的住房价值、平方英尺、卧室数量和浴室数量），并通过电话调查收集与SES有已知关联的其他SES测量指标和健康结局（肥胖、低出生体重和吸烟暴露）。添加对预测健康结局贡献最大的住房特征以制定改良的HOUSES指数。
在原始HOUSES使用的4个住房特征中，评估的住房价值和平方英尺对预测健康结局的贡献最强（综合贡献范围在89%至96%之间）。基于这一观察结果，使用这两个特征来计算改良的HOUSES指数。在两个地点，改良的HOUSES与其他SES测量指标之间的相关性与原始HOUSES相当。与原始HOUSES公式一致，吸烟暴露与改良的HOUSES之间的关联最强（最高HOUSES组与最低组参与者比较的OR = 0.24，95%CI为0.11至0.49；总体p<0.001）。
改良的HOUSES仅需要2个易于获得的住房特征，从而提高了在多个社区（特别是美国中西部地区）使用该指数作为SES替代指标的可行性。
