Measuring Concordance and Discordance between Individual Characteristics and Neighborhood-level Social Determinants of Health

Background: People have both individual and neighborhood level social determinants that may confer health risks or health benefits. While these are often aligned, this is not always the case. An affluent individual may live in a neighborhood with a high median income (concordance) or an affluent individual may live in a neighborhood with a low median income (discordance). Methods: We propose a method to operationalize the concepts of concordance and discordance between individual-level and neighborhood-level social determinants and provide two examples. We first consider a factor that is measured with a continuous variable–household income. We then consider race/ethnicity—a categorical variable. To illustrate the proposed method, we apply our operational definitions to a small dataset that contains self-reported individual data paired with geocoded publicly available neighborhood-level data based on residential address. Results: In our cohort, 38% of participants lived in neighborhoods that were racial/ethnically concordant; 23% of participants in neighborhood that were racial/ethnically discordant, and 39% of participants in neighborhoods that were Neutral. Conclusion: We propose an approach to defining the concepts of concordance and discordance of individual characteristics with neighborhood-level social determinants. Our proposed approach will enable more robust investigations of social determinants of health and their impact on health. Such investigations are needed to inform the growing use of social determinants of health data from various sources for a variety of purposes.