Racial Fairness of Individual- and Community-Level Proxies of Socioeconomic Status Among Birthing Parent–Child Dyads

While precision medicine algorithms can be used to improve health outcomes, concerns have been raised about racial equity and unintentional harm from encoded biases. In this study, we evaluated the fairness of using common individual- and community-level proxies of pediatric socioeconomic status (SES) such as insurance status and community deprivation index often utilized in precision medicine algorithms.

Using 2012–2021 vital records obtained from the Ohio Department of Health, we geocoded and matched each residential birth address to a census tract to obtain community deprivation index. We then conducted sensitivity and specificity analyses to determine the degree of match between deprivation index, insurance status, and birthing parent education level for all, Black, and White children to assess if there were differences based on race.

We found that community deprivation index and insurance status fail to accurately represent individual SES, either alone or in combination. We found that deprivation index had a sensitivity of 61.2% and specificity of 74.1%, while insurance status had a higher sensitivity of 91.6% but lower specificity of 60.1%. Furthermore, these inconsistencies were race-based across all proxies evaluated, with greater sensitivities for Black children but greater specificities for White children.

This may explain some of the racial disparities present in precision medicine algorithms that utilize SES proxies. Future studies should examine how to mitigate the biases introduced by using SES proxies, potentially by incorporating additional data on housing conditions.