Issues in developing multidimensional indices of state-level health inequalitie s: National Health Interview Survey, 2013–2015
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Issues in developing multidimensional indices of state-level health inequalitie s: National Health Interview Survey, 2013–2015

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    Objectives: To describe methodological issues that arise in the construction and design-based estimation of multidimensional indices that aggregate state-specific inequalities in core health measures, using data from the National Health Interview Survey (NHIS). Methods: For each state, an overall, multidimensional health inequalities index was computed from NHIS 2013–2015 by aggregating summary indices of inequalities—by sex, race and Hispanic origin, education, urbanicity, and disability status—in healthy behaviors (HBs), access to medical care (AMC), general physical health status and mental health (PMH), and absence of multiple chronic conditions (MCCs) among adults aged 45–64. Because the choice of summary index impacts the magnitude and relative ranking of state-specific overall indices, two index classes were studied: the Gastwirth (G) and Atkinson (Aα) index classes. Bootstrapped confidence intervals for point estimates and most likely ranks for rank estimates were calculated. Due to data limitations, only the 20 most populous states were analyzed. Findings: HBs had lower prevalence than AMC, PMH, and absence of MCCs in the U.S. population; accordingly, HBs contributed more to the state-specific overall inequalities indices than the other three measures. Rankings differed between G and Aα indices, and by whether Aα indices were adjusted to account for the health of the least healthy subgroups. Yet the majority of the 20 states were ranked in consistent tiers by these index classes. Multidimensional inequalities indices aggregate only inequalities, regardless of population levels for the core health measures selected. As a result, states were not well differentiated based on these indices alone, increasing ranking uncertainty. Summary: This report highlights issues that arise when developing and estimating state-specific multidimensional health inequalities indices using national survey data. Selected results from the analysis emphasize the importance of measure and index selection and illustrate sources of ranking uncertainty. Suggested citation: Talih M, Villarroel MA. Issues in developing multidimensional indices of state-level health inequalities: National Health Interview Survey, 2013–2015. National Center for Health Statistics. Vital Health Stat 2(180). 2018. CS291054
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