Area-level Material Deprivation Research Articles

Association of socioeconomic status with aggressive end-of-life care in patients with cancer before and during the COVID-19 pandemic.

1612 Background: Aggressive care near the end-of-life (EOL) reflects poor quality of cancer care.We examined the association between trends in aggressive EOL cancer care and socioeconomic status (SES) before and during the COVID-19 pandemic. Methods: We conducted a population-based cohort study of adults diagnosed with cancer who died from 03/16/2015 to 03/15/2020 (pre-COVID-19 period) and from 03/16/2020 to 03/15/2021 (COVID-19 period). Aggressive EOL care was defined as a composite outcome of percentage (%) of patients with systemic anticancer therapy (SACT) use, >1 ED visit, >1 hospitalization, or ≥1 ICU admission in the last 30 days of life. We conducted an interrupted time series analysis using segmented linear regression, estimating monthly trends before, at the start of, and during the first year of the pandemic. Analyses were stratified by SES, based on area-level material deprivation quintiles (Q1, least; Q3, intermediate; Q5, most deprived). Results: Of 173,915 decedents with cancer (mean [SD] age 72.1 [12.5] years; females 45.9%), 59,613 (34.3% [95% CI, 34.1-34.5]) had aggressive EOL care; 10.3% (10.2-10.5) received SACT, 14.0% (13.8-14.2) had >1 ED visit, 10.3% (10.2-10.5) >1 hospitalization, and 13.4% (13.2-13.5) ≥1 ICU admission within 30 days of death. During the course of the pre-COVID-19 period, patients in Q1 (33.5% [33.0-34.1]) were less likely to receive aggressive care at the EOL than those in Q3 (34.1% [33.5-34.6]) or Q5 (34.8%, 95% CI, 34.3-35.3). Specifically, patients in Q1 were less likely to have ED visits (Q1, 12.9% vs Q3, 14.2% vs Q5, 14.9%), and hospitalizations (9.7% vs 10.3% vs 10.6%) than Q3 and Q5, and less likely to have ICU admissions than Q5 (13.1 vs 13.0% vs 14.4%); however, they were more likely to receive SACT at EOL (11.1% vs 9.9% vs 9.1%). During the pre-COVID-19 period, aggressive care increased by 0.032% (95% CI, 0.026-0.038, P < 0.0001) monthly; this increase was significant in Q1 (P = 0.002)but not in Q3 (P = 0.31) or Q5 (P = 0.21). Within Q1, there was a pre-COVID-19 increase in EOL SACT use (P < 0.0001)and ED visits (P = 0.04) but not inhospitalizations and ICU admissions. In March 2020, aggressiveness of care decreased by 2.37% (95% CI, -2.98 to -1.76, P = 0.0002), which was significant in Q5 (P = 0.04), but not Q1 (P = 0.07)or Q3 (P = 0.81). Within Q5, there was a decrease in EOL ED visits (P = 0.0008) but not in SACT use, hospitalizations, or ICU admissions. Conclusions: More than one third of adults with advanced cancer received aggressive EOL care, which increased in the 5 years prior to COVID-19 pandemic and was attenuated at its onset. Indicators of aggressive care differed by SES, with greatest SACT use in those with highest SES and greatest hospital services use in those with lowest SES. Measures to reduce aggressiveness of care should take into account disparities related to SES.

Association of socioeconomic status (SES) with use of specialist palliative care (SPC) among people who died with cancer before and during the COVID-19 pandemic.

