The utility of geodemographic indicators in small area estimates of limiting long-term illness

Graham Moon,Liz Twigg,Kelvyn Jones,Grant Aitken,Joanna Taylor

doi:10.1016/j.socscimed.2018.06.029

Abstract

Small area health data are not always available on a consistent and robust routine basis across nations, necessitating the employment of small area estimation methods to generate local-scale data or the use of proxy measures. Geodemographic indicators are widely marketed as a potential proxy for many health indicators. This paper tests the extent to which the inclusion of geodemographic indicators in small area estimation methodology can enhance small area estimates of limiting long-term illness (LLTI). The paper contributes to international debates on small area estimation methodologies in health research and the relevance of geodemographic indicators to the identification of health care needs. We employ a multilevel methodology to estimate small area LLTI prevalence in England, Scotland and Wales. The estimates were created with a standard geographically-based model and with a cross-classified model of individuals nested separately in both spatial groupings and non-spatial geodemographic clusters. LLTI prevalence was estimated as a function of age, sex and deprivation. Estimates from the cross-classified model additionally incorporated residuals relating to the geodemographic classification. Both sets of estimates were compared against direct estimates from the 2011 Census. Geodemographic clusters remain relevant to understanding LLTI even after controlling for age, sex and deprivation. Incorporating a geodemographic indicator significantly improves concordance between the small area estimates and the Census. Small area estimates are however consistently below the equivalent Census measures, with the LLTI prevalence in urban areas characterised as ‘blue collar’ and ‘struggling families’ being markedly lower. We conclude that the inclusion of a geodemographic indicator in small area estimation can improve estimate quality and enhance understanding of health inequalities. We recommend the inclusion of geodemographic indicators in public releases of survey data to facilitate better small area estimation but caution against assumptions that geodemographic indicators can, on their own, provide a proxy measure of health status.

Highlights

Small area data on the prevalence of poor health are needed to plan health services and assess the quality of care
This paper has used a novel extension to multilevel small area estimation methodology incorporating a geodemographic indicator as a cross-classification alongside the more familiar spatial hierarchy of people nested within geographical settings
The addition of a geodemographic indicator enhances the quality of small area estimates

Summary

Introduction

Small area data on the prevalence of poor health are needed to plan health services and assess the quality of care Such data are not always available on a consistent and robust routine basis across nations, necessitating the employment of small area estimation methods to generate local-scale data, or the use of proxy measures. The NZDep index and a more recent health-focused measure have emerged in New Zealand (Atkinson et al, 2014; Exeter et al, 2017; Salmond et al, 2006), and similar national and local indices are evident in Canada (Bell et al, 2007; Pampalon et al, 2010, 2012) and many other countries

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Results

Conclusion