Abstract
BackgroundSpatial health inequalities have often been analysed in terms of deprivation. The aim of this study was to create an ecological deprivation index and evaluate its association with mortality over the entire mainland France territory. More specifically, the variations with the degree of urbanicity, spatial scale, age, gender and cause of death, which influence the association between mortality and deprivation, have been described.MethodsThe deprivation index, 'FDep99', was developed at the 'commune'(smallest administrative unit in France) level as the first component of a principal component analysis of four socioeconomic variables.Proxies of the Carstairs and Townsend indices were calculated for comparison.The spatial association between FDep99 and mortality was studied using five different spatial scales, and by degree of urbanicity (five urban unit categories), age, gender and cause of death, over the period 1997–2001.'Avoidable' causes of death were also considered for subjects aged less than 65 years. They were defined as causes related to risk behaviour and primary prevention (alcohol, smoking, accidents).ResultsThe association between the FDep99 index and mortality was positive and quasi-log-linear, for all geographic scales. The standardized mortality ratio (SMR) was 24% higher for the communes of the most deprived quintile than for those of the least deprived quintile. The between-urban unit category and between-région heterogeneities of the log-linear associations were not statistically significant. The association was positive for all the categories studied and was significantly greater for subjects aged less than 65 years, for men, and for 'avoidable' mortality.The amplitude and regularity of the associations between mortality and the Townsend and Carstairs indices were lower.ConclusionThe deprivation index proposed reflects a major part of spatial socioeconomic heterogeneity, in a homogeneous manner over the whole country. The index may be routinely used by healthcare authorities to observe, analyse, and manage spatial health inequalities.
Highlights
Spatial health inequalities have often been analysed in terms of deprivation
The standardized mortality ratio (SMR) was 24% higher for the communes of the most deprived quintile than for those of the least deprived quintile
The aim of the present study is to propose a deprivation index, based on the census and the tax authority's household income data, which may be used in both rural and urban contexts, and to evaluate the ecological association between that index and mortality
Summary
Spatial health inequalities have often been analysed in terms of deprivation. The aim of this study was to create an ecological deprivation index and evaluate its association with mortality over the entire mainland France territory. Deprivation indices are commonly used to describe spatial health heterogeneity. The weights allocated to each dimension aim to reflect optimally the variability of the socioeconomic dimensions considered within the population studied. This choice implicitly supposes that the probably high correlation between the various components prevents determining which components are the most relevant and their weightings
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