Abstract

Objectives

We aimed to evaluate differential item functioning (DIF) of Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (GH) items by neighborhood socioeconomic deprivation. In addition, we also sought to examine DIF by age, sex, race, marital status, insurance, and comorbidities.

Methods

This retrospective study included patients who had a primary care appointment within Cleveland Clinic health system, lived within the county, and completed PROMIS-GH in 2022. DIF analyses were conducted within the logistic regression framework across groups based on area deprivation index (ADI), age, sex, race, marital status, insurance, and comorbidities. Latent trait was estimated using the graded response model and DIF magnitude was evaluated using McFadden’s R square.

Results

A total of 263 150 adult patients had a primary care appointment in 2022, and 158 685 (60.3%) completed PROMIS-GH (mean age 51.9 ± 17.6 years, 60.7% female, 73.5% White race).

Conclusions

No DIF of PROMIS-GH items were detected, supporting the comparison of PROMIS-GH across levels of socioeconomic deprivation, age, sex, race, marital status, insurance, and comorbidities. Patients living in more disadvantaged neighborhoods have significantly worse health-related quality of life compared with those who live in less disadvantaged neighborhoods. Future research should investigate the factors contributing to health inequities by ADI.