e18504 Background: Access to high-quality care, including SPC, is known to vary according to SES. The effect of SES on access to SPC during the COVID-19 pandemic remains unknown. We measured the association of SES with SPC use in different care settings among people who died with cancer before and during the COVID-19 pandemic. Methods: This retrospective, population-based cohort study included 173,915 adult patients who died with cancer from 16/3/2015 to 15/3/2020 (pre-pandemic), and from 16/3/2020 to 15/3/2021 (pandemic period), in Ontario, Canada; March 16, 2020 coincided with the start of pandemic-related hospital entrance screening. The primary outcome was access to SPC in the last 30 days of life, measured as the percentage of people with at least one SPC visit and the rate of visits/patient/30 days across home, hospital inpatient, and outpatient care settings. We used an interrupted time series analysis with segmented linear regression accounting for serial correlation to examine the immediate and gradual changes due to the pandemic. Analyses were stratified by SES, defined using area-level material deprivation quintiles (Q1, least to Q5, most deprived). Results: In total, 100,462 (57.8%) people received SPC in the last 30 days of life. The access to SPC increased steadily by 0.13% per 30 days over the pre-pandemic period ( P<0.001), with a drop of 5.34% at the start of pandemic ( P<0.001) and a trend increase of 0.19% during the pandemic period ( P = 0.10). The table shows study outcomes by care setting and SES. At baseline, patients in Q5 (vs Q1) had lower rates of SPC home visits, while rates of inpatient visits and outpatient visits were similar. Pre-pandemic for Q1 and Q5, inpatient visits were decreasing, outpatient visits were increasing, and home visits were stable. For both Q1 and Q5, there was an immediate decrease in home visits and increase in outpatient visits at pandemic onset, followed by a recovery in home visits; trends for inpatient and outpatient visits were unchanged. Conclusions: The COVID-19 pandemic led to an immediate decrease in access to SPC among people who died with cancer, particularly for home visits. SES was significantly associated with access to home visits, both before and during the pandemic. [Table: see text]

88 Association between area level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal

Abstract Background Although sociodemographic factors have been linked with SARS-CoV-2 infection and hospitalizations in adults, there are little data on the association between sociodemographic characteristics and SARS-CoV-2-related hospitalization in children. Objectives The objective of this study was to determine the association between area-level material deprivation and incidence of hospitalization with SARS-CoV-2 among children. Design/Methods We conducted a retrospective cohort study of all children (0-17 years of age) with a PCR-confirmed SARS-CoV-2 infection between March 1, 2020, and May 31, 2021, at a tertiary care pediatric hospital. Data were collected through chart review and included age, sex, and postal code. Postal codes were then assigned a dissemination area-level material deprivation score, measured via the Pampalon Material Deprivation Index (PMDI) quintiles. The Pampalon Material Deprivation Index (PMDI) uses postal codes to describe factors related to material deprivation obtained from the Canadian census, which are proxies for individual data in a geographic area. Specifically, the PMDI integrates data regarding (i) the proportion of persons without a high school diploma; (ii) the employment-to-population ratio; (iii) average personal income which is aggregated at the dissemination area level. We examined the association between PMDI quintiles and hospitalization using Poisson regression. Results During the study period, 964 children had a positive PCR-confirmed SARS-CoV-2 test and 124 were hospitalized due to SARS-CoV-2 infection. Children from the most deprived PMDI quintile represented 31.6% of positive cases and 40.7% of hospitalizations (Figure 1 and 2). Both in bivariate and multivariable regression analyses, there was evidence of greater proportion of positive test results in the most deprived PMDI quintile (Quintile 5) compared to the least deprived quintile (Quintile 1) (rate ratio 1.77, 95%CI: 1.36; 2.62) (Table 1). The incidence of hospitalization due to SARS-CoV-2 infection was 2.42 times greater in the most deprived quintile compared to the least deprived quintile (95%CI: 1.33; 4.41) (table 1). In a post-hoc analysis, the risk for severe disease appeared higher for children living in Q5 areas relative to other areas but the difference did not reach statistical significance. Conclusion In conclusion, in this study we found evidence that Canadian children living in neighbourhoods with high material deprivation had a higher incidence of infection and hospitalizations related to SARS-Cov-2 compared to children living in neighbourhoods with less material deprivation. Public health authorities should take these disparities into account when devising public health policy and interventions especially at this crucial point in the pandemic. Special efforts should be deployed to protect children from these more disadvantaged areas, especially as vaccination is not yet available to a majority of children.

