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Paula A. Braveman, MD, MPH, Susan A. Egerter, PhD, Catherine Cubbin, PhD and Kristen S. Marchi, MPH

Paula A. Braveman, Susan A. Egerter, Catherine Cubbin, and Kristen S. Marchi are with the Center on Social Disparities in Health and the Department of Family and Community Medicine, University of California, San Francisco. Catherine Cubbin is also with the Stanford Prevention Research Center, Stanford University, Stanford, CA.

Correspondence: Requests for reprints should be sent to Paula A. Braveman, MD, MPH, Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU 3-E, San Francisco, CA 94143–0900 (email: braveman{at}fcm.uscf.edu).

Objective. We explored methods and potential applications of a systematic approach to studying and monitoring social disparities in health and health care.

Methods. Using delayed or no prenatal care as an example indicator, we (1) categorized women into groups with different levels of underlying social advantage; (2) described and graphically displayed rates of the indicator and relative group size for each social group; (3) identified and measured disparities, calculating relative risks and rate differences to compare each group with its a priori most-advantaged counterpart; (4) examined changes in rates and disparities over time; and (5) conducted multivariate analyses for the overall sample and "at-risk" groups to identify particular factors warranting attention.

Results. We identified at-risk groups and relevant factors and suggest ways to direct efforts for reducing prenatal care disparities.

Conclusions. This systematic approach should be useful for studying and monitoring disparities in other indicators of health and health care.

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