Social Indicators Research

, Volume 129, Issue 2, pp 639–658 | Cite as

An Index of Community-Level Socioeconomic Composition for Global Health Research

  • Shivani A. Patel
  • Susan G. Sherman
  • Subarna K. Khatry
  • Steven C. LeClerq
  • Joanne Katz
  • James M. Tielsch
  • Parul Christian
Article
  • 170 Downloads

Abstract

Despite increasing recognition that community-level socioeconomic factors are critical to individual health outcomes globally, guidance on their measurement remains limited in low and middle income countries. We outline the steps needed to develop and validate a theory-based, multidimensional index of community-level socioeconomic composition using information that is often available in global settings. Census indicators describing human and social capital were analyzed using principal components analysis to construct a community socioeconomic composition index (CSCI) for 30 communities in the Southern plains of Nepal. The index was validated against subsequent child nutrition, household assets, and village infrastructure using data from 1822 children and their households. At the community-level, the CSCI was positively correlated with child height-for-age, and child weight-for-age, household assets, and community infrastructure (r = 0.54, 0.58, 0.85, 0.67, respectively). In multilevel analyses, +1SD of the CSCI was associated with +0.14SD of the household asset index (p < 0.01) after adjusting for confounders. These results suggest that an exclusively census-based strategy to measure socioeconomic composition has construct validity in this setting. This approach to measuring community-level socioeconomic composition may be feasibly reproduced in other resource-constrained settings where census data are available, potentially expanding the scope of place and health research globally.

Keywords

Community socioeconomic composition Socioeconomic status Index Child nutrition Nepal 