Cycling infrastructures and equity: an examination of bike lanes and bike sharing system in Lisbon, Portugal

ABSTRACT Inequity of access to the cycling network may reinforce social disparities in health and access to resources and opportunities. This study aims to examine whether the area-level material deprivation index is associated with different levels of accessibility to Lisbon’s (i) cycling network and (ii) bike-sharing docking stations network. Independent t-tests were implemented, and regression models were performed to estimate the associations of the multiple deprivation index with each dependent bike lane and bike-sharing docking station variable, adjusting for covariates. The results confirm the hypothesis of a significant difference between the most and least deprived areas in terms of the presence of bike lanes and bike-sharing stations as well as in terms of coverage, distance, and connectivity of the both infrastructures. When covariates are controlled, a higher index of material deprivation is associated with (i) a lower presence of, greater distance to, and lower coverage of bike-sharing docking stations; and (ii) is not associated with the presence of, distance to, connectivity of, and coverage of cycle lane networks. Based on these findings, efforts should be directed to increase access to bike lanes and bike-sharing systems to more deprived areas.

Association between area-level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal.

Although sociodemographic factors have been linked with SARS-CoV-2 infection and hospitalizations in adults, there are little data on the association between sociodemographic characteristics and SARS-CoV-2-related hospitalization in children. The objective of this study was to determine the association between area-level material deprivation and incidence of hospitalization with SARS-CoV-2 among children. We conducted a retrospective cohort study of all children (0 to 17 years of age) with a PCR-confirmed SARS-CoV-2 infection March 1, 2020 through May 31, 2021 at a tertiary-care paediatric hospital, in Montreal, Canada. Data were collected through chart review and included age, sex, and postal code, allowing linkage to dissemination area-level material deprivation, measured with the Pampalon Material Deprivation Index (PMDI) quintiles. We examined the association between PMDI quintiles and hospitalization using Poisson regression. During the study period, 964 children had a positive PCR-confirmed SARS-CoV-2 test and 124 were hospitalized. Children living in the most deprived quintile of PMDI represented 40.7% of hospitalizations. Incidence rate ratio of hospitalization for this group compared to the most privileged quintile was 2.42 (95%CI: 1.33; 4.41). Children living in the most materially deprived areas had more than twice the rate of hospitalizations for COVID-19 than children living in most privileged areas. Special efforts should be deployed to protect children who live in disadvantaged areas, especially pending vaccination of younger children.

Opportunistic postpartum depression symptom screening at well-child clinics in Alberta, 2012-2016.

The study objective was to assess the reach and delivery of opportunistic postpartum depression (PPD) symptom screening at well-child clinic (WCC) immunization appointments in Alberta. The relationship between socio-demographic factors and PPD symptom screening status, and PPD symptom scores was explored. In this retrospective population-based cohort study, administrative health data from WCC immunization appointments were used to assess the PPD symptom screening delivery and scores from January 1, 2012 to December 31, 2016. The associations with maternal age and area-level material deprivation were determined by multivariable statistics. The number of births ranged from 51,537 to 55,787 annually. The percentage of mothers screened for PPD symptoms using the Edinburgh Postnatal Depression Scale decreased between 2012 and 2016, from 80.1% to 69.7%. Of those screened, 3-3.2% of the mothers were identified to be at high risk for PPD, annually. Screening status varied according to maternal age: mothers ≤29 years were more likely to be screened than mothers 30-34 years, while mothers ≥35 years were the least likely to be screened. Logistic regression analyses, adjusting for age, found the odds of not being screened increased with increases in area-level material deprivation. Language/cultural barriers were the most commonly reported reasons for not screening. Opportunistic PPD symptom screening at WCCs can be an efficient method to identify mothers who need postpartum support and to inform population-level public health surveillance. Additional work is needed to further understand barriers to PPD symptom screening, especially language, cultural, and socio-demographic factors.

