Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales.
Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales.
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DOI：
10.1136/bmjopen-2020-041714
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发表时间：
2020-11-26
期刊：
影响因子：
2.9
通讯作者：
Woods LM
中科院分区：
文献类型：
--
作者：
Ingleby FC;Belot A;Atherton I;Baker M;Elliss-Brookes L;Woods LM
大多数关于健康不平等的研究都使用分配给患者居住的小区域的汇总剥夺分数；然而，人们对地区一级总体剥夺措施与居住在该地区的个人所经历的个人剥夺之间的一致性知之甚少。我们的目标是检验个人与生态剥夺之间的一致性。我们测试了个人和地区层面的收入、职业和教育指标之间的一致性，并评估了基于地区的贫困措施预测个人贫困情况的可靠性。英格兰和威尔士。从国家统计纵向研究办公室提取的 9547 名癌症患者队列。我们量化了个人和地区层面的收入、职业和教育指标之间的一致性。此外，我们使用ROC（接受者操作特征）曲线和曲线下面积（AUC）来评估基于面积的剥夺措施预测个人剥夺情况的可靠性。我们发现个人层面和地区层面的贫困指标之间的一致性较低（Cramer 的 V 统计范围在 0.07 到 0.20 之间）。健康不平等研究中最常用的指标，即基于地区的收入剥夺，对个人收入状况的预测效果较差（AUC 在 0.56 至 0.59 之间），而教育和职业的预测效果稍好（AUC 在 0.62 至 0.65 之间）。不同性别和六种主要癌症类型的结果是一致的。我们的结果表明，生态剥夺措施仅反映了剥夺与健康结果之间的部分关系，特别是在收入衡量方面。这对于我们理解贫困与健康之间的关系以及医疗政策之间的关系具有重要意义。研究结果对我们衡量和监测不平等现象的方式产生了广泛影响，进而对我们资助和组织旨在减少不平等现象的当前英国医疗政策的方式产生了广泛影响。
Most 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 by individuals living in the area is poorly understood. Our objective was to examine the agreement between individual and ecological deprivation. We tested the concordance between metrics of income, occupation and education at individual and area levels, and assessed the reliability of area-based deprivation measures to predict individual deprivation circumstances. England and Wales. A cancer patient cohort of 9547 individuals extracted from the Office for National Statistics Longitudinal Study. We quantified the concordance between measures of income, occupation and education at individual and area level. In addition, we used ROC (receiver operating characteristic) curves and the area under the curve (AUC) to assess the reliability of area-based deprivation measures to predict individual deprivation circumstances. We found low concordance between individual-level and area-level indicators of deprivation (Cramer’s V statistics range between 0.07 and 0.20). The most commonly used indicator in health inequalities research, area-based income deprivation, was a poor predictor of individual income status (AUC between 0.56 and 0.59), whereas education and occupation were slightly better predictors (AUC between 0.62 and 0.65). The results were consistent across sexes and across six major cancer types. Our results indicate that ecological deprivation measures capture only part of the relationship between deprivation and health outcomes, especially with respect to income measurement. This has important implications for our understanding of the relationship between deprivation and health, and, as a consequence, healthcare policy. The results have a wide-reaching impact for the way in which we measure and monitor inequalities, and in turn, fund and organise current UK healthcare policy aimed at reducing them.
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