Statistical Inference of Health Disparity Indices for Complex Surveys

The United States National Cancer Institute developed the Health Disparities Calculator (HD*Calc) to facilitate disparity research. 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 the National Health and Nutrition Examination Survey 2011–2016 data, we demonstrated the use of these estimators in evaluating socioeconomic disparities in adolescent obesity prevalence in the US Statistical software was developed for ease of disparity analyses using complex survey data.