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. [ABSTRACT FROM AUTHOR]