![Page 1: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/1.jpg)
SUB GROUP BIAS IN PUBLIC HEALTH RESEARCHApplying survey over coverage methodology to health disparities research
Naomi Zewde, MPH and Rhonda Belue, PhD
![Page 2: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/2.jpg)
Presenter Disclosures
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relevant relationships to disclose
![Page 3: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/3.jpg)
Increasing immigration challenges racial classification
• EG: Classifying Hispanic ethnicity when the individual is also either black or white
• ACA charged the DHHS with revising standards of race/ ethnicity data collection1
“While data alone will not reduce disparities, it can be foundational in our efforts to understand the causes, design effect responses and evaluate our progress.”
![Page 4: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/4.jpg)
Obesity Rates among Hispanic and Non-Hispanic White American Adults 2012
Non- Hispanic White Hispanic0.27
0.28
0.29
0.3
0.31
0.32
0.33
Obesity Rate
![Page 5: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/5.jpg)
Sub group bias
• Documented health outcome variation by:2-4
• Socio-economic status• Country of origin• Immigrant status• Combined effects
• African immigrants report higher health than US born whites, while US, West Indian and European born blacks do not
![Page 6: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/6.jpg)
Obesity Rates among Hispanic and Non-Hispanic White American Adults 2012
Non-H
ispan
ic W
hite
Puerto
Rica
n
Mex
ican
Oth
er C
entra
l/ S. A
mer
ican
Oth
er H
isp/ L
atino
Cuban
Domini
can
0.15
0.2
0.25
0.3
0.35
0.4
Obesity Rate
Obesity Rate
![Page 7: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/7.jpg)
Sub group inefficiency• Large sample sizes enable precise estimates
• Racial groups are necessarily larger than sub-groups • There are necessarily more Black Americans than there
are middle-income or African Americans.
![Page 8: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/8.jpg)
Precision - bias tradeoff
• Sub-group analysis is statistically inefficient if the original results are unbiased• No practical difference in outcomes; or• Sub-group is a majority, thus driving the results
• Our paper suggests a method of quantifying the tradeoff between precision and bias.
![Page 9: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/9.jpg)
Objectives
This paper draws a conceptual and methodological parallel between survey over coverage bias and sub- group bias in health disparities research to:
1. Demonstrate a method of quantifying sub-group bias
2. Demonstrate a method of identifying the relative statistical efficiency of using sub-group data
![Page 10: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/10.jpg)
Over coverage bias: sampled persons are not part of the target population
One to one correspondence
F------------T...
F------------T
Over coverage
F-------------...
F------------T
![Page 11: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/11.jpg)
Sub-group : over coverage parallel• Sub group members serve as the target population
• Example: Puerto Rican Americans
• Non sub group members are overrepresented in the data• Non- Puerto Rican Hispanic Americans
![Page 12: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/12.jpg)
Sub-group : over coverage parallel
• Over coverage and sub-group bias each occur when unintended observations contribute to sample statistics
• Survey methodology identifies two drivers of over coverage bias5
• Difference in outcome between foreign and targeted units• Proportion of foreign vs. targeted elements
![Page 13: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/13.jpg)
Applied example• Obesity prevalence among Hispanic Americans
• Obesity is a growing public health concern• Risk factors are correlated with cultural variation
• Data source• 2012 Medical Expenditure Panel Survey (MEPS)• Identifies Hispanic ethnicity across six countries of origin
![Page 14: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/14.jpg)
Mean bias5
Full sample mean
Number of foreign elements
Full sample size Mean of foreign elements
Mean of target population
![Page 15: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/15.jpg)
Ethnic Group Sample Size
Obesity Rate Obesity Ratio to N.H. W.
Bias* Relative Bias
Hispanic 7,446 32.58 1.10 -- --
N.H. White 11,319 29.521.00
-- --
Reported obesity Statistics from MEPS 2012 represent non-institutionalized American adults.* Demonstration of Bias from using obesity statistic calculated on Hispanic ethnicity (Szameitat and Schafer, 1963)
Ethnic Group Sample Size
Obesity Rate Obesity Ratio to N.H. W.
Bias* Relative Bias
Hispanic 7,446 32.58 1.10 -- --
N.H. White 11,319 29.521.00
-- --
Central/S. American1,223
25.74 0.87 6.77 26.32
Dominican
307 27.49 0.93 5.10 18.56
Reported obesity Statistics from MEPS 2012 represent non-institutionalized American adults.* Demonstration of Bias from using obesity statistic calculated on Hispanic ethnicity (Szameitat and Schafer, 1963)
Ethnic Group Sample Size
Obesity Rate Obesity Ratio to N.H. W.
