Ecological Deprivation Research Articles

Hypoparathyroidism-related health care utilization and expenditure during the first postoperative year after total thyroidectomy for cancer: a comprehensive national cohort study.

Hypoparathyroidism is the most common complication of total thyroidectomy for cancer, and requires calcium and/or vitamin D supplementation for an unpredictable period of time. The additional cost associated with this complication has not hitherto been assessed. The aim of this study was to assess the economic burden of postoperative hypoparathyroidism after total thyroidectomy for cancer in France. Based on the French national cancer cohort, which extracts data from the French National Health Data System (SNDS), all adult patients who underwent a total thyroidectomy for cancer in France between 2011 and 2015 were identified, and their healthcare resource use during the first postoperative year was compared according to whether they were treated postoperatively with calcium and/or vitamin D or not. Univariate and multivariate cost analyses were performed with the non-parametric Wilcoxon test and generalized linear model (gamma distribution and log link), respectively. Among the 31,175 patients analyzed (75% female, median age: 52y), 13,247 (42%) started calcium and/or vitamin D supplementation within the first postoperative month, and 2,855 patients (9.1%) were still treated at 1 year. Over the first postoperative year, mean overall and specific health expenditures were significantly higher for treated patients than for untreated patients: €7,233 vs €6,934 per patient (p<0.0001) and €478.6 vs €332.7 per patient (p<0.0001), respectively. After adjusting for age, gender, Charlson Comorbidity index, ecological deprivation index, types of thyroid resection, lymph node dissection and complications, year and region, the incremental cost of overall health care utilization was €142 (p<0.004). Our study found a significant additional cost in respect of health expenditures for patients who had hypoparathyroidism after thyroidectomy for cancer, over the first postoperative year. Five-year follow-up is planned to assess the impact of more severe long-term complications on costs.

Does patents on environmental technologies matter for the ecological footprint in the USA? Evidence from the novel Fourier ARDL approach

The outcome of patents on environmental (POET) technologies on the EF in the USA has not been comprehensively explored. Therefore, to close this breach in the literature, the present study discovers how patents on ecological technologies affect ecological footprint (EF) in the USA while regulatory for GDP and EC using the Fourier-based approaches. The conclusions of the present study reveal that POET are an important predictor of EF in the USA and cause a reduction in ecological deprivation in the long run; as expected, economic growth negatively affects environmental sustainability. The outcomes suggest that it is possible to resolve conflicts between the economy and the environment by using technological innovation. The USA government must reconsider its policy focus, particularly on coal energy sourcing and industrial energy, while continuing with heavy investments in its ambitious renewable energy technology development plan. Moreover, the government should continue to promote investments in environmental technologies.

Exploring the impacts of economic policy uncertainty, natural resources, and energy structure on ecological footprints: evidence from G-10 nations.

The role of energy and natural resources rent has been studied in the literature but very few research works investigated the impacts of economic policy uncertainty and energy structure on ecological footprints (EFs) in the group of ten G-10 countries. Therefore, this research is designed to probe the impacts of economic policy uncertainty (EP), natural resources rent, energy structure, economic growth, and total factor productivity on EF. The annual data for 1995-2018 is analyzed by adopting second-generation methods. The empirical results from the CS-ARDL unveiled that EP is significantly and positively related to EF, indicating that EP is not environmentally friendly in these nations. A 1% increase in EP contributes to EF by 0.025% in the long run. In addition, the results show that natural resource rents and energy structure positively contribute to mitigating EF by 0.012% and 0.095% respectively, while economic growth increases EF by 0.237%. Based on the empirical results, this work suggests addressing the economic policy uncertainty and economic progress to lower ecological deprivation can be a viable solution to attain sustainable development goals. This work recommends adopting feasible economic policies with sound efforts. For this purpose, the economic sector has to be strong enough with sustainable production. They should ensure the supply of continuous renewable energy to the economic sector.

