Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 3;1(5):qxad063.
doi: 10.1093/haschl/qxad063. eCollection 2023 Nov.

Deciphering the Neighborhood Atlas Area Deprivation Index: the consequences of not standardizing

Stephen Petterson  1
Affiliations

Deciphering the Neighborhood Atlas Area Deprivation Index: the consequences of not standardizing

Stephen Petterson. Health Aff Sch. .

Abstract

The Area Deprivation Index (ADI) is a widely used measure recently selected for several federal payment models that adjusts payments based on where beneficiaries live. A recent debate in Health Affairs focuses on seemingly implausible ADI rankings in major cities and across New York. At the root of the issue is the importance of standardization of measures prior to calculating index scores. Neighborhood Atlas researchers are implicitly arguing that their choice to not standardize is of little consequence. Using the same data and methods as the Neighborhood Atlas, this paper focuses on this choice by calculating and comparing standardized and unstandardized ADI scores. The calculated unstandardized ADI nearly perfectly matches the Neighborhood Atlas ADI (r > 0.9999), whereas the correlation with a standardized version is much lower (r = 0.7245). The main finding is that, without standardization, the ADI is reducible to a weighted average of just 2 measures-income and home values-certainly not the advertised multidimensional measure. Federal programs that have incorporated the ADI risk poorly allocating scarce resources meant to reduce health inequities.

Keywords: area measures of deprivation; health inequity; payment reform.

PubMed Disclaimer

Conflict of interest statement

Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials.

Figures

Figure 1.
Figure 1.
Alternative measures of area deprivation in the District of Columbia. Source: 2020 Neighborhood Atlas ADI (version 3.2, retrieved from https://www.neighborhoodatlas.medicine.wisc.edu). All other measures were based on the author's analysis of 2020 American Community Survey data. Home values are reverse coded. Abbreviation: ADI, Area Deprivation Index.
Figure 2.
Figure 2.
Differences in MSSP eligibility across ADI measures, select states. Source: 2020 Neighborhood Atlas ADI (version 3.2. retrieved from https://www.neighborhoodatlas.medicine.wisc.edu). Standardized ADI based on the author's analysis of 2020 American Community Survey data. Abbreviations: ADI, Area Deprivation Index; MSSP, Medicare Shared Savings Program.
See this image and copyright information in PMC

References

    1. Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995:Spec No:80-94. - PubMed
    1. Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood). 2002;21(2):60–76. - PubMed
    1. Health Resources and Services Administration . Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Final Report to the Secretary. Health Resources and Services Administration; 2011. https://www.ruralhealthinfo.org/assets/3262-13308/nrmcfinalreport.pdf
    1. Office of the Assistant Secretary for Planning and Evaluation (ASPE) . Landscape of area-level deprivation measures and other approaches to account for social risk and social determinants of health in health care payments. 2022. Accessed July 29, 2023. https://aspe.hhs.gov/sites/default/files/documents/8dc674c904723bf8a5ce4...
    1. Phillips RL, Liaw W, Crampton P, et al. How other countries use deprivation indices—and why the United States desperately needs one. Health Aff (Millwood). 2016;35(11):1991–1998. - PubMed

LinkOut - more resources