Abstract
Background/Objectives: Versions of deprivation indices have been increasingly used to monitor patterns and magnitudes of inequality in health. For policy-makers, it is of interest to assess whether they need to construct regionally tailored indices, or whether the existing indices perform sufficiently in detecting inequalities in their respective jurisdiction. Few studies have explored the benefits of constructing a more tailored index for a regional context.
METHODS: The study examined, in linear regression models, the proportion of variance (adjusted R2) explained in age-standardized cardiovascular disease (CVD) incidence rate ratios by an index emulating a now-widely-used multiple deprivation index created in Quebec (INSPQI), and a newly created index for Nova Scotia with additional census variables. The magnitudes of inequality were compared by the differences between mean incidences of most and least deprived groups.
RESULTS: The newly created deprivation index did not explain as well as the INSPQI-like index the community-level variability in CVD incidences. The gap in mean CVD incidences between the most and least deprived groups was somewhat narrower with the new index, indicating that the new index is not necessarily more sensitive to the inequality attributed to community social disadvantages.
CONCLUSIONS: Complicating the indices may not necessarily be of benefit when used for surveillance of population health inequalities. For public health practitioners and decision makers who need to make quick decisions in provisions of services and programs, a generic, well-established deprivation index such as INSPQI can serve well in a regional context.
Key Words: Deprivation indices, population health surveillance, small-area variation analysis, geographic context
Résumé
CONTEXTE/OBJECTIFS: On utilise de plus en plus des versions des indices de défavorisation pour surveiller les grandes tendances dans les inégalités de santé et l’ampleur de ces inégalités. Pour les responsables des politiques, il est intéressant de pouvoir évaluer s’ils ont besoin de construire des indices régionaux ou si les indices existants réussissent suffisamment bien à détecter les inégalités sur leur territoire respectif. Peu d’études se sont attachées aux avantages de construire un indice mieux adapté à un contexte régional.
MÉTHODE: Nous avons examiné, dans les modèles de régression linéaire, la part de la variance expliquée par ces modèles (critère R2 ajusté) dans les rapports de taux d’incidence des maladies cardiovasculaires (MCV) standardisés pour l’âge avec un indice émulant un indice de défavorisation multiple créé au Québec (l’INSPQI), aujourd’hui très utilisé, et un indice nouvellement créé pour la NouvelleÉcosse avec des variables supplémentaires du Recensement. L’ampleur des inégalités a été comparée selon les différences entre les incidences moyennes dans les groupes les plus et les moins défavorisés.
RÉSULTATS: L’indice de défavorisation nouvellement créé n’a pas expliqué aussi bien que l’indice semblable à l’INSPQI la variabilité au niveau communautaire dans les incidences de MCV. L’écart dans les incidences moyennes de MCV entre les groupes les plus et les moins défavorisés était un peu plus faible avec le nouvel indice, ce qui montre que celui-ci n’est pas nécessairement plus sensible aux inégalités imputées à la défavorisation sociale des communautés.
CONCLUSIONS: Compliquer les indices n’est pas nécessairement un avantage quand ces indices servent à la surveillance des inégalités de santé des populations. Pour les praticiens et les décideurs de la santé publique qui doivent prendre des décisions rapides sur l’organisation des services et des programmes, un indice de défavorisation général bien établi, comme l’INSPQI, peut très bien faire l’affaire dans un contexte régional.
Mots Clés: indices de défavorisation, surveillance de population, analyse des variations régionales, contexte géographique
Footnotes
Acknowledgement: We thank the Primary Health Care and Business Information Analysis and Privacy sections of the Nova Scotia Department of Health and Wellness for their insights and for providing the health data.
Conflict of Interest: None to declare.
References
- 1.Matheson FI, White HL, Moineddin R, Dunn JR, Glazier RH. Neighbourhood chronic stress and gender inequalities in hypertension among Canadian adults: A multilevel analysis. J Epidemiol Community Health. 2010;64(8):705–13. doi: 10.1136/jech.2008.083303. [DOI] [PubMed] [Google Scholar]
- 2.Morris R, Carstairs V. Which deprivation? A comparison of selected deprivation indexes. J Public Health Med. 1991;13(4):318–26. [PubMed] [Google Scholar]
- 3.Diez Roux AV, Stein Merkin S, Arnett D, Chambless L, Massing M, Nieto J, et al. Neighbourhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345(2):99–106. doi: 10.1056/NEJM200107123450205. [DOI] [PubMed] [Google Scholar]
- 4.Zieler S, Krieger N, Tang Y, Coady W, Siegfried E, DeMaria A, et al. Economic deprivation and AIDS incidence in Massachusetts. Am J Public Health. 2000;90(7):1064–73. doi: 10.2105/AJPH.90.7.1064. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Crooks CJ, West J, Card TR. Upper gastrointestinal haemorrhage and deprivation: A nationwide cohort study of health inequality in hospital admissions. Gut. 2012;61(4):514–20. doi: 10.1136/gutjnl-2011-300186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Cox M, Boyle PJ, Davey P, Feng Z, Morris AD. Locality deprivation and Type 2 diabetes incidence: A local test of relative inequalities. Soc Sci Med. 2007;65(9):1953–64. doi: 10.1016/j.socscimed.2007.05.043. [DOI] [PubMed] [Google Scholar]