Assessing the role of ecological innovation and economic growth in enhancing educational performance: evidence of BRICS countries

Science symbolises education as an integral element in attaining environmental sustainability. Even after having elite-level human intelligence, this universe faces adverse effects of ecological deprivation. Therefore, this study specifically investigates the role of ecological innovation and economic growth on educational performance in BRICS nations. The present study selected the recent year’s data of BRICS nations to explore the repercussions of ecological innovation and the countries’ GDP income, and chooses the potential statistical technique name CS-ARDL method. In addition, this study uses other testing tools such as the CD test, unit root analysis tests, Westerlund and Edgerton test, and Bai and Silvestre-I-Carrion cointegration test to explore the role of these variables on educational performance. The estimated outcomes of the unit root test and CD test signify the structural breaks and heterogeneity in the data, but later Pesaran and Yamagata (2008) test resolved the relative issues. Therefore, long-run and short-run analyses of the CS-ARDL method identified the positive and significant affluence of ecological innovation (GIN) and economic growth (GDP) on educational performance (EDU). Thus, some dynamic policies are introduced in the below section to nourish the educational system of BRICS countries with the help of ecological innovation and economic progression.

Frustration and deprivation in ecology and in people’s life

The article analyses the significance of human frustration and deprivation caused by life conditions or ecological frustration/deprivation. Ecological frustration means deprivation of access to some objects of the environment, more precisely, human environment. Ecological deprivation means formation of a psychological view of an individual (social group) on unfair deprivation of benefits due to it, those connected with the use of environmental resources. The article presents a classification of types of ecological frustration and deprivation. The structure of any frustration and deprivation is based on subjects and objects thereof, and its characteristics are intensity, localisation and spread. The subject of frustration (deprivation) is a person or a group of persons – bearers of the given psychological phenomenon (individual, group or mass mentality); the object thereof is an element of the environment which, in case of its inaccessibility, causes frustration or deprivation. The intensity of these phenomena is measured as an indicator of integral manifestation of their subjects’ response. The localisation of both frustration and deprivation is determined by the composition of the affected societal groups, and their spread – by the proportion of these people in such group or in the society as a whole. Frustration and deprivation of life conditions represent critical factors in shaping environmental attitudes. For most people, poor environment is not a result of analysis of a set of physico-chemical and biological indicators. It is a perception of environmental reality formed under the influence of various frustration and deprivation feelings. Monitoring the processes of formation and spread of such phenomena in the society and analysing the results thereof can prevent numerous socio-ecological conflicts. Frustration and deprivation of life conditions that are prevalent in the society should be taken into account when developing environmental education and training programmes.

Influence of social deprivation on benzodiazepines dispensing among children and adolescents: A large cross-sectional population-based study in France

BackgroundIn Europe, children benzodiazepines consumption is not consistent with existing recommendations, especially among the most economically deprived families. ObjectivesThe objective was to assess the correlation between benzodiazepines dispensing among children in primary care and the European Deprivation Index (EDI), a validated ecological deprivation index that approaches socioeconomic position. MethodA dataset from the national reimbursement database only available for the year 2012 was used including 540,325 children in a large French region. The association between benzodiazepines dispensing and the EDI (described in deciles) was assessed with a multivariate logistic regression, including confounding and mediation factors identified and available in the database. ResultsBenzodiazepines were dispensed among 2.4% of the children. EDI was associated with the dispensing of benzodiazepines (p <0.0001), but there was some heterogeneity between the deciles. The covariates that most influenced the probability of being dispensed benzodiazepines among the most deprived patients were the fact of benefiting from the complementary universal insurance coverage (CMU-C) and the number of consultations with a general practitioner (GP). This could be explained by the interaction between the EDI and CMU-C. CMU-C reflects more precariousness at an individual level: it favors benzodiazepines’ dispensing, mediated by the increased number of consultations with GPs. ConclusionSocial deprivation has an influence over the dispensing of benzodiazepines to children and adolescents. This raises concern about discrepancies in mental health management according to the patients’ social background, particularly by GPs, who are mainly involved.

