Statistical Inference on Health Disparity Indices for Complex Surveys.

The National Cancer Institute developed the Health Disparities Calculator (HD*Calc) to facilitate research on health disparities. HD*Calc calculates multiple measures of health disparities using data collected from population-based disease surveillance systems, such as cancer registries. In this paper, we extend the use of HD*Calc to complex survey data by developing plug-in point estimators and Taylor linearization variance estimators that consider complex designs: stratification, multistage clustering, and differential weighting. Our simulation indicates that the plug-in estimators are approximately unbiased and the Taylor linearization variance estimators are accurate. Using 2011-2016 data from the National Health and Nutrition Examination Survey, we demonstrate the use of these estimators in evaluating socioeconomic disparities in the prevalence of child and adolescent (ages 2-18 years) obesity in the United States. Statistical software has been developed for ease of disparity analyses using complex survey data.