Material deprivation and rates of all-terrain vehicle- and snowmobile-related injuries in Ontario from 2003 to 2018: a population-based study

ObjectivesSocio-economic status (SES) is a well-established predictor of health outcomes; however, there is a dearth of evidence on the relationship between SES and off-road vehicle (ORV) injuries. In Ontario, all-terrain vehicles (ATVs) and snowmobiles present a serious risk for preventable injury. This study assessed the association between area-level material deprivation and the risk of ATV- and snowmobile-related injuries in Ontario, as well as the impact of sex and age.MethodsA population-based, repeat cross-sectional study was conducted using administrative data of ATV- and snowmobile-related emergency room visits from 2003 to 2018. Material deprivation was measured using the Ontario Marginalization Index, which assigned a score and quintile of deprivation to each dissemination area in Ontario. Age-standardized incidence rates and relative index of inequality values were calculated, stratified by quintile of deprivation, sex, age group, vehicle type, and health region.ResultsWe found a significant, positive relationship between ORV-related injuries and quintile of material deprivation (RII = 1.28, 95% CI: 1.01–1.63). Rates of ATV- and snowmobile-related injuries remained stable over time. Across all age groups, sex, and rural categories, we found an inverse u-shaped relationship between rates of injuries and quintile material deprivation. Males, individuals living in rural areas, and adolescents and young adults experienced the highest rates of injuries.ConclusionDespite the positive relationship between ORV-related injuries and quintiles of deprivation, the inverse u-shaped relationship suggests that this increased risk of injury is likely related to exposure to ORVs. These results contribute to an understanding of the prevalence of the injury problem at a local level in Ontario. Stable rates of injury over time suggest that current public health programs are not sufficient in reducing these injuries, and further research should determine which factors amenable to intervention are contributing to increased risk of injury.

Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

Characteristics of immunized and un-immunized students, including non-medical exemptions, in Ontario, Canada: 2016–2017 school year

BackgroundOur objectives were: (1) to quantify and describe un-immunized students in Ontario, Canada and assess the extent to which these students have exemptions; and (2) to quantify and describe students with non-medical exemptions (NMEs), including what proportion have up-to-date immunizations. MethodsWe examined Ontario students 7 to 17 years-of-age in the 2016–2017 school year using information within a centralized immunization repository. We identified and described students with different immunization/exemption classifications by age, sex, school type, geography and area-level material deprivation using descriptive and multivariable logistic regression analyses. Finally, we assessed the immunization status of students with NMEs, by antigen. ResultsWe found that students could be recorded as un-immunized with or without an NME, or be immunized with an NME. From a cohort of 1.65 million students, 2.9% of students had zero vaccine doses recorded, and of these 68% had no exemption of any kind. A total of 2.4% of students had an NME. Of these, 39% were un-immunized and 61% had received ≥1 vaccine. Among all students with NMEs, 19–48% had up-to-date immunizations, varying by antigen. Factors associated with increased odds of having a NME and being un-immunized included: attendance at private and ‘other’ schools, rural residence, and geography. Older age and greater area-level deprivation were associated with a reduced odds. ConclusionsOur assessment revealed that Ontario students with NMEs cannot be assumed to be un-immunized and at risk for all vaccine-preventable diseases. Conversely, not all un-immunized students had NMEs suggesting that future studies of un-immunized children in Ontario must consider additional factors beyond NME status alone. Other jurisdictions that use NME data to inform research and surveillance of vaccine hesitancy and risks for VPD outbreaks may wish to undertake a similar assessment to determine how well student NMEs correlate with student immunization status.