Abbreviations

CSCI

Community socioeconomic composition index

NNIPS

Nepal Nutrition Intervention Project-Sarlahi

PCA

Principal components analysis

SES

Socioeconomic status

VDC

Village Development Community

References

  1. Alderman, H., & King, E. M. (1998). Gender differences in parental investment in education. Structural Change and Economic Dynamics, 9, 453–468.CrossRefGoogle Scholar
  2. Astone, N. M., Nathanson, C. A., Schoen, R., & Kim, Y. J. (1999). Family demography, social theory, and investment in social capital. Population and Development Review, 25(1), 1–31. doi:10.1111/j.1728-4457.1999.00001.x.CrossRefGoogle Scholar
  3. Avan, B. I., & Kirkwood, B. (2010). Role of neighbourhoods in child growth and development: Does “place” matter? Social Science and Medicine, 71(1), 102–109. doi:10.1016/j.socscimed.2010.02.039.CrossRefGoogle Scholar
  4. Axinn, W. G., & Yabiku, S. T. (2001). Social change, the social organization of families, and fertility limitation. American Journal of Sociology, 106(5), 1219–1261. doi:10.1086/320818.CrossRefGoogle Scholar
  5. Benhabib, J., & Spiegel, M. M. (1994). The role of human capital in economic development evidence from aggregate cross-country data. Journal of Monetary Economics, 34(2), 143–173. doi:10.1016/0304-3932(94)90047-7.CrossRefGoogle Scholar
  6. Bishai, D., Patil, P., Pariyo, G., & Hill, K. (2006). The Babel effect: Community linguistic diversity and extramarital sex in Uganda. AIDS and Behavior, 10(4), 369–376. doi:10.1007/s10461-006-9097-3.CrossRefGoogle Scholar
  7. Bollen, K. A., Glanville, J. L., & Stecklov, G. (2001). Socioeconomic status and class in studies of fertility and health in developing countries. Annual Review of Sociology, 27, 153–185. doi:10.2307/2678618.CrossRefGoogle Scholar
  8. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge: President and Fellows of Harvard College.Google Scholar
  9. Brooks-Gunn, J., Duncan, G. J., Klebanov, P. K., & Sealand, N. (1993). Do neighborhoods influence child and adolescent development? American Journal of Sociology, 99, 353–395.CrossRefGoogle Scholar
  10. Carpiano, R. M. (2006). Toward a neighborhood resource-based theory of social capital for health: Can Bourdieu and sociology help? Social Science and Medicine, 62(1), 165–175. doi:10.1016/j.socscimed.2005.05.020.CrossRefGoogle Scholar
  11. Central Bureau of Statistics. (2011). Nepal living standards survey 2010/2011: Statistical report (Vol. 1). Thapathali, Kathmandu.Google Scholar
  12. Chin, B., Montana, L., & Basagaña, X. (2011). Spatial modeling of geographic inequalities in infant and child mortality across Nepal. Health and Place, 17(4), 929–936. doi:10.1016/j.healthplace.2011.04.006.CrossRefGoogle Scholar
  13. Christian, P., Khatry, S. K., Katz, J., Pradhan, E. K., LeClerq, S. C., Shrestha, S. R., & Keith, P. W. (2003a). Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: Double blind randomised community trial. BMJ, 326, 571. doi:10.1136/bmj.326.7389.571.CrossRefGoogle Scholar
  14. Christian, P., Murray-Kolb, L. E., Khatry, S. K., Katz, J., Schaefer, B. A., Cole, P. M., & Tielsch, J. M. (2010). Prenatal micronutrient supplementation and intellectual and motor function in early school-aged children in Nepal. JAMA: The Journal of the American Medical Association, 304, 2716–2723. doi:10.1001/jama.2010.1861.CrossRefGoogle Scholar
  15. Christian, P., West, K. P., Khatry, S. K., Leclerq, S. C., Pradhan, E. K., Katz, J., & Sommer, A. (2003b). Effects of maternal micronutrient supplementation on fetal loss and infant mortality: A cluster-randomized trial in Nepal. The American Journal of Clinical Nutrition, 78, 1194–1202.Google Scholar
  16. Coleman, J. S. (1988). Social Capital in the Creation of Human Capital. American Journal of Sociology, 94. http://www.jstor.org/stable/2780243.
  17. Corsi, D. J., Chow, C. K., Lear, S. A., Rahman, M. O., Subramanian, S., & Teo, K. K. (2011). Shared environments: A multilevel analysis of community context and child nutritional status in Bangladesh. Public Health Nutrition, 14(06), 951–959. doi:10.1017/S1368980010003356.CrossRefGoogle Scholar