How Modern Agronomy is Changing with AI and IoT post COVID-19 Pandemic: A Qualitative Study

AI and IoT are changing our day-to-day lives in every aspect, including but not limited to banking, retail, and agriculture. Dreadful obstacles confronted by agrarian and food associations involve ecological deprivation and biodiversity deficit, enduring hardship, an increasing overweightness epidemic, nutrition uncertainty, and the use of ergonomics. However, managers and decision-makers frequently let down to admit how "awful" these matters are. Wicked difficulties want united act from the social order assemblies with profoundly apprehended, contrasting opinions and principles because their connectedness associations are stiff or incredible to detect, they cannot be expressed or resolved, deprived of detonating arguments amongst investors, and they cannot be resolved unaccompanied. All industries are directly or indirectly getting influenced by this modern technology. This research study aims to study the practical function of these technologies in the agri-food industry, which will be helpful in process models, stakeholder predictions, and correct environmental awareness to change the agri-business model. This research study findings highlight exciting issues and questions related to using AI in the agri-food industry towards the space economy to achieve a sustainable business model and better use of resources during the pandemic. Both hypothetical and administrative consequences are reviewed here.

The impact of CSR on green purchase intention: Empirical evidence from the green building Industries in Taiwan.

Worldwide supplies are being utilized at a disturbing rate and to a significant degree, the building business has been accountable for this ecological deprivation, particularly because of its elevated level of energy expenditure. Hence, this research paper targets the customers of green building industries in Taiwan and developed a framework based on Carroll's corporate social responsibility (CSR) model, theory of planned behavior (TPB), and cognitive consistency theory (CCT), to measure the impact of CSR on green purchase intention (GPI). Furthermore, it analyzes the impact of CSR on green word of mouth (GWOM), green attitude (GA), green concern (GC), and green trust (GT). Moreover, it explores the roles of GA, GC, GWOM, and GT on GPI. Finally, to study the mediating roles of GC, GA, and GWOM, with the relationship between CSR and GPI. The data for this study was collected from 600 customers of green building businesses located in Taiwan with the help of a convenience sampling technique. As per the results of this research, CSR was discovered to have a positive impact on GPI, GWOM, GA, GC, and GT. Furthermore, GWOM had a significant impact on GPI. Moreover, GC and GT were in a significant relationship with GPI. Consequently, all the relationships were significant except the relationship between GA and GPI. Furthermore, GT, GWOM, and GC fully mediate the relationship between CSR and GPI. However, GA was not found to significantly mediate the relationship between CSR and GPI. The findings of this study provide practical implications regarding the impact of CSR on GPI and the trending issue of sustainable career development.

DAPATKAH SITUS JEJARING SOSIAL MENDORONG INTENSI BERWIRAUSAHA HIJAU?

Abstract- Social networking sites are an important aspect of everyday life. Social networks are also thought to have the power to increase the intention of green entrepreneurship which is important in preventing ecological deprivation. Therefore, this study aims to analyze the effect of social networking sites on the green entrepreneurship intentions of Jabodetabek students mediated by self-efficacy and risk-taking tendencies. This research was conducted using quantitative research methods, with the use of convenience sampling and electronic questionnaires as data collection methods from 181 students studying at universities in the Jabodetabek area. Data analysis was performed using PLS-SEM. The results showed that social networking sites had a significant effect on green entrepreneurship intentions directly, without being mediated by self-efficacy or risk-taking tendencies. Thus, there is great hope that social networking sites can be utilized in the realization of green growth. Through the social networking movement that raises awareness and insight into the green economy, it can have a direct effect on increasing the green entrepreneurship intentions of Jabodetabek students.&#x0D; Keywords: Social Networking Sites; Self-Efficacy; Propensity to Take Risks, Green Entrepreneurship Intentions

