An Approach to Studying Social Disparities in Health and Health Care

OBJECTIVE: We explored methods and potential applications of a systematic approach to studying and monitoring social disparities in health and health care. METHODS: Using delayed or no prenatal care as an example indicator, we (1) categorized women into groups with different levels of underlying social advantage; (2) described and graphically displayed rates of the indicator and relative group size for each social group; (3) identified and measured disparities, calculating relative risks and rate differences to compare each group with its a priori most-advantaged counterpart; (4) examined changes in rates and disparities over time; and (5) conducted multivariate analyses for the overall sample and "at-risk" groups to identify particular factors warranting attention. RESULTS: We identified at-risk groups and relevant factors and suggest ways to direct efforts for reducing prenatal care disparities. CONCLUSIONS: This systematic approach should be useful for studying and monitoring disparities in other indicators of health and health care.