Individual-level and neighborhood-level income measures: agreement and association with outcomes in a cardiac disease cohort

Abstract

Background: Census-based measures of income often are used as proxies for individual-level income. Yet, the validity of such area-based measures relative to 'true' individual-level income has not been fully characterized.

Objectives: The objectives of this study were (1) to determine whether area-based measures of household income are a suitable proxy for self-reported household income and (2) to assess whether these measures are associated with outcomes in a cardiac disease cohort.

Research design: We used a prospective cohort from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) cardiac catheterization registry.

Subjects: A total of 4372 patients having undergone cardiac catheterization and who also completed a 1-year follow-up questionnaire on self-reported income level were studied.

Measures: Our measurements were survival to 2.5 years after catheterization and health-related quality of life (EuroQoL).

Results: Agreement between the 2 income measures generally was poor (unweighted Kappa = 0.07), particularly for the low-income patients. Despite this poor agreement, both income measures were positively associated with survival and EuroQoL scores. An outcome analysis that simultaneously considered individual level income and area-based income revealed that low-income individuals have poorer survival and lower quality of life scores if they live in low income neighborhoods, but not if they live in high income neighborhoods.

Conclusions: The area-based estimates of household income in these data demonstrate poor agreement with self-reported household income at the level of individual patients, particularly for low-income patients. Despite this, both income measures appear to be prognostically relevant, perhaps because individual and neighborhood income measure different constructs.