Area-based Deprivation Measures Research Articles

Inequality in green space distribution and its association with preventable deaths across urban neighbourhoods in the UK, stratified by Index of Multiple Deprivation

BackgroundThis study investigated inequalities in the distribution of green space (GS) and the association between inequalities in amounts of GS and preventable deaths across urban neighbourhoods with different Index of...

The Neighborhood Atlas Area Deprivation Index And Recommendations For Area-Based Deprivation Measures.

Edward Hannan and colleagues found that a lack of standardization of input variables to the Area Deprivation Index (ADI) available from the Neighborhood Atlas overweights the index for median home value and thus potentially further disadvantages already disadvantaged communities. We recommend that a revised ADI be created that addresses the error, and we offer five steps to avoid future errors in the creation of area deprivation measures.

Disparities in the age at osteoarthritis diagnosis: an indicator for equity-focused prevention.

Dear Editor, Primary prevention of OA aims to extend OA-free life expectancy for joints. Calls for more coherent and concerted preventive action highlight a number of challenges: they include appropriate methods and metrics to monitor and evaluate action [1, 2]. We propose a visual population health metric, obtainable from routinely available data, that may be useful for equity-focused monitoring of OA prevention in populations. It draws on classic work by van Saase and colleagues [3] who noted a strong tendency towards ‘parallelism’ (populations differ in their level of OA but not in their age-related slopes), by Brenner et al. [4] on prevention as rate postponement and a recent comprehensive analysis of the age at disease onset using national primary care electronic healthcare record (EHR) data [5]. We used data from the Clinical Practice Research Datalink Aurum database linked to the Index of Multiple Deprivation (IMD) 2015, an area-based measure of deprivation based on patient residential postcode. Using previously established methods of a standard code list of OA diagnostic codes, a 3-year look-back period to exclude prevalent consulters and exact person-time for denominator, we identified cases of incident (first) recorded diagnosis of OA in 2019 in England, in adults aged 45 years and over, stratified by IMD deciles (national ranking) [6]. We used kernal density plots to display the age distribution of incident OA cases in the least and the most deprived deciles weighted to the mid-2019 English population.

Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013-2018.

We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 - 22.8) for males and 25.1 years (95% CI: 24.4 - 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 - 19.9) vs. 26.3 years (95% CI: 24.5 - 28.1) among males, and 21.2 years (95% CI: 19.7 - 22.7) vs. 29.3 years (95% CI: 27.5 - 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 - 6.1) vs. 9.3 years (95% CI: 7.5 - 11.1) among males, and 5.3 years (95% CI: 3.7 - 6.9) vs. 10.3 years (95% CI: 8.3 - 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.

Are deprivation-specific cancer survival patterns similar according to individual-based and area-based measures? A cohort study of patients diagnosed with five malignancies in England and Wales, 2008–2016

ObjectiveTo investigate if measured inequalities in cancer survival differ when using individual-based (‘person’) compared with area-based (‘place’) measures of deprivation for three socioeconomic dimensions: income, deprivation and occupation.DesignCohort study.SettingData from...

Interaction of race and socioeconomic status as risk modulators of treatment delay and cancer-specific mortality in uterine cancer.

5595 Background: The majority of studies of uterine cancer combine high and low-grade histologies and do not sample a diverse cohort of patients. In many studies race is treated as biologic construct, when it may be better thought of as a proxy for socioeconomic inequity and deprivation. Socioeconomic (SE) deprivation may play a significant role in the disease trajectory of women with uterine cancer. Methods: Data were drawn from the Metropolitan Detroit Cancer Surveillance System which covers a tri-county area of approximately 4 million people. We included non-Hispanic Black (NHB) and White (NHW) women diagnosed with uterine cancer between 2010 and 2018. Poorly differentiated and undifferentiated endometrioid, serous, clear cell, mixed, carcinosarcoma and mucinous histologies were considered high grade. Patients diagnosed by death certificate, or with unknown stage or histology were excluded. Socioeconomic status was assessed using the Yost Score, an area-level composite measure of socioeconomic deprivation derived from census-tract data at cancer diagnosis. Lower Yost quintile indicates higher deprivation. Competing risk analysis was used to determine risk of uterine cancer specific mortality (reported as subdistribution hazard ratio [SHR]) and to assess statistical interaction between race and Yost score. Results: A total of 4,840 patients were identified. Race conferred significant increased risk of cancer-specific mortality (SHR 2.11, p < 0.0001). Race and Yost score interacted to increase risk of cancer-specific mortality in NHB women in the lowest Yost quintile (SHR 2.23, p < 0.0001) compared to NHW and NHB women in the highest quintiles. The interaction between race and Yost score persisted only among women with low grade cancers (SHR 1.7, p = 0.04). Time from diagnosis to surgery increased as Yost score decreased. Women in the lowest Yost quintile had lower likelihood of receiving surgery within 6 weeks of diagnosis (OR 0.74, p = 0.001). This effect persisted among women with low grade cancer (NHB OR 0.75, p = 0.014; lowest Yost quintile OR 0.68, p < 0.0001). An association between race, Yost score and delays in time to surgery was not seen among women with high grade cancers. Conclusions: Race and Yost score, an area-based measure of socioeconomic deprivation, are associated with increased cancer-specific mortality risk among women with low grade cancer. NHB race and high socioeconomic deprivation are associated with delayed primary surgery. The interaction between race and socioeconomic deprivation may underlie known disparities in uterine cancer survival, particularly in low grade disease where there is the greatest opportunity for timely curative surgery.

