BACKGROUND: Measuring household economic status is crucial, as it is a key determinant of health. In low-income settings, no single measure of economic status is universally accepted. This study aims to assess the agreement between a single-item tool for measuring socioeconomic status (SES) and the wealth index.

METHODS: The Addis Health and Demographic Surveillance System (Addis-HDSS), based in Addis Ababa, Ethiopia, collects data on various socioeconomic indicators, including income, expenditure, and asset ownership. In this study, a single question, "Does your family's income cover basic needs?" was used as a proxy for SES. The percent agreement with the wealth index was calculated, and significance was assessed using the Pearson chi-square test. Scale reliability was evaluated using Cronbach’s alpha (α).

RESULTS: Data from 30,533 households showed strong agreement (α = 0.925) between self-reported income adequacy and wealth for both lower and higher wealth groups. The highest agreement was found between the lowest wealth index and "very low" income adequacy (93.84%) and between the highest wealth index and "high" income adequacy (89.47%) (p < 0.001).

CONCLUSION: The single-item SES measure showed good agreement with the wealth index in an urban setting. This simple tool can effectively identify vulnerable populations for targeted health interventions. Further research is needed to assess its applicability in other contexts.

KEYWORDS: Wealth index, socioeconomic status, urban, household income adequacy, Addis Ababa