  18. Cortinovis, I., Vella, V., & Ndiku, J. (1993). Construction of a socio-economic index to facilitate analysis of health data in developing countries. Social Science and Medicine, 36(8), 1087–1097. doi:10.1016/0277-9536(93)90127-P.CrossRefGoogle Scholar
  19. Das Gupta, M. (1990). Death clustering, mothers’ education and the determinants of child mortality in rural Punjab, India. Population Studies, 44(3), 489–505. doi:10.1080/0032472031000144866.CrossRefGoogle Scholar
  20. de Onis, M., Onyango, A. W., Borghi, E., Siyam, A., Nishida, C., & Siekmann, J. (2007). Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization, 85(9), 660–667. doi:10.1590/S0042-96862007000900010.CrossRefGoogle Scholar
  21. Degraff, D. S., Bilsborrow, R. E., & Guilkey, D. K. (1997). Community-level determinants of contraceptive use in the Philippines: A structural analysis. Demography, 34(3), 385–398. doi:10.2307/3038291.CrossRefGoogle Scholar
  22. DeVellis, R. (2003). Scale development: Theory and applications. Thousand Oaks: Sage Publications Inc.Google Scholar
  23. Diamantopoulos, A., & Winklhofer, H. M. (2001). Index construction with formative indicators: An alternative to scale development. Journal of Marketing Research, 38, 269–277.CrossRefGoogle Scholar
  24. Diez-Roux, A. V. (1998). Bringing context back into epidemiology: Variables and fallacies in multilevel analysis. American Journal of Public Health, 88(2), 216–222. doi:10.2105/AJPH.88.2.216.CrossRefGoogle Scholar
  25. Duncan, G. J., & Raudenbush, S. W. (1999). Assesing the effects of context in studies of child and youth development. Educational Psychologist, 34, 29–41.CrossRefGoogle Scholar
  26. Entwisle, D. R., & Astone, N. M. (1994). Some practical guidelines for measuring youth’s race/ethnicity and socioeconomic status. Child Development, 65(6), 1521–1540. doi:10.1111/j.1467-8624.1994.tb00833.x.CrossRefGoogle Scholar
  27. Evans, G. W., & Kantrowitz, E. (2002). Socioeconomic status and health: The potential role of environmental risk exposure. Annual Review of Public Health, 23, 303–331.CrossRefGoogle Scholar
  28. Filmer, D., & Pritchett, L. (2001). Estimating wealth effects without expenditure data—Or tears: An application to educational enrollments in states of India*. Demography, 38(1), 115–132. doi:10.1353/dem.2001.0003.Google Scholar
  29. Fotso, J.-C., & Kuate-Defo, B. (2005). Socioeconomic inequalities in early childhood malnutrition and morbidity: Modification of the household-level effects by the community SES. Health and Place, 11(3), 205–225. doi:10.1016/j.healthplace.2004.06.004.CrossRefGoogle Scholar
  30. Glass, T. A., & McAtee, M. J. (2006). Behavioral science at the crossroads in public health: Extending horizons, envisioning the future. Social Science and Medicine, 62, 1650–1671.CrossRefGoogle Scholar
  31. Grosh, M., & Glewwe, P. (1995). A guide to living standards measurement study surveys and their data sets (Working Paper No. 120). World Bank.Google Scholar
  32. Howe, L. D., Galobardes, B., Matijasevich, A., Gordon, D., Johnston, D., Onwujekwe, O., & Hargreaves, J. R. (2012). Measuring socio-economic position for epidemiological studies in low- and middle-income countries: A methods of measurement in epidemiology paper. International Journal of Epidemiology,. doi:10.1093/ije/dys037.Google Scholar
  33. Jencks, C., & Mayer, S. (1990). The social consequences of growing up in a poor neighborhood. In L. Lynn & M. McGeary (Eds.), Inner-city poverty in the United States (pp. 111–186). Washington, DC: National Academy Press.Google Scholar
  34. Jones, K., & Duncan, C. (1995). Individuals and their ecologies: Analysing the geography of chronic illness within a multilevel modelling framework. Health and Place, 1(1), 27–40. doi:10.1016/1353-8292(95)00004-6.CrossRefGoogle Scholar