Socio-economic patterning of food and drink advertising at public transport stops in Edinburgh, UK.

Outdoor advertisements for food and drink products form a large part of the food environment and they disproportionately promote unhealthy products. However, less is known about the social patterning of such advertisements. The main aim of this study was to explore the socio-economic patterning of food and drink advertising at bus stops in Scotland's capital city, Edinburgh. Bus stop advertisements were audited to identify food/drink adverts and classify them by food/drink category (i.e. 'advert category'). This data were then linked to area-based deprivation and proximity measures. Neighbourhood deprivation was measured using the bus stop x/y co-ordinates, which were converted to postcodes to identify the matching 2012 deprivation level via the Scottish Index of Multiple Deprivation. Distance to schools and leisure centres were also collected using location data. Generalised estimating equations and linear regression analyses were used to assess associations between the promotion of advert categories and deprivation and proximity to schools/leisure centres, respectively. Edinburgh city, United Kingdom. 561 food/drink advertisements were identified across 349 bus stops, with 8 advertisement categories noted and included in the final analysis, including alcohol, fast food outlets and confectionary. The majority of adverts were for 'unhealthy' food and drink categories, however there was no evidence for any socio-economic patterning of these advertisements. There was no evidence of a relationship between advertisements and proximity to schools and leisure centres. While there is no evidence for food and drink advertising being patterned by neighbourhood deprivation, the scale of unhealthy advertising is an area for policy evaluations and interventions on the control of such outdoor advertising.

Is place or person more important in determining higher rural cancer mortality? A data-linkage study to compare individual versus area-based measures of deprivation.

Data from Northeast Scotland for 11,803 cancer patients (diagnosed 2007-13) were linked to UK Censuses to explore relationships between hospital travel-time, timely-treatment and one-year-mortality, adjusting for both area and individual-level socioeconomic status (SES). Adjusting for area-based SES, those living >60 minutes from hospital received timely-treatment more often than those living <15 minutes. Substituting individual-level SES changed little. Adjusting for area-based SES those living >60 minutes from hospital died within one year more often than those living <15 minutes. Again, substituting individual-level SES changed little. In Northeast Scotland distance to services, rather than individual SES, likely explains poorer rural cancer survival.Background and objectiveThe Northeast and Aberdeen Scottish Cancer and Residence (NASCAR) study found rural-dwellers are treated quicker but more likely to die within a year of a cancer diagnosis. A potential confounder of the relationship between geography and cancer mortality is socioeconomic status (SES). We linked the original NASCAR cohort to the UK Censuses of 2001 and 2011, at an individual level, to explore the relationship between travel time to key healthcare facilities, timely cancer treatment and one-year mortality adjusting for both area and individual-level markers of socioeconomic status.MethodsA data linkage study of 11803 patients examined the association between travel times, timely treatment and one-year mortality with adjustment for area, and for individual-level, markers of socioeconomic status.ResultsFollowing adjustment for area-based SES measures those living more than 60 minutes from the cancer treatment centre were significantly more likely to be treated within 62 days of GP referral than those living within 15 minutes (Odds Ratio [OR]) 1.41; 95% (Confidence Interval [CI]) 1.23, 1.60]. Replacing area-based with individual-level SES measures from UK Censuses made little impact on the results [OR 1.39; 95% CI 1.22, 1.57].Following adjustment for area-based SES measures of socioeconomic status those living more than 60 minutes from the cancer treatment centre were significantly more likely to die within one year than those living closer by [OR 1.22; 95% CI 1.08, 1.38]. Again, replacing area-based with individual-level SES measures from UK Censuses made little impact on the result [OR 1.20; CI 1.06, 1.35].ConclusionsDistribution of individual measures of socioeconomic status did not differ significantly between rural and urban cancer patients. The relationship between distance to service, timely treatment and one-year survival were the same adjusting for both area-based and individual SES. Overall, it seems that distance to services, rather than personal characteristics, influences poorer rural cancer survival.

