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BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Ability of ecological deprivation indices to measure social inequalities in a French cohort

Authors: Sofia Temam, Raphaëlle Varraso, Carole Pornet, Margaux Sanchez, Aurélie Affret, Bénédicte Jacquemin, Françoise Clavel-Chapelon, Grégoire Rey, Stéphane Rican, Nicole Le Moual

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

Despite the increasing interest in place effect to explain health inequalities, there is currently no consensus on which kind of area-based socioeconomic measures researchers should use to assess neighborhood socioeconomic position (SEP). The study aimed to evaluate the reliability of different area-based deprivation indices (DIs) in capturing socioeconomic residential conditions of French elderly women cohort.

Methods

We assessed area-based SEP using 3 DIs: Townsend Index, French European Deprivation Index (FEDI) and French Deprivation index (FDep), among women from E3N (Etude épidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale). DIs were derived from the 2009 French census at IRIS level (smallest geographical units in France). Educational level was used to evaluate individual-SEP. To evaluate external validity of the 3 DIs, associations between two well-established socially patterned outcomes among French elderly women (smoking and overweight) and SEP, were compared. Odd ratios were computed with generalized estimating equations to control for clustering effects from participants within the same IRIS.

Results

The analysis was performed among 63,888 women (aged 64, 47% ever smokers and 30% overweight). Substantial agreement was observed between the two French DIs (Kappa coefficient = 0.61) and between Townsend and FEDI (0.74) and fair agreement between Townsend and FDep (0.21). As expected among French elderly women, those with lower educational level were significantly less prone to be ever smoker (Low vs. High; OR [95% CI] = 0.43 [0.40–0.46]) and more prone to being overweight (1.89 [1.77–2.01]) than women higher educated. FDep showed expected associations at area-level for both smoking (most deprived vs. least deprived quintile; 0.77 [0.73–0.81]) and overweight (1.52 [1.44–1.62]). For FEDI opposite associations with smoking (1.13 [1.07–1.19]) and expected association with overweight (1.20 [1.13–1.28]) were observed. Townsend showed opposite associations to those expected for both smoking and overweight (1.51 [1.43–1.59]; 0.93 [0.88–0.99], respectively).

