Ecological association between a deprivation index and mortality in France over the period 1997-2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death
Ecological association between a deprivation index and mortality in France over the period 1997-2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death
复制标题
DOI：
10.1186/1471-2458-9-33
复制
发表时间：
2009-01-22
影响因子：
4.5
通讯作者：
Hemon, Denis
中科院分区：
文献类型：
--
作者：
Rey, Gregoire;Jougla, Eric;Hemon, Denis
背景：空间健康不平等往往被分析的剥夺。本研究的目的是建立一个生态剥夺指数，并评估其与死亡率在整个大陆法国领土。更具体地说，说明了城市化程度、空间规模、年龄、性别和死亡原因的变化，这些变化影响了死亡率与贫困之间的关系。贫困指数"FDep 99“，是在“公社”里发展起来的（法国最小的行政单位）水平作为四个社会经济变量的主成分分析的第一个成分。计算卡斯泰尔斯和汤森指数的代理以进行比较。空间在1997-2001年期间，使用五个不同的空间尺度，并按城市化程度（五个城市单元类别）、年龄、性别和死亡原因，研究了FDep 99与死亡率之间的关系。对于年龄小于65岁的受试者，也考虑了“避免”死亡原因。他们被定义为与风险行为和初级预防（酒精，吸烟，事故）的原因。结果：FDep 99指数和死亡率之间的关联是积极的和准对数线性，所有的地理尺度。最贫困的五分之一人口社区的标准化死亡率比最贫困的五分之一人口社区高24%。城市单位类别之间和地区之间的异质性的对数线性关联没有统计学意义。该协会是积极的所有类别的研究，年龄小于65岁的受试者，男性，和“可避免的”mortality.The幅度和规律性的死亡率和汤森和卡斯泰尔斯指数之间的关联是lower.Conclusion：提出的剥夺指数反映了一个重要组成部分的空间社会经济异质性，在一个均匀的方式在整个国家。该指数可被卫生保健当局常规使用，以观察，分析和管理空间健康不平等。
Background: Spatial health inequalities have often been analysed in terms of deprivation. The aim of this study was to create an ecological deprivation index and evaluate its association with mortality over the entire mainland France territory. More specifically, the variations with the degree of urbanicity, spatial scale, age, gender and cause of death, which influence the association between mortality and deprivation, have been described.Methods: The deprivation index, 'FDep99', was developed at the 'commune'(smallest administrative unit in France) level as the first component of a principal component analysis of four socioeconomic variables.Proxies of the Carstairs and Townsend indices were calculated for comparison.The spatial association between FDep99 and mortality was studied using five different spatial scales, and by degree of urbanicity (five urban unit categories), age, gender and cause of death, over the period 1997-2001.'Avoidable' causes of death were also considered for subjects aged less than 65 years. They were defined as causes related to risk behaviour and primary prevention (alcohol, smoking, accidents).Results: The association between the FDep99 index and mortality was positive and quasi-log-linear, for all geographic scales. The standardized mortality ratio (SMR) was 24% higher for the communes of the most deprived quintile than for those of the least deprived quintile. The between-urban unit category and between-region heterogeneities of the log-linear associations were not statistically significant. The association was positive for all the categories studied and was significantly greater for subjects aged less than 65 years, for men, and for 'avoidable' mortality.The amplitude and regularity of the associations between mortality and the Townsend and Carstairs indices were lower.Conclusion: The deprivation index proposed reflects a major part of spatial socioeconomic heterogeneity, in a homogeneous manner over the whole country. The index may be routinely used by healthcare authorities to observe, analyse, and manage spatial health inequalities.