Indicators used to measure inequities

This section reviews the definitions and sources of the indicators used to describe health inequities in this platform. Some capture fundamental drivers of inequities (such as individual-level race ethnicity, neighborhood poverty, and city segregation) and others may capture the specific mechanisms through which fundamental causes affect inequities (e.g. overcrowding or insurance coverage).

INDIVIDUAL-LEVEL INDICATORS USED TO DESCRIBE INEQUITIES ACROSS PEOPLE

Based on data availability the individual-level indicator currently used is race and ethnicity categorized as describe below. Source: data reported by cities linked to cases, hospitalizations and deaths.
 Indicators  Description
 NH White  Population that self-identified as non-Hispanic White.
 NH Black  Population that self-identified as non-Hispanic Black.
 Hispanic  Population that self-identified as Hispanic.
 NH White  Population that self-identified as non-Hispanic Asian/Pacific Islander.

A notable missing category of special relevance to COVID-19 is Native American or American Indian/Alaskan Native. We will expand the categories shown as more data becomes available.

Neighborhood Level Indicators

Neighborhoods are currently proxied by zip codes. This may be changed to census tracts if data becomes available.
Source: All data is derived from U.S. Census Bureau (2019). American Community Survey (ACS) 5-Year Estimates retrieved from: https://www.census.gov/programs-surveys/acs/data.html
Demographics
 Indicators  Description
 % Hispanic  Percentage of population that self-identified as Hispanic.
 % NH White  Percentage of population that self-identified as non-Hispanic White.
 % NH Black  Percentage of population that self-identified as non-Hispanic Black.
 % NH Asian/PI  Percentage of population that self-identified as non-Hispanic Asian/Pacific Islander.
% Native American
Percentage of population that self-identified as non-Hispanic American Indian or Alaska Native.
 % Foreign Born  Percentage of persons that are foreign born.
Income, Wealth, & Poverty
 Indicators  Description
 Median HH Income  Median household income.
 % Poverty
Percentage of population with income below the poverty level.
 Median House Value
The median value of how much the owner-occupied property (house and lot) would sell for if it were for sale.
Education
 Indicators  Description
 % Complete College
Percent of population that completed college. The percentages are obtained by dividing the counts of college graduates by the total number of persons 25 years old and over.
 % Complete High School
Percent of population that completed high school. The percentages are obtained by dividing the counts of high school graduates by the total number of persons 25 years old and over.
Occupation
 Indicators  Description
 % Healthcare Workers
Percentage of the population age 16+ that work in healthcare (Healthcare Practitioners, Technical Occupations, and Healthcare Support Occupations).
 % Service Workers
Percentage of the population age 16+ that work as service workers (Food Preparation, Serving-related Occupations, Personal Care and Service Occupations).
 % Production Workers
Percentage of the population age 16+ that works as production workers (Production Occupation).
Segregation (Index of Concentration at the Extremes)
 Indicators  Description

ICE - Income

The Index of Concentration at the extremes (ICE) captures the concentration of extremes of privilege and deprivation in a single metric. A value of 1 indicates that all residents in the area are in the privileged group and a value of -1 denotes that all residents are in the most deprived group. Privilege and deprivation can be defined in different ways. For the ICE-income privilege is defined as annual household (HH) income > 80th percentile ($100,000) in the American Community Survey (ACS). Deprivation is defined as HH income <20th percentile ($25,000).

Citation: Krieger, Nancy, et al. "Public health monitoring of privilege and deprivation with the index of concentration at the extremes." American journal of public health 106.2 (2016): 256-263.

 ICE - NH Black
The Index of Concentration (ICE) for NH-Black defines the most privileged group as non-Hispanic White and the least privileged as non-Hispanic Black.
 ICE - Hispanic
The Index of Concentration (ICE) for Hispanic defines the most privileged group as non-Hispanic White and the least privileged as Hispanic.
 ICE - Income + NH Black
The Index of Concentration (ICE) for Income + NH Black defines the most privileged group as non-Hispanic White with income >$100,000 and the least privileged as NH Black with income <$25,000.
ICE - Income + People of Color
Index of Concentration (ICE) for income and race/ethnicity combined: the extreme groups are non-Hispanic White persons whose HH income was greater than or equal to the 80th income percentile or $100,000 (most privileged) versus non-Whites whose households income was below the 20th income percentile or $25,000 (least privileged). The denominator is the total population with known income.
ICE - Occupation + Black

Index of Concentration for Occupation and race combined: the extreme groups are non-Hispanic White workers in “management, professional and related occupations” (which are largely amenable to work-from-home arrangements - most privileged) versus non-Hispanic Black or African American workers in “service, natural resources, construction, and maintenance operations or production occupations" (which are less amenable to work-from-home arrangements - least privileged). Denominator is the total Population 16 years and over with known occupation.

Citation: Saha, Sudipta, and Justin M. Feldman. "Neighbourhood-level Racial/Ethnic and Economic Inequities in COVID-19 Burden Within Urban Areas in the US and Canada." medRxiv (2020).