Trends in Socioeconomic Inequalities in Hypertension in Ontario, Canada, 2000-2012

IntroductionHypertension is leading risk factor for cardiovascular disease and mortality. Low socioeconomic position (e.g., income or high material deprivation) is an important risk factor for hypertension. However, there is limited evidence monitoring the extent to which socioeconomic inequalities in hypertension exist and are changing over time in Ontario.
 Objectives and ApproachThe study objective was to estimate socioeconomic trends in prevalent hypertension by household income and material deprivation in Ontario from 2000 to 2012. A pooled cross-sectional study was conducted using data from 6 Canadian Community Health Surveys linked to the Discharge Abstract Database and Ontario Health Insurance Plan data (n=121,390 over 35 years, 54\% female). Relative-weighted Poisson regression models were used to estimate hypertension rates (adjusted for age, sex, ethnicity and immigration) across quintiles of equivalized household income and area-level material deprivation. Socioeconomic inequalities were estimated using the slope index of inequality (SII) and relative index of inequality (RII).
 ResultsSocioeconomic inequalities in hypertension were observed across income quintiles on both absolute (SII: 1428 per 10,000, 95\%CI:1126,1730) and relative (RII:1.74, 95\%CI:1.53,1.94) scales in 2000, decreasing by 2012 (SII:297 per 10,000, 95%CI: -82,676; RII:1.19, 95%CI:0.93,1.45). A similar pattern was observed across material deprivation quintiles, however with smaller inequalities in 2000 (SII:595 per 10,000, 95%CI:306,884; RII:1.25, 95%CI:1.11,1.39) and 2012 (SII:389 per 10,000, 95%CI:17,761; RII:1.24, 95%CI:0.99,1.49).
 Conclusion/ImplicationsSocioeconomic inequalities in hypertension were observed in Ontario, with decreasing trends between 2000 and 2012. Area-level material deprivation underestimated individual-level socioeconomic inequalities in hypertension.

Trends in Socioeconomic Inequalities in Ischemic Heart Disease, 2000-2012

IntroductionLow socioeconomic position (SEP) is an important risk factor for ischemic heart disease (IHD). Current surveillance methods use area-based SEP measures to monitor trends in socioeconomic inequalities in IHD. The extent to which these methods underestimate individual-level socioeconomic inequalities in IHD is unclear.
 Objectives and ApproachThe study objective was to estimate socioeconomic trends in IHD by household income and material deprivation in Ontario from 2000 to 2012. A pooled cross-sectional study was conducted using data from 6 Canadian Community Health Survey (CCHS) cycles (2000-2012) linked to the Discharge Abstract Database (n= 119,529 over 35 years of age, 55% female). Relative-weighted Poisson regression models were used to estimate IHD prevalence rates (adjusted for age, sex, ethnicity and immigration) across quintiles of equivalized household income and area-level material deprivation. Socioeconomic inequalities were estimated using the slope index of inequality (SII) and relative index of inequality (RII).
 ResultsSocioeconomic inequalities in IHD were observed across income and material deprivation quintiles. Measured using the SII, adjusted IHD rates were 345 per 10,000 (95%CI: 207,483) higher at the bottom of the income distribution than the top in 2000, decreasing to 167 per 10,000 (95%CI: 40,293) by 2012. These differences represented 2.52 (95%CI: 1.58,3.46) times higher IHD rates in 2000, an increased risk that remained in 2012 (RII: 1.80, 95%CI: 0.97,2.63). A similar pattern was observed across material deprivation quintiles, however with smaller absolute and relative inequalities observed in 2000 (SII:195 per 10,000, 95%CI:79,312; RII:1.64, 95%CI:1.16,2.11) and 2012 (SII:142 per 10,000, 95%CI:16,268; RII:1.54, 95%CI:0.94,2.14).
 Conclusion/ImplicationsConsistent socioeconomic inequalities in IHD were observed in Ontario, with an absolute reduction between 2000 and 2012. Area-level material deprivation underestimated individual-level socioeconomic inequalities in IHD.

