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Use of Nonresponse Adjustment Factors for the Social Determinants and Health Equity Module in the Behavioral Risk
1Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
AJPM Focus
|July 21, 2025
Summary
Nonresponse bias in social determinants and health equity data was addressed using a novel adjustment factor. This factor is crucial for accurate analysis of health-related social needs in public health research.
Area of Science:
- Public Health
- Health Equity Research
- Survey Methodology
Background:
- The 2022 Behavioral Risk Factor Surveillance System (BRFSS) included a new module on social determinants and health equity.
- This module aims to capture data on health-related social needs, crucial for understanding health disparities.
- Significant nonresponse was observed in this optional module, potentially biasing results.
Purpose of the Study:
- To address nonresponse bias in the 2022 BRFSS social determinants and health equity module.
- To develop a nonresponse adjustment factor for analyzing data on social determinants of health.
Main Methods:
- Utilized data from 2022 BRFSS participants across 39 states, DC, and 2 territories.
- Employed sequential multiple imputation for household income and multivariable logistic regression to estimate nonresponse propensity.
- Developed state-specific nonresponse adjustment factors based on propensity scores.
Main Results:
- Florida, California, and New Jersey exhibited the highest nonresponse rates (29.3%, 26.4%, 25.6%).
- Excluding Puerto Rico, median nonresponse adjustment factors varied from 1.09 (Idaho) to 1.67 (Florida).
Conclusions:
- The developed nonresponse adjustment factor is essential for mitigating bias in social determinants and health equity data analysis.
- This adjustment factor will enhance the accuracy and reliability of research on social determinants of health across various settings.
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