Bias* Relative Bias
Hispanic 7,446 32.58 1.10 -- --
N.H. White 11,319 29.521.00
-- --
Central/S. American1,223
25.74 0.87 6.77 26.32
Dominican
307 27.49 0.93 5.10 18.56
Puerto Rican
687 36.99 1.25 -4.46 -12.07
Other Hisp/ Latino
303 28.59 0.97 4.06 14.22
Cuban
336 35.15 1.19 -2.56 -7.27
Mexican
4,590 34.10 1.16 -1.45 -4.25
Reported obesity Statistics from MEPS 2012 represent non-institutionalized American adults.* Demonstration of Bias from using obesity statistic calculated on Hispanic ethnicity (Szameitat and Schafer, 1963)
Mean bias in Hispanic ethnic sub-groups
![Page 16: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/16.jpg)
Statistical Efficiency• Efficiency can be measured by relative mean squared
error• Rewards sample size• Penalizes unexplained variation and bias
• Relative efficiency of sub-group analysis is ambiguous apriori
![Page 17: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/17.jpg)
Relative Efficiency
Relative Mean Squared Error=
![Page 18: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/18.jpg)
Relative efficiency of Hispanic ethnic sub- groups
Ethnic Group Sample Size Relative Bias MSE Relative MSE*
Hispanic 7,446 -- 1.05E-04 --
Central/S. American 1,223 26.32 4.07E-02 11.77
Puerto Rican 687 -12.07 9.18E-02 2.23
Mexican 4,590 -4.25 1.64E-02 2.05
Reported obesity statistics from MEPS 2012 represents non-institutionalized American adults. *Ratio of sub- group MSE to full sampling frame MSE (all Hispanic)
Ethnic Group Sample Size Relative Bias MSE Relative MSE*
Hispanic 7,446 -- 1.05E-04 --
Central/S. American 1,223 26.32 4.07E-02 11.77
Puerto Rican 687 -12.07 9.18E-02 2.23
Mexican 4,590 -4.25 1.64E-02 2.05
Dominican 307 18.56 2.74E-01 0.99
Other Hisp/ Latino 303 14.22 1.82E-01 0.93
Cuban 336 -7.27 2.03E-01 0.38Reported obesity statistics from MEPS 2012 represents non-institutionalized American adults. *Ratio of sub- group MSE to full sampling frame MSE (all Hispanic)
![Page 19: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/19.jpg)
Non H
ispan
ic W
hite
Puerto
Rica
n
Mex
ican
Domini
can/
Cub
an/O
ther
Hisp
. Lat
ino
CS Am
erica
n0.00
0.10
0.20
0.30
0.40
0.50
Obesity Among Hispanic and Non-Hispanic Amer-ican Adults, 2012
Obesity Rate
![Page 20: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/20.jpg)
Discussion• Over coverage methodology provides a concrete tool to
assess the tradeoff between precision and bias to present racial ethnic minority findings
• Mean bias has been demonstrated in survey over coverage methodology, future research is needed to identify bias in other statistics, including regression coefficients.
![Page 21: SUB GROUP BIAS IN PUBLIC HEALTH RESEARCH Applying survey over coverage methodology to health disparities research Naomi Zewde, MPH and Rhonda Belue, PhD](https://reader035.vdocuments.mx/reader035/viewer/2022062407/56649e535503460f94b48913/html5/thumbnails/21.jpg)
References
1. U.S. Department of Health and Human Services. (2011, October). Implementation
guidance on data collection standards for race, ethnicity, sex, primary language and disability
status. Retrieved from: http://aspe.hhs.gov/datancl/standards/ACA/4302
2. Read, J. G., Emerson, M. O., & Tarlov, A. (2005). Implications of black immigrant health
for U.S. racial disparities in health. Journal of Immigrant Health , 205-212.
3. National Research Council. (2004). Eliminating health disparities: Measurement and data
needs. Panel on DHHS Collection of Race and Ethnicity Data, Committee on National
Statistics.Washington, DC: National Academies Press.
4. Liang, J., Van Tran, T., Krause, N., and Markides, K. S.Generational differences in the
structure of the CES-D Scale in Mexican Americans.Journal of Gerontology: Social
Sciences44(1989).5110–5120.
5. Szameitat, K., & Schaffer, K. A. (1963). Imperfect Frames in Statistics and the
consequences for their use in sampling. Bulletin of the International Statistical Institute ,
40, pp. 517- 544.