A two-county comparison of the HOUSES index on predicting self-rated health

Background: Mortality, incidence of most diseases, and prevalence of adverse health behaviours follow an inverse gradient with social class. Many proxies for socioeconomic status (SES) exist; however, each bears a different relation to health outcomes, probably following a different aetiological pathway. Additionally, data on SES can be quite difficult to gather. Five measures of SES were compared, including a novel measure, the HOUSES index, in the prediction of selfrated health (SRH) in two Midwestern settings, Olmsted County, Minnesota, and Jackson County, Missouri. Methods: Using a probability sampling design, a crosssectional telephone survey was administered to a randomised sample of households. The questionnaire collected a variety of sociodemographic and personal health information. The dependent variable, SRH, was dichotomised into excellent/very good/good versus fair/poor health. Information for the HOUSES index was collected through public property records and corroborated through the telephone questionnaire. Participants were parents/guardians of children aged 1-17 residing in Olmsted County (n=746) and Jackson County (n=704). Results: The HOUSES index was associated with adverse SRH in Jackson County adults. All five SES measures were significant predictors in this group. Composite SES indices showed significant associations with SRH in Olmsted County adults. Conclusions: The HOUSES index makes a unique contribution to the measurement of SES and prediction of health outcomes. Its utility is qualified by specific social contexts, and it should be used in concert with other SES indices.