Agreement between area- and individual-level income measures in a population-based cohort: Implications for population health research
Agreement between area- and individual-level income measures in a population-based cohort: Implications for population health research
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DOI：
10.1016/j.ssmph.2020.100553
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发表时间：
2020-04-01
影响因子：
4.7
通讯作者：
Rosella, Laura C.
中科院分区：
文献类型：
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作者：
Buajitti, Emmalin;Chiodo, Sabrina;Rosella, Laura C.
社会经济地位是健康的重要决定因素，其测量对人口健康研究具有重要意义。然而，许多卫生行政数据中缺乏个人层面的社会经济因素，导致广泛使用地区层面的措施来代替。本研究旨在通过比较收入指标，阐明加拿大安大略省个人和地区层面社会经济地位的作用。利用加拿大社区健康调查四个周期（2005-2012）的数据，我们使用百分比一致性和卡帕统计来评估个人和地区层面收入五分位之间的一致性。在基线时比较个体水平的特征。计算访谈后 5 年的累积成人过早死亡率。税率分别针对地区层面和个人层面的收入进行计算，并针对每个收入组的组合进行联合计算。在调整基本人口统计数据（年龄、性别、访谈周期）和关键风险因素（酒精、吸烟、体力活动和体重指数）后，多变量负二项式模型适合估计地区和个人水平收入五分位与过早死亡率之间的关联。个人和地区水平收入衡量指标之间的一致性较低。相同和相似（即 +/- 1 五分位）测量值的 Kappa 统计值为 0.11 和 0.48，分别表明一致性较低和中等。个人收入水平过早死亡的社会经济差异大于地区收入水平。当同时按地区和个人收入五分位对比率进行分层时，个人水平收入梯度在每个地区水平收入组内持续存在。收入和过早死亡率之间的关联对于这两项指标都很显着，包括在充分调整之后。地区层面的社会经济地位不适合代表缺失的个人层面数据。地区和个人层面的收入衡量标准之间的一致性较低，以及人口概况的差异表明，这两种社会经济地位衡量标准并未涵盖相同的人口群体。然而，我们的研究结果表明，个人和地区层面的收入指标都与过早死亡有关，并描述了独特的社会经济不平等。
Socioeconomic status is an important determinant of health, the measurement of which is of great significance to population health research. However, individual-level socioeconomic factors are absent from much health administrative data, resulting in widespread use of area-level measures in their place. This study aims to clarify the role of individual- and area-level socioeconomic status in Ontario, Canada, through comparison of income measures.Using data from four cycles (2005-2012) of the Canadian Community Health Survey, we assessed concordance between individual- and area-level income quintiles using percent agreement and Kappa statistics. Individual-level characteristics were compared at baseline. Cumulative adult premature mortality was calculated for 5-years following interview. Rates were calculated separately for area-level and individual-level income, and jointly for each combination of income groups. Multivariable negative binomial models were fit to estimate associations between area- and individual-level income quintile and premature mortality after adjustment for basic demographics (age, sex, interview cycle) and key risk factors (alcohol, smoking, physical activity, and body mass index).Agreement between individual- and area-level income measures was low. Kappa statistics for same and similar (i.e +/- 1 quintile) measures were 0.11 and 0.48, indicating low and moderate agreement, respectively. Socioeconomic disparities in premature mortality were greater for individual-level income than area-level income. When rates were stratified by both area- and individual-level income quintiles simultaneously, individual-level income gradients persisted within each area-level income group. The association between income and premature mortality was significant for both measures, including after full adjustment.Area-level socioeconomic status is an inappropriate proxy for missing individual-level data. The low agreement between area- and individual-level income measures and differences in demographic profile indicate that the two socioeconomic status measures do not capture the same population groups. However, our findings demonstrate that both individual- and area-level income measures are associated with premature mortality, and describe unique socioeconomic inequities.