Frequently Asked Questions
How much will my project cost?
Costs vary from project to project, depending on sample size and requested services. Contact the research team for details.
Will all my study individuals have a HOUSES Index?
The HOUSES Index is available for nearly all residential addresses in the United States. The HOUSES Index will not be available for P.O. Box addresses or nonresidential addresses, such as hospitals or schools.
What methodology is used to calculate the HOUSES Index?
Each property item corresponding to an individual's address was standardized into a z-score within each county. The data is then aggregated into an overall z-score, which is converted to quartile, decile and percentile. A higher HOUSES score indicates a higher socioeconomic status (SES).
What does the HOUSES Cloud provide?
The HOUSES Cloud is a customer-centric service providing users with the HOUSES Index and other SES tools for exploring health disparities. Additionally, the HOUSES Cloud is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPPA).
Should subject identifiers be uploaded to the cloud?
No. The HOUSES Cloud only requires full address information and index year. The system does not save address information. Also, only verified end users can see the address information.
How easily accessible and usable is the HOUSES dataset?
The HOUSES Index is up and running through a HIPAA-compliant cloud platform. Nationwide assessment property data, which is updated annually for tax purposes, and HOUSES algorithms are currently stored in Amazon Web Services. Users inside and outside of Mayo Clinic obtain HOUSES Index data via a publicly accessible password-protected HOUSES Cloud dashboard or API access model.
How does the HOUSES Index compare to the Area Deprivation Index (ADI)?
The main difference between the ADI and the HOUSES Index is that the HOUSES Index is an individual-level measure or composite z-score for individual housing value, housing size, and the number of bedrooms and bathrooms. Whereas the ADI assigns a single score for all subjects living in the same census block group. Since the HOUSES Index is normalized within a county, it measures a ranking for relative social-determinants-of-health (SDH) within a county.
What other services in addition to the HOUSES Index does the program provide?
Apart from the HOUSES Index, the HOUSES Program currently provides the following services to users:
- Area Deprivation Index (ADI).
- Rural classification.
- Distance to a reference point such as a hospital or clinic — a tool for assessing physical access to healthcare that is important for time-sensitive health outcomes, such as heart attack or stroke, especially in rural areas.
- Geospatial report.
How does the HOUSES Index reflect the housing value differences that exist between rural and urban areas?
The HOUSES Index is normalized within a county. The index uses the property information for all residential parcels and measures a relative SES ranking within a county. This standardization, which may not be available for income or educational attainment, makes SES comparisons easier and fairer among populations residing in different regions, such as urban versus rural.
Housing value differs across the counties or regions. Our program's experience has been that when housing values vary between urban and rural areas within a given county, the resultant HOUSES Index reflects different SES. For example, unlike other regions, in the community of Olmsted County, a mixed urban-rural setting in southeastern Minnesota, one study found that people living in rural areas have overall higher SES, as defined by HOUSES, than SES in urban areas. Therefore, the people had better health outcomes, such as a lower prevalence of obesity and mood disorder, as well as better preventive healthcare utilization compared with urban residents.
For example, the community of Olmsted County is a mixed urban-rural setting in southeastern Minnesota, unlike other regions. One study found that people living in rural areas have overall higher SES, as defined by the HOUSES Index, than SES in urban areas. Also, the study findings point to SDH as the potential root cause of rural health disparities.
How feasible is it to map a HOUSES Index output to individual patients such as a Medicare beneficiary?
The HOUSES Index is based on individual residential addresses by matching to publicly available real property assessment data for each housing unit in the United States. HOUSES may not be calculated for a very small portion of participants, such as those with P.O. Box or invalid addresses. In general, about 95% or greater of previous study cohorts or practice patients had HOUSES Index matched with their addresses including rental properties, such as apartments.
Similarly, the ADI is often missing for some census block groups due to either low population or a high group quarters population. For example, in our program's ongoing risk adjustment model study using the Mayo panel cohort (n=120,622), the ADI was missing in 7,008 (5.8%) participants, whereas the HOUSES data was missing in 6,507 (5.4%) of the study cohort. In another study, 15% of the study cohort missed ADI data.
With valid addresses available in electronic health records (EHRs), there should not be any major challenges mapping HOUSES Index to Medicare beneficiaries.
How does the HOUSES Index account for cost-of-living disparities between different areas of the country?
There is comparatively little variation by region relative to costs of food, energy transportation and services. However, variation in housing costs have been reported to be a major driver for differential cost of living across regions. Therefore, our program conceptualizes that each county's cost of living is reflected in its housing market.
The HOUSES Index reflects regional housing markets and provides a within-market comparison enabling a between-market comparison. Given that the county is also the general geographic unit for property taxation, we chose county as the geographic unit of standardization. As housing prices are significant sources of cost-of-living differences across counties, normalizing HOUSES at a county level is likely to address the concern about differential cost of living across different regions.