Measuring health-related social deprivation in small areas: development of an index and examination of its association with cancer mortality

Kailu Wang,Jiaying Zhao,Roger Yat-Nork Chung,Benjamin Hon-Kei Yip,Alvin Yik-Kiu Hui,Eng Kiong Yeoh,Chi-Kin Law

doi:10.1186/s12939-021-01545-9

Kailu Wang, Jiaying Zhao + Show 5 more

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https://doi.org/10.1186/s12939-021-01545-9

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Abstract

BackgroundThe small-area deprivation indices are varied across countries due to different social context and data availability. Due to lack of chronic disease-related social deprivation index (SDI) in Hong Kong, China, this study aimed to develop a new SDI and examine its association with cancer mortality.MethodsA total of 14 socio-economic variables of 154 large Tertiary Planning Unit groups (LTPUGs) in Hong Kong were obtained from 2016 population by-census. LTPUG-specific all-cause and chronic condition-related mortality and chronic condition inpatient episodes were calculated as health outcomes. Association of socio-economic variables with health outcomes was estimated for variable selection. Candidates for SDI were constructed with selected socio-economic variables and tested for criterion validity using health outcomes. Ecological association between the selected SDI and cancer mortality were examined using zero-inflated negative binomial regression.ResultsA chronic disease-related SDI constructed by six area-level socio-economic variables was selected based on its criterion validity with health outcomes in Hong Kong. It was found that social deprivation was associated with higher cancer mortality during 2011–2016 (most deprived areas: incidence relative risk [IRR] = 1.40, 95% confidence interval [CI]: 1.27–1.55; second most deprived areas: IRR = 1.34, 95%CI: 1.21–1.48; least deprived areas as reference), and the cancer mortality gap became larger in more recent years. Excess cancer death related to social deprivation was found to have increased through 2011–2016.ConclusionsOur newly developed SDI is a valid and routinely available measurement of social deprivation in small areas and is useful in resource allocation and policy-making for public health purpose in communities. There is a potential large improvement in cancer mortality by offering relevant policies and interventions to reduce health-related deprivation. Further studies can be done to design strategies to reduce the expanding health inequalities between more and less deprived areas.

Highlights

Social deprivation is a concept referring to disadvantages of an individual or a group of individuals in accessing material and social resources and fragility of social networks from family to community [1, 2].Wang et al Int J Equity Health (2021) 20:216Plenty of aspects need to be involved to comprehensively define social deprivation and selection of indicators to construct an index for measuring social deprivation should consider a number of demographic, social, and economic domains
Oneperson and two-person household size was associated with worse health outcomes, but 6 + persons household was associated with better outcomes, which supports the findings in a previous study [49] and suggested that health-related deprivation could be reduced as household size and level of connection to the community increased
It was found that social deprivation was associated with higher cancer mortality in small areas, and the association became stronger in 2016 for those in the second most deprived areas, which suggested deprivation’s impact to cancer mortality was substantial and continuously expanding

Summary

Introduction

Plenty of aspects need to be involved to comprehensively define social deprivation and selection of indicators to construct an index for measuring social deprivation should consider a number of demographic, social, and economic domains. Studies have found socio-economic domains that are related to social deprivation, including income, education, home ownership, employment status, and social class in terms of occupation [2,3,4]. Several indices developed in 1980s, including the Underprivileged Area (UPA) score [4], the Carstair score [3], the Townsend score [2], and numerous indices in more recent years in Europe [8, 9], North America [10, 11] and New Zealand [12], provided a wide range of selection for variables for constructing social deprivation index. The small-area deprivation indices are varied across countries due to different social context and data availability. Due to lack of chronic disease-related social deprivation index (SDI) in Hong Kong, China, this study aimed to develop a new SDI and examine its association with cancer mortality

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