Transportation
 Indicators  Description
 % Using Public Transit
Percentage of population that uses public transport (excluding taxi) to travel to work.
Housing
 Indicators  Description
 % Overcrowding > 1
Percentage of people living in housing units with greater than 1 occupant per room.
% Housing With complete Plumbing
Percentage of all housing units that have complete plumbing facilities.
Health Insurance Coverage
 Indicators  Description
 % Not Insured
Percentage of population that is uninsured.
Vulnerability
 Indicators  Description
Social Vulnerability Index (SVI)
The Social Vulnerability Index (SVI) draws together 15 different measures of vulnerability using four themes: Socioeconomic Status, Household Composition & Disability, Minority Status & Language, Housing Type & Transportation. Each neighborhood is ranked (relative to all neighborhoods within a particular state of interest), and a percentile is assigned, with higher values indicating greater vulnerability.

Citation: Flanagan, Barry E., et al. "A social vulnerability index for disaster management." Journal of homeland security and emergency management 8.1 (2011).
SVI – Socioeconomic Status
SVI score, specific to the theme of Socioeconomic Status (below poverty, unemployed, income, no high school diploma).
SVI – Household Composition & Disability
SVI score, specific to the theme of Household Composition & Disability (aged 65 or older, aged 17 or younger, older than age 5 with a disability, single-parent households).
SVI – Minority Status & Language
SVI score, specific to the theme of Minority Status & Language (non-White, speak English “less than well”).
SVI – Housing Type & Transportation
SVI score, specific to the theme of Housing Type & Transportation (multi-unit structures, mobile homes, crowding, no vehicle, group quarters).
COVID Local Risk Index
 Indicators  Description
COVID Local Risk Index
Neighborhood-level COVID risk index, reflecting social and economic factors and health outcomes relative to other neighborhoods on the Dashboard.

Citation: City Health Dashboard, incorporating data from the American Community Survey and the Centers for Disease Control and Prevention's PLACES Project and Social Vulnerability Index. This has been created by the City Health Dashboard project at NYU Langone’s Department of Population Health. More information is available here.

City Level Indicators

Cities are defined as counties, collections of counties, or census-defined places depending on the city.
Source: All data is derived from U.S. Census Bureau (2019). American Community Survey (ACS) 5-Year Estimates retrieved from: https://www.census.gov/programs-surveys/acs/data.html
Demographic
 Indicators  Description
Census Bureau Region 2010 United States Census Bureau definition of four statistical regions as detailed here.
 Population size  Count of persons in the population.
 Population Density  Number of persons in a population per square kilometer (# persons/km2).
 % Hispanic  Percentage of population that self-identified as Hispanic.
 % NH White  Percentage of population that self-identified as non-Hispanic White.
 % NH Black  Percentage of population that self-identified as non-Hispanic Black.
 % NH Asian/PI  Percentage of population that self-identified as non-Hispanic Asian/Pacific Islander.
% Native American
Percentage of population that self-identified as non-Hispanic American Indian or Alaska Native.
 % Foreign Born  Percentage of persons that are foreign born.
Income, Wealth, & Poverty
 Indicators  Description
 % Poverty
Percentage of population with income below the poverty level.
 GINI
Gini Index of Income Inequality is a measure of income inequality that summarizes the distribution of income across the population. The Gini coefficient ranges from 0-1 where a Gini coefficient of 0 indicates perfect equality (everyone receives an equal share of the income) and 1 indicates perfect inequality (one group receives all of the income).
Occupation
 Indicators  Description
 % Service Workers
Percentage of the population age 16+ that work as service workers (Food Preparation, Serving-related Occupations, Personal Care and Service Occupations).
 % Production Workers
Percentage of the population age 16+ that works as production workers (Production Occupation).
Segregation
 Indicators  Description
Dissimilarity: NH-Black and NH-White.
The dissimilarity Index measures the fraction of one group that would have to move to another area, in order to equalize the population distribution. The index ranges between 0 and 1, with 0 being full integration and 1 being full segregation. Typically values over 0.5 are considered to be very high levels of segregation. We used tract level population estimates of NH-Whites and NH-Blacks to calculate this index.
Dissimilarity: Hispanic and NH-White.
The dissimilarity Index measures the fraction of one group that would have to move to another area, in order to equalize the population distribution. The index ranges between 0 and 1, with 0 being full integration and 1 being full segregation. Typically values over 0.5 are considered to be very high levels of segregation. We used tract level population estimates of NH-Whites and Hispanics to calculate this index.
 Isolation: NH-Black
The isolation index is a probability that ranges between 0 and 1. Higher values (closer to 1), indicate more isolation of the group, while values near 0 indicate less isolation. We used tract level estimates of the non-Hispanic Black population to calculate this index.
 Isolation: Hispanic
The isolation index is a probability that ranges between 0 and 1. Higher values (closer to 1), indicate more isolation of the group, while values near 0 indicate less isolation. We used tract level estimates of the Hispanic population to calculate this index.
Housing
 Indicators  Description
% Overcrowding
Percentage of people living in housing units with greater than 1 occupants per room.