Socioeconomic inequalities in childhood mortality from congenital heart defects: need for internal comparison cohort

BackgroundAn increasing proportion of children with congenital heart defects survive into childhood. Since study populations typically do not contain children without such defects, how survival compares with the general population is unknown. Whereas socioeconomic inequalities in child mortality persist in the general population, such inequalities have not been investigated in children with congenital heart defects. We estimated postneonatal mortality in children with congenital heart defects by socioeconomic status and assessed whether inequalities differed from those in children without major congenital anomalies. MethodsA population-based cohort of 264 247 children born 1990–09 was constructed from the Health Improvement Network, a UK database of prospectively collected primary care records. Diagnoses of major congenital anomalies were classified with the European Surveillance of Congenital Anomalies criteria. Socioeconomic status was measured by quintiles of the Townsend Index of Deprivation, a nationally standardised ranking of area-level material deprivation. Mortality rates (age 1 month to 5 years) were calculated per 1000 person-years for children with congenital heart defects and for those without major congenital anomalies, stratified by socioeconomic status quintile; mortality rate ratios (MRRs) were used to compare risk between each population by quintile. The stratified log-rank test was used to test whether MRRs differed by socioeconomic status. FindingsAmong 2012 children with congenital heart defects, mortality was 6·4 per 1000 person-years (95% CI 4·9–8·6). Rates were lowest in the least deprived quintile (4·26/1000, 2·13–8·51) and rose with each quintile to 12·33/1000 (7·00–21·7) in the most deprived quintile. Risk of death in children with congenital heart defects was 20 times higher than in those without major congenital anomalies (MRR 20·0, 95% CI 14·8–27·2). However, the effect of socioeconomic status on mortality was similar between children with congenital heart defects and those without major congenital anomalies (stratified log-rank test p=0·891). This non-statistically significant result might have resulted from insufficient sample size to generate precise mortality risk ratios. InterpretationDeprivation was associated with an increased risk of death in children with congenital heart defects and without major congenital anomalies, but no evidence was found to suggest that the association with socioeconomic status was different between the two populations. These findings highlight the need to target health inequalities in children with congenital heart defects as well as in the general population. FundingRS is supported by a post-graduate scholarship from the Economic and Social Research Council.

Moving beyond the residential neighborhood to explore social inequalities in exposure to area-level disadvantage: Results from the Interdisciplinary Study on Inequalities in Smoking

The focus, in place and health research, on a single, residential, context overlooks the fact that individuals are mobile and experience other settings in the course of their daily activities. Socio-economic characteristics are associated with activity patterns, as well as with the quality of places where certain groups conduct activities, i.e. their non-residential activity space. Examining how measures of exposure to resources, and inequalities thereof, compare between residential and non-residential contexts is required. Baseline data from 1890 young adults (18–25 years-old) participating in the Interdisciplinary Study of Inequalities in Smoking, Montreal, Canada (2011–2012), were analyzed. Socio-demographic and activity location data were collected using a validated, self-administered questionnaire. Area-level material deprivation was measured within 500-m road-network buffer zones around participants' residential and activity locations. Deprivation scores in the residential area and non-residential activity space were compared between social groups. Multivariate linear regression was used to estimate associations between individual- and area-level characteristics and non-residential activity space deprivation, and to explore whether these characteristics attenuated the education–deprivation association. Participants in low educational categories lived and conducted activities in more disadvantaged areas than university students/graduates. Educational inequalities in exposure to area-level deprivation were larger in the non-residential activity space than in the residential area for the least educated, but smaller for the intermediate group. Adjusting for selected covariates such as transportation resources and residential deprivation did not significantly attenuate the education–deprivation associations. Results support the existence of social isolation in residential areas and activity locations, whereby less educated individuals tend to be confined to more disadvantaged areas than their more educated counterparts. They also highlight the relevance of investigating both residential and non-residential contexts when studying inequalities in health-relevant exposures.