Self-Rated Health Inequalities in British Nurses

IntroductionImprovements in health in the UK are beginning to stall. Differences between the health of people living in the most and least deprived areas continue to grow. An excess in mortality, not explained by deprivation, has been observed in Scotland. Some of this difference likely results from limitations in deprivation measures.&#x0D; Objectives and ApproachWe seek to test whether Nurses experience health inequalities in Self-Rated Health comparable with the general population. We also aim to explore cross-national differences within the Nursing occupational group.&#x0D; We utilise data from Census-derived Longitudinal Studies in Scotland and England &amp; Wales which are linked to an adjusted UK-consistent Multiple Deprivation measure. The databases can only be accessed securely, so an innovative method (eDatashield) has been used to conduct analysis as if the two were combined.&#x0D; Nurses are of interest as they are a large occupational group with potentially protective characteristics against inequalities including high health literacy and level of education. Socioeconomic homogeneity in this group may reduce the effect of confounding when exploring area-based deprivation measures.&#x0D; ResultsComparing Nurses to Non-Nurses we found they have systematically different and more homogenous characteristics. Nurses are; older, have a higher level of education, are more likely to be female, own their home, are less likely to live in deprived areas and they report better Self-Rated Health. However, inequalities persist.&#x0D; Comparing Self-Rated Health of Scottish with English &amp; Welsh Nurses will determine whether an ‘excess’ in worse health outcomes exists and if so, whether the UK- consistent Deprivation Measure can account for this. Full results will be cleared for dissemination through disclosure control, prior to the conference.&#x0D; Conclusion / ImplicationsEven in a privileged group with characteristics which protect against poor health, inequalities remain. The methods applied here present an opportunity for improved cross-national comparison and address limitations in confounding when exploring inequalities based on area deprivation.

Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales

ObjectivesMost research on health inequalities uses aggregated deprivation scores assigned to the small area where the patient lives; however, the concordance between aggregate area-level deprivation measures and personal deprivation experienced...

Are NHS dental practices socioeconomically distributed in Scotland, Wales and Northern Ireland?

Aim To investigate the relationship between deprivation and distance to NHS dental providers in Scotland, Wales and Northern Ireland.Methods A total of 1,795 NHS dental practices were located at the smallest geographic areas for Scotland, Wales and Northern Ireland. A geographic information system (GIS) was used to overlay the distribution of dental practices with areas graded by the Index of Multiple Deprivation (IMD) and population census from 2011.Results In Scotland, Wales and Northern Ireland, 15%, 17.8% and 27.5% of the population lived outside 2.5 km of an NHS dental practice, respectively. NHS dental clinics were distributed mostly among people that lived in IMD 1 and 5 areas across the respective deprivation measures of all three nations. There were negligible differences in area-based deprivation measures and NHS dental clinic distribution.Conclusion NHS dental practices in Scotland, Wales and Northern Ireland were not socioeconomically distributed, suggesting an equitable spatial availability of services based on need.

Abstract A117: Area deprivation index and rurality in relation to lung cancer prevalence and mortality in a rural state

