The Area Deprivation Index (ADI) is based on a measure created by the Health Resources & Services Administration (HRSA) over two decades ago for primarily county-level use, but refined, adapted, and validated to the Census block group/neighborhood level by Amy Kind, MD, PhD and her research team at the University of Wisconsin-Madison. It allows for rankings of neighborhoods by socioeconomic status disadvantage in a region of interest (e.g. at the state or national level). It includes factors for the theoretical domains of income, education, employment, and housing quality. It can be used to inform health delivery and policy, especially for the most disadvantaged neighborhood groups.
The ADI is limited insofar as it uses 2013 American Community Survey Five Year Estimates in its construction. All limitations of the source data will persist throughout the ADI. The choice of geographic units will also influence the ADI value. In the case of the 2013 ADI the Census block group is the geographic unit of construction and all results are subject to the accuracy and errors contained within the 2013 American Community Survey data release.
This site offers several different ways to use the Area Deprivation Index (ADI).
For additional information about the ADI, please read our FAQ.
This project was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number R01MD010243 (PI: Kind), the National Institute on Aging of the National Institutes of Health under Award Number RF1AG057784 (PI: Kind), and the University of Wisconsin School of Medicine and Public Health Department of Medicine. The content of this website is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or of the University of Wisconsin.
University of Wisconsin School of Medicine and Public Health. Area Deprivation Index. 5/1/2018. Available at: https://www.neighborhoodatlas.medicine.wisc.edu/
To download a PDF of the mapped ADI rankings in both national percentiles and state deciles, please choose your region below, then click "Download PDF". If you would like to explore the ADI through an interactive map, please see the Mapping function.
What do the ADI values mean? The ADIs on this website are provided in national percentile rankings at the block group level from 1 to 100. The percentile are constructed by ranking the ADI from low to high for the nation and grouping the block groups/neighborhoods into bins corresponding to each 1% range of the ADI. Group 1 is the lowest ADI and group 100 is the highest ADI. A block group with a ranking of 1 indicates the lowest level of "disadvantage" within the nation and an ADI with a ranking of 100 indicates the highest level of "disadvantage".
Similarly, ADIs are also available in deciles from 1 to 10 for each individual state. The state deciles are constructed by ranking the ADI from low to high for each state alone without consideration of national ADIs. Again, group 1 is the lowest ADI (least disadvantaged) and 10 is the highest ADI (most disadvantaged).
What methodology was used to create these ADI datasets? The following two articles explain the methodology that was used to create these ADI datasets:
The current version of the ADI available on this website was created using 2009-2013 American Community Survey data.
How can I use the ADI? The ADI can be used for several different purposes. Health systems and health care providers can use the ADI to target program delivery by geographic location based on the area of greatest disadvantage. For example, the Centers for Medicare and Medicaid (CMS) is currently using the ADI to target program delivery of the Everyone with Diabetes Counts program.
The ADI can also be used for research purposes. For example, using the ADI based on 2000 Census data, Kind et al (2014) found that the risk of living in a disadvantaged neighborhood is similar to that of having a chronic lung disease, like emphysema, and worse than that of health conditions such as diabetes when it comes to readmission risk.
What is the difference between a percentile and a decile? A percentile splits the ADI scores into 100 equal sections, categorizing the individual block group/neighborhood, with those in the first percentile being the least disadvantaged, and those in the hundredth being the most. A decile groups the ADI scores into 10 equal sections.
Percentiles are created using the ADI scores for the entire nation, and deciles are created for each state individually.
What is the difference between a raw score and a ranking? A raw score is the actual score a neighborhood receives based on the theoretical domains that the ADI measures, while the rankings sort the scores by disadvantage at either the state or national level, allowing for easier comparison between neighborhoods.
Rankings, not raw scores, are used for purposes of analysis due to statistical considerations of the ADI.
Why are some ZIP codes missing ADI ranks? When ADI values are not represented in the nine digit ZIP code file, it is due to one of three conditions. First, a P indicates that the ZIP code is a post office box and not geographically representative nor included within ACS metrics. Second, a U indicates a unique ZIP code, often these are assigned to businesses or large footprint entities who have large volume of mail delivery and would also be omitted from the ACS. Lastly, a blank ADI value indicates that the conversion of the block group ADI score to ZIP+4 did not produce a match. These are most common in coastal areas where a generalized ZIP+4 may be outside of a block group or offshore.
Do you have a 5-digit ZIP code dataset available, or a ZCTA-level dataset? No. In recent validation work that uses 2009-2013 American Community Survey data, it has become clear that the ADI should not be used at any levels other than those core geographic units defined by the Census (see diagram of Census levels). Those with interest in using a ZIP-based methodology may still employ the 9-digit ZIP code crosswalk, which was built to correspond directly to Census block groups and accompanies the Census block group level ADI.
"Employment of ZIP Code Tabulation Areas to link geographic data is a convenient but, ultimately, inferior method for this sort of assessment (Grubesic and Matisziw, 2006). It results in relatively large geographic zones with linkages that can lead to less precise estimates, especially in areas in which concentrated poverty abuts more wealthy regions." - Excerpt drawn directly from Kind et al., Health Affairs, Sept 15, 2016. Reference:
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