Prevalence of overweight, obesity, and early adiposity rebound in nursery school children in southeastern France

BackgroundThe aim of the present study was to assess the prevalence of overweight, obesity, and early adiposity rebound in nursery school children aged 3.5–4.5 years and to evaluate associations with deprivation. MethodsA cross-sectional study was conducted in the Bouches-du-Rhône department in southeastern France. Data for all nursery school children aged 3.5–4.5 years were collected during systematic medical examinations. The prevalence of overweight and obesity was determined using French, International Obesity Task Force (IOTF), and World Health Organization reference values. A French ecological deprivation index was used to assess associations with deprivation. ResultsAmong 19,295 children included in the study, the prevalence of overweight (IOTF-25 < BMI < IOTF-30) was 9.1% and the prevalence of obesity (BMI > IOTF-30) was 2.6%. Children attending nursery schools in the most disadvantaged areas were 4.3 times more likely to be affected by obesity than those from schools in the most advantaged areas (OR: 4.32; 95% CI: 2.98–6.25, p < 0.001), after adjusting for gender, age group, and school status. Early adiposity rebound was observed in 2131 of 9872 children (21.6%). ConclusionPrograms to prevent childhood overweight and obesity in France should be intensified and take account of major persistent social inequalities. Medical practitioners should learn to systematically assess BMI curve dynamics and early adiposity rebound.

Neighborhoods, Schools, and Adolescent Violence: Ecological Relative Deprivation, Disadvantage Saturation, or Cumulative Disadvantage?

Neighborhood and school socioeconomic "disadvantage" are consequential for youth violence perpetration. This study considers alternative ecological cumulative disadvantage, disadvantage saturation, and relative deprivation hypotheses regarding how the association between neighborhood disadvantage and violence varies by levels of socioeconomic disadvantage in schools. These hypotheses are tested with data from Wave I of Add Health (n = 15,581; 51% Female; Age mean = 15.67, SD = 1.74). Cross-classified multilevel Rasch models are used to estimate the interaction between neighborhood and school disadvantage in predicting adolescent violence. Consistent with the ecological relative deprivation hypothesis, results indicate that the association between neighborhood disadvantage and violence is most pronounced among youth attending low-disadvantage schools. Further, youth exposed to high-disadvantage neighborhoods and low-disadvantage schools tend to be at the greatest risk of perpetrating violence. These patterns are evident among both males and females, and particularly among older youth and those from low-parent education families. This study motivates future investigations considering how adolescents' experiences beyond the neighborhood shape how they engage with and experience the effects of their neighborhoods.

Examining the dynamics of ecological footprint in China with spectral Granger causality and quantile-on-quantile approaches

ABSTRACT With 2.5 global hectares (gha) per capita against 2.7 gha per capita, China’s ecological footprint is desirably below the world’s average ecological footprint per capita. Undesirably, the country’s per person ecological footprint outweighs the world’s average biocapacity per person of 1.7 gha, thus signifying an enormous pressure on the country’s ecological capacity. This reason accounts for the motivation to explore the dynamics of ecological footprint for China over the period 1971–2016 by employing a series of empirical techniques that include quantile-on-quantile regression (QQR), spectral Granger causality (SGC), and quantile regression. Indicatively, the empirical findings are in folds. First, from the QQR, economic growth exerts a positive effect on (i) ecological footprint especially in the middle quantile (0.4–0.7) and (ii) all quantiles (0.01–0.95) of economic growth. Second, both fossil fuel and primary energy utilization exert a positive impact on (i) all quantiles (0.01–0.95) of ecological footprint and (ii) all quantiles (0.01–0.95) of the two energy profiles. Third, it is surprising to see renewable energy utilization exerting a positive effect on ecological footprint at the lower tail (0.1–0.40) and on renewable energy use at the higher tail (0.70–0.95). Additionally, the SGC result revealed Granger causality from primary energy use and economic growth to the ecological footprint in the long-run without reverse. Additionally, without reverse, there is a Granger causality from renewable energy use to the ecological footprint in the short-, medium-, and long-term. Importantly, the overall policy implication suggests a more drastic decoupling of the country’s growth from the supply side (ecological pressure and environmental 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...

