Mikiko Terashima1, Daniel G C Rainham, Adrian R Levy. 1. Health Geomatics Laboratory Environmental Science Programme Department of Community Health & Epidemiology Dalhousie University. mikiko.terashima@dal.ca.
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.
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.
Entities:
Keywords:
Deprivation indices; geographic context; population health surveillance; small-area variation analysis
Authors: Katherine L Frohlich; James R Dunn; Lindsay McLaren; Alan Shiell; Louise Potvin; Penelope Hawe; Clément Dassa; Wilfreda E Thurston Journal: Health Place Date: 2006-03-03 Impact factor: 4.078