Abstract
Material deprivation contributes to inequalities in health; areas of high deprivation have higher rates of ill-health. How deprivation is measured has a great impact on its explanatory power with respect to health. We compare previous deprivation measures used in Scotland and proposes a new deprivation measure using the 2001 and 2011 Scottish census data. We calculate the relative index of inequality (RII) for self-reported health and mortality. While across all age groups different deprivation measures provide similar results, the assessment of health inequalities among those aged 20–29 differs markedly according to the deprivation measure. In 2011 the RII for long-term health problem for men aged 20–24 was only 0.71 (95% CI 0.60–0.83) using the Carstairs score, but 1.10 (0.99–1.21) for the new score and 1.13 (1.03–1.24) for the income domain of Scottish Index of Multiple Deprivation (SIMD). The RII for mortality in that age group was 1.25 (0.89–1.58) for the Carstairs score, 1.69 (1.35–2.02) for the new measure and 1.76 (1.43–2.08) for SIMD. The results suggest that researchers and policy makers should consider the suitability of deprivation measures for different social groups.
Highlights
Area-level measures of material deprivation are important for understanding and describing health inequalities (Adhikari, 2006; Barnett et al, 2001; Krieger et al, 2003) and are sometimes used by governments in an attempt to focus funding on the most disadvantaged communities (Welsh Government, 2011)
The differences are greatest for ages 20–24, while the relative index of inequality (RII) using the Carstairs score is 0.71, it is 1.10 for the new measure and 1.13 for the Scottish Index of Multiple Deprivation (SIMD) income domain
Major differences between the three measures emerge when we analyse the effect of deprivation on health and mortality by age groups
Summary
Area-level measures of material deprivation are important for understanding and describing health inequalities (Adhikari, 2006; Barnett et al, 2001; Krieger et al, 2003) and are sometimes used by governments in an attempt to focus funding on the most disadvantaged communities (Welsh Government, 2011). The availability of the Carstairs score for such a long time-span is a great strength, but has made it vulnerable to social change This has caused some debate about whether the index is still able to measure deprivation as well as it did in the past (Tunstall et al, 2011; Reid, 2009; Hanlon et al, 2005). While census questions change, they remain relatively constant over time and across different areas both within the UK and internationally, such that a reasonable comparison across decades or countries is possible For this reason larger comparative studies prefer census based measures of deprivation (Exeter et al, 2011; Norman et al, 2011; Marí-Dell'Olmo et al, 2015). We compare the association of the new measure, the Carstairs score and the SIMD income domain to self-reported measures of health and mortality
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