An Index of Community-Level Socioeconomic Composition for Global Health Research

Despite increasing recognition that community-level socioeconomic factors are critical to individual health outcomes globally, guidance on their measurement remains limited in low and middle income countries. We outline the steps needed to develop and validate a theory-based, multidimensional index of community-level socioeconomic composition using information that is often available in global settings. Census indicators describing human and social capital were analyzed using principal components analysis to construct a community socioeconomic composition index (CSCI) for 30 communities in the Southern plains of Nepal. The index was validated against subsequent child nutrition, household assets, and village infrastructure using data from 1822 children and their households. At the community-level, the CSCI was positively correlated with child height-for-age, and child weight-for-age, household assets, and community infrastructure (r = 0.54, 0.58, 0.85, 0.67, respectively). In multilevel analyses, +1SD of the CSCI was associated with +0.14SD of the household asset index (p < 0.01) after adjusting for confounders. These results suggest that an exclusively census-based strategy to measure socioeconomic composition has construct validity in this setting. This approach to measuring community-level socioeconomic composition may be feasibly reproduced in other resource-constrained settings where census data are available, potentially expanding the scope of place and health research globally.