Abstract Objectives: Lung cancer is the leading cause of cancer-related mortality. In rural areas, socioeconomic deprivation and geographic barriers to care may both influence lung cancer prevalence and outcomes. We sought to describe how socioeconomic deprivation and rurality are related to lung cancer prevalence and mortality. Methods: We conducted a population-based cross-sectional analysis of: 1) prevalent lung cancers identified in a statewide all-payer claims dataset between 2012 and 2016; 2) lung cancer deaths in Maine from 2012-2016, ascertained by the state death registry; 3) rurality; and 4) area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small/isolated rural, large rural, or urban) and ADI (in quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by Behavioral Risk Factor Surveillance System data. Results: Among 1,223,006 adults aged 20+ in the all-payer claims dataset during the 5-year observation period, 8300 received care for prevalent lung cancer and there were 4618 deaths from lung cancer between 2012 and 2016. Of the prevalent lung cancer cases, 36.1% resided in isolated or small rural areas, and 42.6% resided in the highest two quintiles for ADI. Increasing rurality was positively associated with lung cancer prevalence and mortality, but these associations did not persist after adjusting for age, sex and smoking rates. However, increasing ADI was positively associated with both lung cancer prevalence (rate ratio 1.41 (95% CI 1.30-1.54) for ADI quintile 5 vs. quintile 1) and mortality (rate ratio for ADI quintile 5 vs. quintile 1, 1.59 (95% CI 1.41-1.79) in multivariable models adjusted for age, sex, and smoking rates. Conclusion: Socioeconomic deprivation was associated with higher lung cancer prevalence and mortality, but rurality was not. These findings suggest that interventions aimed at improving access to lung cancer prevention, screening, and treatment services should target populations with socioeconomic deprivation, rather than rurality per se. Future research should examine the relationship between socioeconomic deprivation and other indicators of population health in rural areas. Citation Format: Kathleen M Fairfield, Adam Black, Erika Ziller, Kimberly Murray, Lee Lucas, Leo B Waterston, Neil Korsen, Darlene Ineza, Paul KJ Han. Area deprivation index and rurality in relation to lung cancer prevalence and mortality in a rural state [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A117.

Area Deprivation Index and Rurality in Relation to Lung Cancer Prevalence and Mortality in a Rural State.

BackgroundWe sought to describe lung cancer prevalence and mortality in relation to socioeconomic deprivation and rurality.MethodsWe conducted a population-based cross-sectional analysis of prevalent lung cancers from a statewide all-payer claims dataset from 2012 to 2016, lung cancer deaths in Maine from the state death registry from 2012 to 2016, rurality, and area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small and isolated rural, large rural, or urban) and ADI (quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by the Behavioral Risk Factor Surveillance System.ResultsAmong 1 223 006 adults aged 20 years and older during the 5-year observation period, 8297 received lung cancer care, and 4616 died. Lung cancer prevalence and mortality were positively associated with increasing rurality, but these associations did not persist after adjusting for age, sex, and smoking rates. Lung cancer prevalence and mortality were positively associated with increasing ADI in models adjusted for age, sex, and smoking rates (prevalence rate ratio for ADI quintile 5 compared with quintile 1 = 1.41, 95% confidence interval [CI] =1.30 to 1.54) and mortality rate ratio = 1.59, 95% CI = 1.41 to 1.79).ConclusionSocioeconomic deprivation, but not rurality, was associated with higher lung cancer prevalence and mortality. Interventions should target populations with socioeconomic deprivation, rather than rurality per se, and aim to reduce lung cancer risk via tobacco treatment and control interventions and to improve patient access to lung cancer prevention, screening, and treatment services.

Socioeconomic deprivation and blood lipids in first-episode psychosis patients with minimal antipsychotic exposure: Implications for cardiovascular risk

BackgroundThe influence of socioeconomic deprivation on the cardiovascular health of patients with psychosis-spectrum disorders (PSD) has not been investigated despite the growing recognition of social factors as determinants of health, and the disproportionate rates of cardiovascular mortality observed in PSD. Discordant results have been documented when studying dyslipidemia –a core cardiovascular risk factor– in first-episode psychosis (FEP), before chronic exposure to antipsychotic medications. The objective of the present study is to determine the extent to which socioeconomic deprivation affects blood lipids in patients with FEP, and examine its implications for cardiovascular risk in PSD. MethodsLinear regression models, controlling for age, sex, exposure to pharmacotherapy, and physical anergia, were used to test the association between area-based measures of material and social deprivation and blood lipid levels in a sample of FEP patients (n = 208). ResultsSocial, but not material deprivation, was associated with lower levels of total and HDL cholesterol. This effect was statistically significant in patients with affective psychoses, but not in schizophrenia-spectrum disorders. ConclusionsContrary to other reports from the literature, the relationship between socioeconomic disadvantage and blood lipid levels was contingent on the social rather than the material aspects of deprivation. Furthermore, this association also depended on the main diagnostic category of psychosis, suggesting a complex interaction between the environment, psychopathology, and physical health. Future studies exploring health issues in psychosis might benefit from taking these associations into consideration. A better understanding of the biology of blood lipids in this context is necessary.

Assessing the potential utility of commercial 'big data' for health research: Enhancing small-area deprivation measures with Experian™ Mosaic groups.