Association between Congenital Anomalies and Area-Level Deprivation among Infants in Neonatal Intensive Care Units

To examine the relationship between area-level material deprivation and the risk of congenital anomalies in infants admitted to neonatal intensive care units (NICUs) across Canada. The Canadian Neonatal Network database was used to identify admitted infants who had congenital anomalies between 2005 and 2009. The association between congenital anomalies and material deprivation quintile was assessed using logistic regression analysis. Of 55,961 infants admitted to participating NICUs during the study period, 6002 (10.7%) had major, 6244 (11.2%) had minor, and 43,715 (78.1%) had no anomalies. There were higher odds of major anomalies (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03 to 1.24) but not minor anomalies (OR 1.01, 95% CI 0.93 to 1.11) in the highest-deprivation areas as compared with the lowest-deprivation area of maternal residence. Analyses of groups of major anomalies revealed higher odds for chromosomal (OR 1.48, 95% CI 1.05 to 2.10) and multiple-systems (OR 1.40, 95% CI 1.14 to 1.71) anomalies in the highest-deprivation areas compared with the lowest-deprivation areas. There are socioeconomic inequalities in the risk of major congenital anomalies, especially chromosomal and multiple-systems anomalies, in the NICU population with the highest rates in the most socioeconomically deprived areas.

Sex, age, deprivation and patterns in life expectancy in Quebec, Canada: a population-based study.

BackgroundLittle research has evaluated disparities in life expectancy according to material deprivation taking into account differences across the lifespan between men and women. This study investigated age- and sex-specific life expectancy differentials related to area-level material deprivation for the province of Québec, Canada from 1989-2004.MethodsAge- and sex-specific life expectancy across the lifespan was calculated for three periods (1989-1992, 1995-1998, and 2001-2004) for the entire Québec population residing in 162 community groupings ranked according to decile of material deprivation. Absolute and relative measures were calculated to summarize differences between the most and least deprived deciles.ResultsLife expectancy differentials between the most and least deprived deciles were greatest for men. Over time, male differentials increased for age 20 or more, with little change occurring at younger ages. For women, differentials increased across the lifespan and were comparable to men at advanced ages. Despite gains in life expectancy among men relative to women, differentials between men and women were greater for most deprived relative to least deprived deciles.ConclusionsSimilar to the US, differentials in life expectancy associated with area-level material deprivation increased steadily in Québec from 1989-2004 for males and females of all ages. Differentials were comparable between men and women at advanced ages. Previous research indicating that life expectancy differentials between most and least deprived areas are greater in men may be due to a focus on younger age groups.

Bayesian Factor Analysis for Spatially Correlated Data, With Application to Summarizing Area-Level Material Deprivation From Census Data

This article describes a Bayesian hierarchical model for factor analysis of spatially correlated multivariate data. The first level specifies, for each area on a map, the distribution of a vector of manifest variables conditional on an underlying latent factor; at the second level, the area-specific latent factors have a joint distribution that incorporates spatial correlation. The framework allows for both marginal and conditional (e.g., conditional autoregressive) specifications of spatial correlation. The model is used to quantify material deprivation at the census tract level using data from the 1990 U.S. Census in Rhode Island. An existing and widely used measure of material deprivation is the Townsend index, an unweighted sum of four standardized census variables (i.e., Z scores) corresponding to area-level proportions of unemployment, car ownership, crowding, and home ownership. The Townsend and many related indices are computed as linear combinations of measured census variables, which motivates the factor-analytic structure adopted here. The model-based index is the posterior expectation of the latent factor, given the census variables and model parameters. Index construction based on a model allows several improvements over Townsend's and similarly constructed indices: (1) The index can be represented as a weighted sum of (standardized) census variables, with data-driven weights; (2) by using posterior summaries, the indices can be reported with corresponding measures of uncertainty; and (3) incorporating information from neighboring areas improves precision of the posterior parameter distributions. Using data from Rhode Island census tracts, we apply our model to summarize variations in material deprivation across the state. Our analysis entertains various spatial covariance structures. We summarize the relative contributions of each census variable to the latent index, suggest ways to report material deprivation at the area level, and compare our model-based summaries with those found by applying the standard Townsend index.