Impact of deprivation on hospital efficiency and financial balance in paediatrics

Abstract Background In healthcare systems where hospital tariffs are based on average national length of stay (LOS), deprived patients may be a source of inefficiency for hospitals as deprivation has been shown to be associated with increased LOS. They may also negatively impact hospitals’ financial balance as few hospital payment methods include deprivation. Our objective was to study the impact of deprivation on hospital efficiency and financial balance. Methods A study was carried out using an exhaustive national hospital discharge database. All inpatient stays in mainland France between 2012 and 2014 by children over 28 days and under 18 in hospitals with a paediatric ward were included. Deprivation was estimated with an ecological deprivation index divided into national quintiles. Efficiency was assessed by variations in patients’ LOS compared to different mean national LOS (paediatric LOS, LOS of admissions for a similar condition...). Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level with the difference between all revenues and production costs for said hospital. Multivariate models assessed the association between those indicators and deprivation. Results 4,124,510 inpatient stays were included. LOS was shorter than national means for less deprived patients and longer for the more deprived, and the difference was higher for diagnosis-related groups (DRGs) that included both adult and paediatric patients compared to paediatric-only DRGs. The multivariate model confirmed those significant associations. Deprivation also had a significant impact on hospitals’ financial balance, especially for hospitals with a percentage of paediatric patients in the two most deprived quintiles between 20% and 60%. Conclusions Measures to reform hospital payment methods must be encouraged to improve resource allocation efficiency and equity in access to good paediatric care. Key messages A reform of hospital funding to better account for deprivation is needed. A modulation of tariffs using an allocation key at the patient level must be considered to mitigate the effect of deprivation. DRGs specific to children should be encouraged to become the norm rather the exception to provide an adequate picture of resources used during admission and therefore an appropriate tariff.

Are social inequalities in acute myeloid leukemia survival explained by differences in treatment utilization? Results from a French longitudinal observational study among older patients

BackgroundEvidences support social inequalities in cancer survival. Studies on hematological malignancies, and more specifically Acute Myeloid Leukemia (AML), are sparser. Our study assessed: 1/ the influence of patients’ socioeconomic position on survival, 2/ the role of treatment in this relationship, and 3/ the influence of patients’ socioeconomic position on treatment utilization.MethodsThis prospective multicenter study includes all patients aged 60 and older, newly diagnosed with AML, excluding promyelocytic subtypes, between 1st January 2009 to 31st December 2014 in the South-West of France. Data came from medical files. Patients’ socioeconomic position was measured by an ecological deprivation index, the European Deprivation Index. We studied first, patients’ socioeconomic position influence on overall survival (n = 592), second, on the use of intensive chemotherapy (n = 592), and third, on the use of low intensive treatment versus best supportive care among patients judged unfit for intensive chemotherapy (n = 405).ResultsWe found an influence of patients’ socioeconomic position on survival (highest versus lowest position HRQ5: 1.39 [1.05;1.87] that was downsized to become no more significant after adjustment for AML ontogeny (HRQ5: 1.31[0.97;1.76] and cytogenetic prognosis HRQ5: 1.30[0.97;1.75]). The treatment was strongly associated with survival. A lower proportion of intensive chemotherapy was observed among patients with lowest socioeconomic position (ORQ5: 0.41[0.19;0.90]) which did not persist after adjustment for AML ontogeny (ORQ5: 0.59[0.25;1.40]). No such influence of patients’ socioeconomic position was found on the treatment allocation among patients judged unfit for intensive chemotherapy.ConclusionsFinally, these results suggest an indirect influence of patients’ socioeconomic position on survival through AML initial presentation.

