SpringerLink
Log in

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

  • Published:
Social Indicators Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. We use the term “community socioeconomic composition” rather than “community socioeconomic status” to clearly differentiate between the construct at the community versus individual level.

  2. Six senior staff were asked to rank the top five best and worst VDCs with respect to infrastructural development in 2007. These responses were used to rank the VDCs using a modified Borda count method.

  3. The PCA-based rankings of a subset of VDCs using the reduced set of infrastructural items was conducted using the same method described here. Discrepancies between the previously collected VDC data and retrospectively VDC data we collected were verified in the field and corrected as needed.

Abbreviations

CSCI:

Community socioeconomic composition index

NNIPS:

Nepal Nutrition Intervention Project-Sarlahi

PCA:

Principal components analysis

SES:

Socioeconomic status

VDC:

Village Development Community

References

  • Alderman, H., & King, E. M. (1998). Gender differences in parental investment in education. Structural Change and Economic Dynamics, 9, 453–468.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Bollen, K. A., Glanville, J. L., & Stecklov, G. (2001). Socioeconomic status and class in studies of fertility and health in develo** countries. Annual Review of Sociology, 27, 153–185. doi:10.2307/2678618.

    Article  Google Scholar 

  • Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge: President and Fellows of Harvard College.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Central Bureau of Statistics. (2011). Nepal living standards survey 2010/2011: Statistical report (Vol. 1). Thapathali, Kathmandu.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • Coleman, J. S. (1988). Social Capital in the Creation of Human Capital. American Journal of Sociology, 94. http://www.jstor.org/stable/2780243.

  • 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.

    Article  Google Scholar 

  • Cortinovis, I., Vella, V., & Ndiku, J. (1993). Construction of a socio-economic index to facilitate analysis of health data in develo** countries. Social Science and Medicine, 36(8), 1087–1097. doi:10.1016/0277-9536(93)90127-P.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • DeVellis, R. (2003). Scale development: Theory and applications. Thousand Oaks: Sage Publications Inc.

    Google Scholar 

  • Diamantopoulos, A., & Winklhofer, H. M. (2001). Index construction with formative indicators: An alternative to scale development. Journal of Marketing Research, 38, 269–277.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Duncan, G. J., & Raudenbush, S. W. (1999). Assesing the effects of context in studies of child and youth development. Educational Psychologist, 34, 29–41.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Grosh, M., & Glewwe, P. (1995). A guide to living standards measurement study surveys and their data sets (Working Paper No. 120). World Bank.

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • Kravdal, Ø. (2004). Child mortality in India: The community-level effect of education. Population Studies, 58(2), 177–192. doi:10.1080/0032472042000213721.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • McKenzie, D. J. (2005). Measuring inequality with asset indicators. Journal of Population Economics, 18(2), 229–260. doi:10.1007/s00148-005-0224-7.

    Article  Google Scholar 

  • McLoyd, V. C. (1998). Socioeconomic disadvantage and child development. American Psychologist, 53, 185–204.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Nepal Central Bureau of Statistics, National Planning Commission Secretariat. (2001). Nepal National Population & Housing Census.

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Robert, S. A. (1999). Socioeconomic position and health: The independent contribution of community socioeconomic context. Annual Review of Sociology, 25(1), 489.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • United Nations Development Programme. (2013). Human development report 2013. Nepal.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

Download references

Acknowledgments

Data collection was funded by the National Institutes of Health grants R01 HD050254 and HD 38753; the Bill and Melinda Gates Foundation, Seattle, Washington; the Micronutrients for Health Cooperative Agreement No. HRN-A-00-97-00015-00 and the Global Research Activity Cooperative Agreement No.GHS-A-00-03-00019-00 between the Johns Hopkins University and the Office of Health, Infectious Diseases and Nutrition, United States Agency for International Development, Washington, DC. Bill and Melinda Gates Foundation, Seattle, Washington; Sight and Life Research Institute; and the Doctoral Thesis Research Fund of the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. We thank all of the field staff and supervisors who made data collection possible, and we thank Drs. Thomas Glass and Amy Tsui for their helpful critiques in conceptualizing the measurement and validation of the indices.

Author information

Authors and Affiliations

  1. Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Rm 6002, Atlanta, GA, 30322, USA

    Shivani A. Patel

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA

    Susan G. Sherman

  3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA

    Subarna K. Khatry, Steven C. LeClerq, Joanne Katz & Parul Christian

  4. The Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal

    Subarna K. Khatry

  5. Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, 20037, USA

    James M. Tielsch

Authors
  1. Shivani A. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan G. Sherman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Subarna K. Khatry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven C. LeClerq
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joanne Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James M. Tielsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Parul Christian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shivani A. Patel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patel, S.A., Sherman, S.G., Khatry, S.K. et al. An Index of Community-Level Socioeconomic Composition for Global Health Research. Soc Indic Res 129, 639–658 (2016). https://doi.org/10.1007/s11205-015-1114-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11205-015-1114-3

Keywords

Search

Navigation