A Comparative Analysis of Area-Based Socioeconomic Measures: Implications for Future Equity-focused Public Health Response

Effectively identifying communities in need of public health resources is critical for addressing health disparities. However, clear strategies for doing so and prioritizing resources are not well established. As area-based socioeconomic measures (ABSMs), which include indices that capture determinants of health for a specific geographical unit, increasingly gain traction for guiding policy and resource allocation, it is essential to understand how different ABSMs perform in relation to health outcomes of interest. This proof-of-concept study illustrates an approach to compare how different ABSMs as place-based indicators are associated with disease outcomes. Using monthly COVID-19 public health surveillance data for 2020-2021 at the census tract level in California, we qualitatively and quantitatively compare five prominent ABSMs: California Healthy Places Index, Area Deprivation Index, Social Vulnerability Index, Index of Concentration at the Extremes, and Home Owners Loan Corporation (HOLC) "redlining" grades. Our findings demonstrate that no single ABSM consistently aligned with COVID-19 case and mortality rates across geographies or time, highlighting the importance of selecting measures based on context, data availability, data quality, and the specific health outcome of interest. Moreover, our analysis revealed that associations between poor health outcomes and proxy measures for historical disinvestment and racial discrimination suggest these patterns are important to identify when developing equitable public health strategies. This work underscores the potential for public health decision-makers and implementers to use both qualitative and quantitative approaches to select among ABSMs for targeting interventions more effectively.