Spatial heterogeneity of KRAS mutations in colorectal cancers in northern France.

BackgroundSomatic mutations in the KRAS gene are the most common oncogenic mutations found in human cancers. However, no clinical features have been linked to KRAS mutations in colorectal cancer [CRC].PurposeIn this study, we attempted to identify the potential geographical population clusters of KRAS mutations in CRC patients in northern France.Patients and methodsAll patients with CRC who were identified to have KRAS mutations between 2008 and 2014 at the Regional Molecular Biology Platform at Lille University Hospital were included. 2,486 patients underwent a KRAS status available, with 40.9% of CRC with KRAS mutations in northern France. We retrospectively collected demographic and geographic data from these patients. The proportions of KRAS mutation were smoothed to take into account the variability related to low frequencies and spatial autocorrelation. Geographical clusters were searched using spatial scan statistical models.ResultsA mutation at KRAS codon 12 or 13 was found in 1,018 patients [40.9%]. We report 5 clusters of over-incidence but only one elongated cluster that was statistically significant [Cluster 1; proportion of KRAS mutation among CRC: 0.4570; RR=1.29; P=0.0314]. We made an ecological study which did not highlight a significant association between KRAS mutations and the distance to the Closest Waste Incineration Plant, and between KRAS mutations and The French Ecological Deprivation Index but few socio-economic and environmental data were available.ConclusionThere was a spatial heterogeneity and a greater frequency of KRAS mutations in some areas close to major highways and big cities in northern France. These data demand deeper epidemiological investigations to identify environmental factors such as air pollution as key factors in the occurrence of KRAS mutations.

Spatial heterogeneity of KRAS mutations in colorectal cancers: A population-based study in northern France.

e15101 Background: Somatic mutations in the KRAS gene are present in about 40% of tumors from colorectal cancer (CRC) patients and are associated with a resistance to anti-EGFR therapies. However, no clinical features have been linked to KRAS mutations in CRC. In this study, we attempted to identify the potential geographical population clusters of KRAS mutations in CRC patients in northern France. Methods: All patients with CRC who were identified to have KRAS mutations performed by pyrosequencing between 2008 and 2014 at the Regional Molecular Biology Platform at Lille University Hospital were included. We retrospectively collected demographic and geographic data from these patients. The proportions of KRAS mutation were smoothed to take into account the variability related to low frequencies and spatial autocorrelation. Geographical clusters were searched using spatial scan statistical models. Then, we made an ecological study. Results: 2,486 patients underwent a KRAS status available. A mutation of KRAS codon 12 or 13 performed by pyrosequencing was found in 1,018 patients (40.9%). We report 5 clusters of over-incidence but only one elongated cluster that was statistically significant ranging from the city of Tourcoing to the city of Marquion (Cluster 1; smoothed proportion of KRAS mutation: 0.4570; RR = 1.29; p = 0.0314). The ecological study did not highlight a significant association between KRAS mutations and the distance to the Closest Waste Incineration Plant , and between KRAS mutations and The French Ecological Deprivation Index. There was a greater frequency of KRAS mutations in some areas close to major highways and big cities in northern France. Conclusions: There is a spatial heterogeneity of KRAS codon 12 or 13 mutations in CRC in northern France. These data demand deeper epidemiological investigations to identify environmental factors such as air pollution as key factors in the occurrence of KRAS mutations.

Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany

Abstract Empirical evidence demonstrates associations between socioeconomic or environmental area deprivation and public health. To measure such structural effects, deprivation indices have been developed in the UK initially. Meanwhile their application is increasingly discussed in Germany, however with little attempts to adapt the concept to national conditions. In this paper, we develop a model of area deprivation differentiating between material, social and ecological deprivation effects. We apply structural equation modelling to endogenously estimate the latent deprivation dimensions as well as their relative impact on the health outcome, accounting for potential measurement errors and controlling for health care infrastructure. We use data at the level of German municipal associations (n=4,491) for the years 2013 and 2016, if available. We find that differences in material (βmaterial=−0.168, p&lt;0.001) and social deprivation (βsocial=−0.249, p&lt;0.001) as well as ecological damage (βecological=−0.077, p&lt;0.001) explain part of the health differences in Germany. The social dimension is paramount in a health context. Moreover, deprivation dimensions cancel out each other and combining them in one overall index blurs the diverse picture of area deprivation in Germany. The small area analysis illustrates, that different strategies in environmental-, education- or health policy are necessary to reduce deprivation in different regions.

Deprivation-specific life tables using multivariable flexible modelling \u2013 trends from 2000\u20132002 to 2010\u20132012, Portugal

BackgroundCompleting mortality data by information on possible socioeconomic inequalities in mortality is crucial for policy planning. The aim of this study was to build deprivation-specific life tables using the Portuguese version of the European Deprivation Index (EDI) as a measure of area-level socioeconomic deprivation, and to evaluate mortality trends between the periods 2000–2002 and 2010–2012.MethodsStatistics Portugal provided the counts of deaths and population by sex, age group, calendar year and area of residence (parish). A socioeconomic deprivation level was assigned to each parish according to the quintile of their national EDI distribution. Death counts were modelled within the generalised linear model framework as a function of age, deprivation level and calendar period. Mortality Rate Ratios (MRR) were estimated to evaluate variations in mortality between deprivation groups and periods.ResultsLife expectancy at birth increased from 74.0 and 80.9 years in 2000–2002, for men and women, respectively, and to 77.6 and 83.8 years in 2010–2012. Yet, life expectancy at birth differed by deprivation, with, compared to least deprived population, a deficit of about 2 (men) and 1 (women) years among most deprived in the whole study period. The higher mortality experienced by most deprived groups at birth (in 2010–2012, mortality rate ratios of 1.74 and 1.29 in men and women, respectively) progressively disappeared with increasing age.ConclusionsPersistent differences in mortality and life expectancy were observed according to ecological socioeconomic deprivation. These differences were larger among men and mostly marked at birth for both sexes.

Estimation of the Ecological Fallacy in the Geographical Analysis of the Association of Socio-Economic Deprivation and Cancer Incidence.

Ecological deprivation indices at the level of spatial units are often used to measure and monitor inequalities in health despite the possibility of ecological fallacy. For the purpose of this study, the European Deprivation Index (EDI) was used, which is based on Townsend theorization of relative deprivation. The Slovenian version of EDI (SI-EDI) at the aggregated level (SI-EDI-A) was calculated to the level of the national assembly polling stations. The SI-EDI was also calculated at the individual level (SI-EDI-I) by the method that represents a methodological innovation. The degree of ecological fallacy was estimated with the Receiver Operating Characteristics (ROC) curves. By calculating the area under the ROC curve, the ecological fallacy was evaluated numerically. Agreement between measuring deprivation with SI-EDI-A and SI-EDI-I was analysed by graphical methods and formal testing. The association of the socio-economic status and the cancer risk was analysed in all first cancer cases diagnosed in Slovenia at age 16 and older in the period 2011–2013. Analysis was done for each level separately, for SI-EDI-I and for SI-EDI-A. The Poisson regression model was implemented in both settings but adapted specifically for aggregated and individual data. The study clearly shows that ecological fallacy is unavoidable. However, although the association of cancer incidence and socio-economic deprivation at individual and aggregated levels was not the same for all cancer sites, the results were very similar for the majority of investigated cancer sites and especially for cancers associated with unhealthy lifestyles. The results confirm the assumptions from authors’ previous research that using the level of the national assembly polling stations would be the acceptable way to aggregate data when explaining inequalities in health in Slovenia in ecological studies.