  35. Knack, S., & Keefer, P. (1997). Does social capital have an economic payoff? A cross-country investigation. The Quarterly Journal of Economics, 112(4), 1251–1288. doi:10.1162/003355300555475.CrossRefGoogle Scholar
  36. Koenig, M. A., Stephenson, R., Ahmed, S., Jejeebhoy, S. J., & Campbell, J. (2006). Individual and contextual determinants of domestic violence in North India. American Journal of Public Health, 96(1), 132–138. doi:10.2105/AJPH.2004.050872.CrossRefGoogle Scholar
  37. Kravdal, Ø. (2002). Education and fertility in sub-Saharan Africa: Individual and community effects. Demography, 39(2), 233–250. doi:10.1353/dem.2002.0017.Google Scholar
  38. Kravdal, Ø. (2004). Child mortality in India: The community-level effect of education. Population Studies, 58(2), 177–192. doi:10.1080/0032472042000213721.CrossRefGoogle Scholar
  39. Krieger, N. (2001). Theories for social epidemiology in the 21st century: An ecosocial perspective. International Journal of Epidemiology, 30, 668–677. doi:10.1093/ije/30.4.668.CrossRefGoogle Scholar
  40. Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378. doi:10.1146/annurev.publhealth.18.1.341.CrossRefGoogle Scholar
  41. Kubzansky, L. D., Subramanian, S. V., Kawachi, I., Fay, M. E., Soobader, M.-J., & Berkman, L. F. (2005). Neighborhood contextual influences on depressive symptoms in the elderly. American Journal of Epidemiology, 162(3), 253–260. doi:10.1093/aje/kwi185.CrossRefGoogle Scholar
  42. Luke, N., & Xu, H. (2011). Exploring the meaning of context for health: Community influences on child health in South India. Demographic Research, 24, 345–374. doi:10.4054/DemRes.2011.24.15.CrossRefGoogle Scholar
  43. Macintyre, S., Maciver, S., & Sooman, A. (1993). Area, class and health: Should we be focusing on places or people? Journal of Social Policy, 22, 213–234.CrossRefGoogle Scholar
  44. McKenzie, D. J. (2005). Measuring inequality with asset indicators. Journal of Population Economics, 18(2), 229–260. doi:10.1007/s00148-005-0224-7.CrossRefGoogle Scholar
  45. McLoyd, V. C. (1998). Socioeconomic disadvantage and child development. American Psychologist, 53, 185–204.CrossRefGoogle Scholar
  46. McNay, K., Arokiasamy, P., & Cassen, R. (2003). Why are uneducated women in India using contraception? A multilevel analysis. Population Studies, 57(1), 21–40. doi:10.1080/0032472032000061703.CrossRefGoogle Scholar
  47. Messer, L. C., Laraia, B. A., Kaufman, J. S., Eyster, J., Holzman, C., Culhane, J., & O’Campo, P. (2006). The development of a standardized neighborhood deprivation index. Journal of Urban Health, 83(6), 1041–1062. doi:10.1007/s11524-006-9094-x.CrossRefGoogle Scholar
  48. Moursund, A., & Kravdal, Ø. (2003). Individual and community effects of women’s education and autonomy on contraceptive use in India. Population Studies, 57(3), 285–301. doi:10.1080/0032472032000137817.CrossRefGoogle Scholar
  49. Mujahid, M. S., Diez Roux, A. V., Morenoff, J. D., & Raghunathan, T. (2007). Assessing the measurement properties of neighborhood scales: From psychometrics to ecometrics. American Journal of Epidemiology, 165, 858–867. doi:10.1093/aje/kwm040.CrossRefGoogle Scholar
  50. Nepal Central Bureau of Statistics, National Planning Commission Secretariat. (2001). Nepal National Population & Housing Census.Google Scholar
  51. Neuman, M., Kawachi, I., Gortmaker, S., & Subramanian, S. V. (2013). Urban-rural differences in BMI in low- and middle-income countries: The role of socioeconomic status. The American Journal of Clinical Nutrition,. doi:10.3945/ajcn.112.045997.Google Scholar
  52. Oakes, J. M., & Rossi, P. H. (2003). The measurement of SES in health research: Current practice and steps toward a new approach. Social Science and Medicine, 56(4), 769–784. doi:10.1016/S0277-9536(02)00073-4.CrossRefGoogle Scholar
  53. Parashar, S. (2005). Moving beyond the mother-child dyad: Women’s education, child immunization, and the importance of context in rural India. Social Science and Medicine, 61(5), 989–1000. doi:10.1016/j.socscimed.2004.12.023.CrossRefGoogle Scholar
