Cargando…

Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales

OBJECTIVES: 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 understo...

Descripción completa

Detalles Bibliográficos
Autores principales: Ingleby, Fiona C, Belot, Aurélien, Atherton, Iain, Baker, Matthew, Elliss-Brookes, Lucy, Woods, Laura M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692821/
https://www.ncbi.nlm.nih.gov/pubmed/33243814
http://dx.doi.org/10.1136/bmjopen-2020-041714
_version_ 1783614601447866368
author Ingleby, Fiona C
Belot, Aurélien
Atherton, Iain
Baker, Matthew
Elliss-Brookes, Lucy
Woods, Laura M
author_facet Ingleby, Fiona C
Belot, Aurélien
Atherton, Iain
Baker, Matthew
Elliss-Brookes, Lucy
Woods, Laura M
author_sort Ingleby, Fiona C
collection PubMed
description OBJECTIVES: 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. SETTING: England and Wales. PARTICIPANTS: A cancer patient cohort of 9547 individuals extracted from the Office for National Statistics Longitudinal Study. OUTCOMES: 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. RESULTS: 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. CONCLUSIONS: 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.
format Online
Article
Text
id pubmed-7692821
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-76928212020-12-09 Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales Ingleby, Fiona C Belot, Aurélien Atherton, Iain Baker, Matthew Elliss-Brookes, Lucy Woods, Laura M BMJ Open Epidemiology OBJECTIVES: 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. SETTING: England and Wales. PARTICIPANTS: A cancer patient cohort of 9547 individuals extracted from the Office for National Statistics Longitudinal Study. OUTCOMES: 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. RESULTS: 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. CONCLUSIONS: 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. BMJ Publishing Group 2020-11-26 /pmc/articles/PMC7692821/ /pubmed/33243814 http://dx.doi.org/10.1136/bmjopen-2020-041714 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Epidemiology
Ingleby, Fiona C
Belot, Aurélien
Atherton, Iain
Baker, Matthew
Elliss-Brookes, Lucy
Woods, Laura M
Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales
title Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales
title_full Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales
title_fullStr Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales
title_full_unstemmed Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales
title_short Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales
title_sort assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in england and wales
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692821/
https://www.ncbi.nlm.nih.gov/pubmed/33243814
http://dx.doi.org/10.1136/bmjopen-2020-041714
work_keys_str_mv AT inglebyfionac assessmentoftheconcordancebetweenindividuallevelandarealevelmeasuresofsocioeconomicdeprivationinacancerpatientcohortinenglandandwales
AT belotaurelien assessmentoftheconcordancebetweenindividuallevelandarealevelmeasuresofsocioeconomicdeprivationinacancerpatientcohortinenglandandwales
AT athertoniain assessmentoftheconcordancebetweenindividuallevelandarealevelmeasuresofsocioeconomicdeprivationinacancerpatientcohortinenglandandwales
AT bakermatthew assessmentoftheconcordancebetweenindividuallevelandarealevelmeasuresofsocioeconomicdeprivationinacancerpatientcohortinenglandandwales
AT ellissbrookeslucy assessmentoftheconcordancebetweenindividuallevelandarealevelmeasuresofsocioeconomicdeprivationinacancerpatientcohortinenglandandwales
AT woodslauram assessmentoftheconcordancebetweenindividuallevelandarealevelmeasuresofsocioeconomicdeprivationinacancerpatientcohortinenglandandwales