Should Health Studies Measure Wealth? A Systematic Review
Background
Health researchers rarely measure accumulated wealth to reflect socioeconomic status/position (SES). In order to determine whether health research should more frequently include measures of wealth, this study assessed the relationship between wealth and health.
Methods
Studies published between 1990 to 2006 were systematically reviewed. Included studies used wealth and at least one other SES measure as independent variables, and a health-related dependent variable.
Results
Twenty-nine studies met inclusion criteria. Measures of wealth varied greatly. In most studies, greater wealth was associated with better health, even after adjusting for other SES measures. The findings appeared most consistent when using detailed wealth measures on specific assets and debts, rather than a single question. Adjusting for wealth generally decreased observed racial/ethnic disparities in health.
Conclusions
Health studies should include wealth as an important SES indicator. Failure to measure wealth may result in under-estimating the contribution of SES to health, such as when studying the etiology of racial/ethnic disparities. Validation is needed for simpler approaches to measuring wealth that would be feasible in health studies.
aRobert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania
bVA Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
cLeonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
dCenters for Disease Control and Prevention, Epidemic Intelligence Service, University of California, San Francisco
eCenter on Social Disparities in Health and Department of Family and Community Medicine, University of California, San Francisco
fPopulation Research Center, The University of Texas at Austin, Austin, Texas
gDepartment of Medicine, Division of Geriatrics, University of California, San Francisco, California.
Address correspondence and reprint requests to: Paula Braveman, MD, MPH, Center on Social Disparities in Health and Department of Family and Community Medicine, University of California, San Francisco, Box 0900, 500 Parnassus Avenue, MU 3E, San Francisco CA 94143-0900.
The full text of this article is available via AJPM Online at www.ajpm-online.net; 1 unit of Category-1 CME credit is also available.
ABSTRACT