In contrast to area-based deprivation measures, commercial datasets remain infrequently used in health research and policy. Experian collates numerous commercial and administrative data sources to produce Mosaic groups which stratify households into 15 groups for marketing purposes. We assessed the potential utility of Mosaic groups for health research purposes by investigating their relationships with Indices of Multiple Deprivation (IMD) for the British population. Mosaic groups showed significant associations with IMD quintiles. Correspondence Analysis revealed variations in patterns of association, with Mosaic groups either showing increasing, decreasing, or some mixed trends with deprivation quintiles. These results suggest that Experian's Mosaics additionally measure other aspects of socioeconomic circumstances to those captured by deprivation measures. These commercial data may provide new insights into the social determinants of health at a small area level.

Area deprivation measures used in Brazil

ABSTRACTOBJECTIVETo describe and assess currently used area-based measures of deprivation in Brazil for health research, to the purpose of informing the development of a future small area deprivation index.METHODSWe searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were: studies proposing measures of deprivation for small areas (i.e., finer geography than country-level) in Brazil, published in English, Portuguese or Spanish. After data-extraction, results were tabulated according to the area level the deprivation measure was created for and to the dimensions of deprivation or poverty included in the measures. A narrative synthesis approach was used to summarize the measures available, highlighting their utility for public health research.RESULTSA total of 7,199 records were retrieved, 126 full-text articles were assessed after inclusion criteria and a final list of 30 articles was selected. No small-area deprivation measures that have been applied to the whole of Brazil were found. Existing measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs.CONCLUSIONSNo up-to-date small area-based deprivation measure in Brazil covers the whole country. There is a need to develop such an index for Brazil to measure and monitor inequalities in health and mortality, particularly to assess progress in Brazil against the Sustainable Development Goal targets for different health outcomes, showing progress by socioeconomic groups.

Social equity and primary healthcare financing: lessons from New Zealand.

This paper reviews the effect of a primary care financing scheme introduced in New Zealand as a component of the New Zealand Primary Health Care Strategy, a comprehensive reform of the way that primary healthcare was governed, financed and delivered. The population-based funding formulae incorporated an area-based measure of social deprivation and ethnicity in an explicit attempt to improve access to care for certain population groups and fund social interventions aimed at addressing conditions that lead to improved health outcomes. The New Zealand experience shows that introducing a nationwide, comprehensive program to improve access and reduce health disparities is possible. However, the effect of this effort on reducing health disparities is not entirely clear because success ultimately relies on local implementation of a complex set of interventions that need to be evaluated more rigorously. In addition, the partial subsidies for first contact care that came with the Strategy have been shown to improve access, but, the success of this approach relies on compliance by private-practising general practitioners with a fee reduction regimen, which is subject to local variation.

The Scottish school leavers cohort: linkage of education data to routinely collected records for mortality, hospital discharge and offspring birth characteristics

PurposeThe Scottish school leavers cohort provides population-wide prospective follow-up of local authority secondary school leavers in Scotland through linkage of comprehensive education data with hospital and mortality records. It considers...

Socioeconomic status and susceptibility to alcohol-related harm

Socioeconomic status and susceptibility to alcohol-related harm

Molecular Genetic Contributions to Social Deprivation and Household Income in UK Biobank

SummaryIndividuals with lower socio-economic status (SES) are at increased risk of physical and mental illnesses and tend to die at an earlier age [1, 2, 3]. Explanations for the association between SES and health typically focus on factors that are environmental in origin [4]. However, common SNPs have been found collectively to explain around 18% of the phenotypic variance of an area-based social deprivation measure of SES [5]. Molecular genetic studies have also shown that common physical and psychiatric diseases are partly heritable [6]. It is possible that phenotypic associations between SES and health arise partly due to a shared genetic etiology. We conducted a genome-wide association study (GWAS) on social deprivation and on household income using 112,151 participants of UK Biobank. We find that common SNPs explain 21% of the variation in social deprivation and 11% of household income. Two independent loci attained genome-wide significance for household income, with the most significant SNP in each of these loci being rs187848990 on chromosome 2 and rs8100891 on chromosome 19. Genes in the regions of these SNPs have been associated with intellectual disabilities, schizophrenia, and synaptic plasticity. Extensive genetic correlations were found between both measures of SES and illnesses, anthropometric variables, psychiatric disorders, and cognitive ability. These findings suggest that some SNPs associated with SES are involved in the brain and central nervous system. The genetic associations with SES obviously do not reflect direct causal effects and are probably mediated via other partly heritable variables, including cognitive ability, personality, and health.