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BACKGROUND: Poverty is associated with adverse health outcomes, but individual-level poverty is often difficult to measure because data are unavailable or inaccurate. Consequently, the New York City (NYC) Health Department adopted area-based poverty measures for routine analysis. Whether these measures are interchangeable is unknown. To determine if individual-level poverty and area-based poverty have similar associations with health outcomes, we analyzed NYC’s 2012 Community Health Survey (a random-digit–dial survey of 8,797 adults), which contains both measures.
METHODS: Individual-level poverty was categorized into 4 groups (household income ≥400% [lowest poverty], 200%–<400%, 100%–<200%, <100%, of federal poverty level [FPL]). Area-based poverty was categorized into 4 groups (<10% [lowest], 10%–19%, 20%–29%, ≥30% residents with household income below FPL in respondent’s zip code). Respondents with missing individual-level poverty or area-based poverty were excluded (19.6%). Using SAS®-callable SUDAAN®, we calculated weighted prevalences of self-reported asthma, obesity, and hypertension by poverty level and tested associations of these outcomes with increasing individual-level poverty, controlling for area-based poverty and vice-versa with logistic regression.
RESULTS: Among persons with lowest versus highest individual-level poverty, asthma prevalence was 13.2% versus 16.6%, obesity 24.8% versus 38.1%, and hypertension 21.6% versus 31.2%. Among persons with lowest versus highest area-based poverty, asthma prevalence was 9.9% versus 15.5%, obesity 20.1% versus 29.8%, and hypertension 25.5% versus 30.7%. Area-based poverty was independently associated with asthma (P=.03) and obesity (P=.002) but not hypertension (P=.82). Individual-level poverty was independently associated with obesity (P=.005) and hypertension (P <.001) but not asthma (P=.42).
CONCLUSIONS: Individual-level poverty and area-based poverty might measure different health effects of poverty. For certain health outcomes, one measure might be more important than the other. In NYC, Community Health Survey data should be routinely analyzed by both.