Cultural context index: A geospatial measure of social determinants of health in the United States

Alaina M Beauchamp; Gordon C Shen; Syed H Hussain; Atif Adam; Linda Highfield; Kai Zhang

doi:10.1016/j.ssmph.2023.101591

Cultural context index: A geospatial measure of social determinants of health in the United States

SSM Popul Health. 2023 Dec 29:25:101591. doi: 10.1016/j.ssmph.2023.101591. eCollection 2024 Mar.

Authors

Alaina M Beauchamp^{1

2}, Gordon C Shen³, Syed H Hussain³, Atif Adam⁴, Linda Highfield³, Kai Zhang⁵

Affiliations

¹ The University of Texas Health Science Center at Houston School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Dallas, TX, USA.
² UT Southwestern Medical Center, O'Donnell School of Public Health, Dallas, TX, USA.
³ The University of Texas Health Science Center at Houston School of Public Health, Department of Management, Policy, and Community Health, Houston, TX, USA.
⁴ John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ University at Albany, State University of New York School of Public Health, Department of Environmental Health Sciences, Rensselaer, NY, USA.

Abstract

Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot and cold spots that are the highest and lowest CCI quintile, respectively. Hot spots census tracts were mostly located in metropolitan areas (84.8%), in the Southern census region (41.5%), and also had larger Black and Hispanic populations. The census tracts with the greatest need for culturally competent health care also had the sickest populations. Census tracts with a CCI rank of 5 ('greatest need') had higher prevalences of self-reported poor physical health (17.2%) and poor mental health (17.4%), compared to either the general population (13.9% and 14.5%) or to CCI rank of 1 ('lowest need') (11.9% and 10.8%). The CCI can pinpoint census tracts with a need for culturally competent health care and inform supply-side policy planning as healthcare and social service providers will inevitably come in contact with consumers from different backgrounds.

Keywords: Cultural competency; Cultural context index; Geospatial index; Social determinants of health.