Alternative definitions of “low SES” – 9/17/09

Q:  West Virginia is researching different ways of defining “low socioeconomic status,” especially when looking at health behavior variables and Social Determinants of Health (SDOH) in BRFSS data. We are especially interested in a working definition without using / stating a specific level of household income.

Are there any states that are considering or have done this? If so, please share your definition of “low SES” or any information you have on this.

A: 

  1. California:  The California Tobacco Control Program's definition of socioeconomic status includes income.  By definition, socioeconomic status requires an economic component.  You could use economics in broader ways, such as median neighborhood income, but our state does not collect income in this manner.
     
  2. Louisiana:  In Louisiana, we collect BRFSS but due to low sample size (approximately less than 7000) we have to limit the number of variables we use in order to include as many individuals as possible when looking at Low SES among smokers.  However our working definition of Low SES consists of those who make less than 25,000 annually and have less than a high school diploma.  However for Louisiana if income level was not used I would consider using the following variables:
    • Employment = those who are unemployed
    • Location = those who live in a rural area
    • Education = those who have less than a high school diploma
       
    These above variables would probably include many of the same people that our working definition includes.
     
  3. Michigan: 
     
    Response #1: In Michigan, we defined the low SES population, in terms of the BRFSS, as the population that did not have health insurance, did not graduate high school and was currently making < $20,000.
     
    Response #2:  Please see NPR story about New York City defining poverty level in a new way.
     
  4. Washington:  We have gone round and round with this, and settled on "Less than 200% of Federal Poverty level" for the following reasons.
    1. Eligibility criteria for the Washington Basic Health Plan and Medicaid
    2. More sensitive measure than only using income - takes into account household size
    3. Takes into account inflation
    4. Uses terminology that people are familiar with - specifically the term "federal poverty level"
    5. More tangible than just educational attainment - people can have high education but not have high income; People can also too young to have earned a college education

      Caveats:
       
      • ~10% missing income data
      • Income can be stretched further in different environments across the state
      • BRFSS does not measure exact income rather an income range
      • BRFSS data - general limitation - under-represents economically disadvantaged.

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