  54. Pongou, R., Ezzati, M., & Salomon, J. A. (2006). Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon. BMC Public Health, 6, 98. doi:10.1186/1471-2458-6-98.CrossRefGoogle Scholar
  55. Pradhan, E. K., West, K. P., Katz, J., LeClerq, S. C., Khatry, S. K., & Shrestha, S. R. (2007). Risk of flood-related mortality in Nepal. Disasters, 31(1), 57–70. doi:10.1111/j.1467-7717.2007.00340.x.CrossRefGoogle Scholar
  56. Reed, B. A., Habicht, J.-P., & Niameogo, C. (1996). The effects of maternal education on child nutritional status depend on socio-environmental conditions. International Journal of Epidemiology, 25(3), 585–592. doi:10.1093/ije/25.3.585.CrossRefGoogle Scholar
  57. Robert, S. A. (1999). Socioeconomic position and health: The independent contribution of community socioeconomic context. Annual Review of Sociology, 25(1), 489.CrossRefGoogle Scholar
  58. Sampson, R. J., Morenoff, J. D., & Gannon-Rowley, T. (2002). Assessing “neighborhood effects”: Social processes and new directions in research. Annual Review of Sociology, 28, 443–478.CrossRefGoogle Scholar
  59. Schulz, A., & Northridge, M. E. (2004). Social determinants of health: Implications for environmental health promotion. Health Education and Behavior: The Official Publication of the Society for Public Health Education, 31(4), 455–471. doi:10.1177/1090198104265598.CrossRefGoogle Scholar
  60. Stephenson, R., & Elfstrom, K. M. (2012). Community influences on antenatal and delivery care in Bangladesh, Egypt, and Rwanda. Public Health Reports, 127(1), 96–106.Google Scholar
  61. Stephenson, R., & Tsui, A. O. (2002). Contextual influences on reproductive health service use in Uttar Pradesh, India. Studies in Family Planning, 33(4), 309–320. doi:10.1111/j.1728-4465.2002.00309.x.CrossRefGoogle Scholar
  62. Stephenson, R., & Tsui, A. O. (2003). Contextual influences on reproductive wellness in Northern India. American Journal of Public Health, 93(11), 1820–1829. doi:10.2105/AJPH.93.11.1820.CrossRefGoogle Scholar
  63. Thapa, R. B., & Murayama, Y. (2010). Drivers of urban growth in the Kathmandu valley, Nepal: Examining the efficacy of the analytic hierarchy process. Applied Geography, 30(1), 70–83. doi:10.1016/j.apgeog.2009.10.002.CrossRefGoogle Scholar
  64. Tielsch, J. M., Khatry, S. K., Stoltzfus, R. J., Katz, J., LeClerq, S. C., Adhikari, R., & Black, R. E. (2006). Effect of routine prophylactic supplementation with iron and folic acid on preschool child mortality in southern Nepal: Community-based, cluster-randomised, placebo-controlled trial. The Lancet, 367, 144–152.CrossRefGoogle Scholar
  65. Tielsch, J. M., Khatry, S. K., Stoltzfus, R. J., Katz, J., LeClerq, S. C., Adhikari, R., & Shresta, S. (2007). Effect of daily zinc supplementation on child mortality in southern Nepal: A community-based, cluster randomised, placebo-controlled trial. Lancet, 370(9594), 1230–1239. doi:10.1016/S0140-6736(07)61539-6.CrossRefGoogle Scholar
  66. United Nations Development Programme. (2013). Human development report 2013. Nepal.Google Scholar
  67. Vyas, S., & Kumaranayake, L. (2006). Constructing socio-economic status indices: How to use principal components analysis. Health Policy and Planning, 21(6), 459–468. doi:10.1093/heapol/czl029.CrossRefGoogle Scholar
  68. West, K. P, Jr, Katz, J., LeClerq, S. C., Pradhan, E. K., Tielsch, J. M., Sommer, A., & Pandey, M. R. (1991). Efficacy of vitamin A in reducing preschool child mortality in Nepal. The Lancet, 338(8759), 67–71. doi:10.1016/0140-6736(91)90070-6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Shivani A. Patel
    • 1
  • Susan G. Sherman
    • 2
  • Subarna K. Khatry
    • 3
    • 4
  • Steven C. LeClerq
    • 3
  • Joanne Katz
    • 3
  • James M. Tielsch
    • 5
  • Parul Christian
    • 3
  1. 1.Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.The Nepal Nutrition Intervention Project-SarlahiKathmanduNepal
  5. 5.Department of Global HealthGeorge Washington University School of Public Health and Health ServicesWashingtonUSA

Personalised recommendations