ZIP-code-based versus tract-based income measures as long-term risk-adjusted mortality predictors

Avis J. Thomas, Lynn E Eberly, George Davey Smith, Jim Neaton

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126 Scopus citations


There is a well-established, strong association between socioeconomic position and mortality. Public health mortality analyses thus routinely consider the confounding effect of socioeconomic position when possible. Particularly in the absence of personally reported data, researchers often use area-based measures to estimate the effects of socioeconomic position. Data are limited regarding the relative merits of measures based on US Census tract versus ZIP code (postal code). ZIP-code measures have more within-unit variation but are also more easily obtained. The current study reports on 293,138 middle-aged men screened in 14 states in 1973-1975 for the Multiple Risk Factor Intervention Trial and having 25-year mortality follow-up. In risk-adjusted proportional hazards models containing either ZIP-code-based or tract-based median household income, all-cause mortality hazard ratios were 1.16 (95% confidence interval: 1.14, 1.17) per $10,000 less ZIP-code-based income and 1.15 (95% confidence interval: 1.13, 1.16) per $10,000 less tract-based income; adding either income variable to a risk-adjusted model improved model fit substantially. Both were significant independent predictors in a combined model; tract-based income was a slightly stronger mortality predictor (hazard ratios = 1.05 and 1.11 for ZIP-code-based and tract-based income, respectively). These patterns held across various causes of death, for both Blacks and non-Blacks, and with or without adjustment for ZIP-code-based income diversity or tract-based proportion below poverty.

Original languageEnglish (US)
Pages (from-to)586-590
Number of pages5
JournalAmerican journal of epidemiology
Issue number6
StatePublished - Sep 2006

Bibliographical note

Funding Information:
The Multiple Risk Factor Intervention Trial was conducted under contract with the National Heart, Lung, and Blood Institute, Bethesda, Maryland. This work was supported by National Heart, Lung, and Blood Institute grants R01-HL-43232 and R01-HL-68140. Conflict of interest: none declared.


  • Censuses
  • Geography
  • Income
  • Inequalities
  • Longitudinal studies
  • Neighborhood
  • Social class
  • Socioeconomic factors


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