- 7.Dupont MA, Pampalon R, Hamel D. Deprivation and cancer mortality among Quebec women and men, 1994–1998. Québec, QC: Institut national de santé publique du Québec; 2004. [Google Scholar]
- 8.Bentham G, Eimermann J, Haynes R, Lovett A, Brainhard J. J Epidemiol Community Health. 1995. Limiting long term illness and its associations with mortality and indicators of social deprivation. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Lang IA, Llewellyn DJ, Langa KM, Wallace RB, Melzer D. Neighbourhood deprivation and incident mobility disability in older adults. Age Ageing. 2008;37(4):403–10. doi: 10.1093/ageing/afn092. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Townsend P. J Soc Policy. 1987. Deprivation; p. 125. [Google Scholar]
- 11.Pampalon R, Raymond G. A deprivation index for health and welfare planning in Quebec. Chronic Dis Can. 2000;21(3):104–13. [PubMed] [Google Scholar]
- 12.Pampalon R, Hamel D, Gamache P. Recent changes in the geography of social disparities in premature mortality in Québec. Soc Sci Med. 2008;67(8):1269–81. doi: 10.1016/j.socscimed.2008.06.010. [DOI] [PubMed] [Google Scholar]
- 13.Pampalon R, Hamel D, Gamache P. Health inequalities in urban and rural Canada: Comparing inequalities in survival according to an individual and area-based deprivation index. Health Place. 2009;16(2):416–20. doi: 10.1016/j.healthplace.2009.11.012. [DOI] [PubMed] [Google Scholar]
- 14.Pampalon R, Hamel D, Gamache P. Health Rep. 2009. A comparison of individual and areabased socio-economic data for monitoring social inequalities in health. [PubMed] [Google Scholar]
- 15.Pampalon R, Martinez J, Hamel D. Does living in rural areas make a difference for health in Québec? Health Place. 2006;12(4):421–35. doi: 10.1016/j.healthplace.2005.04.002. [DOI] [PubMed] [Google Scholar]
- 16.Philibert MD, Pampalon R, Hamel D, Thouez J-P, Loisell CG. Material and social deprivation and health and social services utilisation in Québec: A localscale evaluation system. Soc Sci Med. 2007;64(8):1651–64. doi: 10.1016/j.socscimed.2006.12.010. [DOI] [PubMed] [Google Scholar]
- 17.Bell N, Schuurman N, Oliver L, Hayes MV. Towards the construction of placespecific measures of deprivation: A case study from the Vancouver Metropolitan area. Canadian Geographer. 2007;51:444–61. doi: 10.1111/j.1541-0064.2007.00191.x. [DOI] [Google Scholar]
- 18.Frohlich N, Carriere K. Issues in Developing Indicators for Needs-Based Funding. Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation; 1997. [Google Scholar]
- 19.Matheson FI, Dunn JR, Smith KLW, Moineddin R, Glazier RH. Ontario Marginalization Index User Guide Version 1.0. Centre for Research on Inner City Health. 2011. [Google Scholar]
- 20.Matheson FI, Dunn JR, Smith KLW, Moineddin R, Glazier RH. Canadian Marginalization Index User Guide Version 1.0. 2012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Quick Stats [database on the Internet]. Available at: http://secure/cihi.ca.chiweb.dispPage.jsp?cw_page=statistics_topic_e (Accessed November 20, 2012).
- 22.Public Health Agency of Canada. Disease Surveillance On-Line. 2012. [Google Scholar]
- 23.Terashima M. Geographical Epidemiology of Health and Deprivation: A Population-Based, Spatio-Temporal Analysis of Health and Social Inequality in Nova Scotia, Canada. Halifax, NS: Dalhousie University; 2011. [Google Scholar]
- 24.Health Rep. 2009.
- 25.Pampalon R, Hamel D, Gamache P, Raymond G. A deprivation index for health planning in Canada. Chronic Dis Can. 2009;29(4):178–91. [PubMed] [Google Scholar]
- 26.Primary Health Care. Nova Scotia Department of Health. 2009. Developing social and health status indicators to help decision makers: Final project report. [Google Scholar]
- 27.Langille D, Rainham D, Kisely S. Is Francophone language status associated with differences in the health services use of rural Nova Scotians? Can J Public Health. 2012;103(1):65–68. doi: 10.1007/BF03404071. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Veugelers P, Kim A, Guernsey J. Inequalities in health. Analytic approaches based on life expectancy and suitable for small area comparisons. J Epidemiol Community Health. 2000;54(5):375–80. doi: 10.1136/jech.54.5.375. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.SAS, Inc. SAS/STAT 9.22 User’s Guide. Cary, NC: SAS Institute; 2010. [Google Scholar]
- 30.Frohlich K, Dunn JR, McLaren L, Shiell A, Potvin L, Hawe P, et al. Understanding place and health: A heuristic for using administrative data. Health Place. 2006;13(2):299–309. doi: 10.1016/j.healthplace.2006.01.007. [DOI] [PubMed] [Google Scholar]
- 31.Kisley S, Terashima M, Langille D. A population-based analysis of the health experience of African Nova Scotians. CMAJ. 2008;179(7):653–58. doi: 10.1503/cmaj.071279. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Ross NA, Tremblay S, Graham K. Neighbourhood influences on health in Montreal, Canada. Soc Sci Med. 2004;59:1485–94. doi: 10.1016/j.socscimed.2004.01.016. [DOI] [PubMed] [Google Scholar]