Conclusion

FDep seemed reliable to capture socioeconomic residential conditions of the E3N women, more educated in average than general French population. Results varied strongly according to the DI with unexpected results for some of them, which suggested the importance to test external validity before studying social disparities in health in specific populations.
Appendix
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Literature
1.
Riva M, Gauvin L, Barnett TA. Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. J Epidemiol Community Health. 2007;61(10):853–61.CrossRefPubMedPubMedCentral
2.
Macintyre S, Ellaway A, Cummins S. Place effects on health: how can we conceptualise, operationalise and measure them? Soc Sci Med. 2002;55(1):125–39.CrossRefPubMed
3.
Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: the public health disparities Geocoding project (US). J Epidemiol Community Health. 2003;57(3):186–99.CrossRefPubMedPubMedCentral
4.
Macintyre S, Ellaway A, Cummins S. Measuring socioeconomic position in health research. Br Med Bull. 2007;81–82(1):21–37.
5.
Townsend P. Deprivation. J Soc Policy. 1987;16(2):125.
6.
Lejeune C, Sassi F, Ellis L, Godward S, Mak V, Day M, et al. Socio-economic disparities in access to treatment and their impact on colorectal cancer survival. Int J Epidemiol. 2010;39(3):710–7.CrossRefPubMed
7.
Le Fur S, Isis-Diab collaborative group, Bougnères P, Valleron AJ. Comparison of a French pediatric type 1 diabetes cohort’s responders and non-responders to an environmental questionnaire. BMC Public Health. 2014;14(1):1241.CrossRefPubMedPubMedCentral
8.
Bertin M, Chevrier C, Pelé F, Serrano-Chavez T, Cordier S, Viel JF. Can a deprivation index be used legitimately over both urban and rural areas? Int J Health Geogr. 2014;13(1):22.CrossRefPubMedPubMedCentral
9.
Brown R, Benton L. Indices of multiple deprivation predict breastfeeding duration in England and Wales. Eur J Public Health. 2010;20(2):231–5.CrossRefPubMed
10.
Pampalon R, Hamel D, Gamache P, Simpson A, Philibert MD. Validation of a deprivation index for public health: a complex exercise illustrated by the Quebec index. Chronic Dis Inj Can. 2014;34(1):12–22.PubMed
11.
Allik M, Brown D, Dundas R, Leyland A. Measures of deprivation and their effect on inequalities in health: recent small area statistics from Scotland. Eur J Pub Health. 2014;24(Supplement 2):2014.
12.
Chan E, Serrano J, Chen L, Stieb DM, Jerrett M, Osornio-Vargas A. Development of a Canadian socioeconomic status index for the study of health outcomes related to environmental pollution. BMC Public Health. 2015;15(1):714.CrossRefPubMedPubMedCentral
13.
Gilthorpe MS, Wilson RC. Rural/urban differences in the association between deprivation and healthcare utilisation. Soc Sci Med. 2003;57(11):2055–63.
14.
Fu M, Exeter DJ, Anderson A. “So, is that your ‘relative’ or mine?” a political-ecological critique of census-based area deprivation indices. Soc Sci Med. 2015;142:27–36. Elsevier LtdCrossRefPubMed
15.
O'Reilly D. Standard indicators of deprivation: do they disadvantage older people? Age Ageing. 2002;31(3):197–202.CrossRefPubMed
16.
Grundy E, Holt G. The socioeconomic status of older adults : How should we measure it in studies of health inequalities ? J Epidemiol Community Health. 2001;55(12):895–904.
17.
Krieger N, Chen JT, Selby JV. Comparing individual-based and household-based measures of social class to assess class inequalities in women’s health: a methodological study of 684 US women. J Epidemiol Community Health. 1999;53(10):612–23.CrossRefPubMedPubMedCentral
18.
Labbe E, Blanquet M, Gerbaud L, Poirier G, Sass C, Vendittelli F, et al. A new reliable index to measure individual deprivation: the EPICES score. Eur J Public Health. 2015;25(4):604–9.CrossRefPubMed
19.
Pornet C, Delpierre C, Dejardin O, Grosclaude P, Launay L, Guittet L, et al. Construction of an adaptable European transnational ecological deprivation index: the French version. J Epidemiol Community Health. 2012;66(11):982–9.CrossRefPubMedPubMedCentral
20.
Havard D, Bodin L, Laurent B. A small-area index of socioeconomic deprivation to capture health inequalities in France. Soc Sci Med. 2008;67(12):2007–16.CrossRefPubMed
21.
Lalloué B, Monnez JM, Padilla C, Kihal W, Le Meur N, Zmirou-Navier D, et al. A statistical procedure to create a neighborhood socioeconomic index for health inequalities analysis. Int J Equity Health. 2013;12:21.CrossRefPubMedPubMedCentral
22.
Rey G, Jougla E, Fouillet A, Hémon D. 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. BMC Public Health. 2009;9:33.CrossRefPubMedPubMedCentral
23.
Hurtado JL, Bacigalupe A, Calvo M, Esnaola S, Mendizabal N, Portillo I, et al. Social inequalities in a population based colorectal cancer screening programme in the Basque Country. BMC Public Health. 2015;15(1):1021.CrossRefPubMedPubMedCentral
24.
Bryere J, Pornet C, Copin N, Launay L, Gusto G, Grosclaude P, et al. Assessment of the ecological bias of seven aggregate social deprivation indices. BMC Public Health. 2017;17(1):86.CrossRefPubMedPubMedCentral
25.
Legleye K, Beck P-W. Widening inequalities in smoking initiation and cessation patterns: a cohort and gender analysis in France. Drug Alcohol Depend. 2011;117(2–3):233–41.CrossRefPubMed
26.
Graham H. Smoking prevalence among women in the European Community 1950-1990. Soc Sci Med. 1996;43(2):243–54.CrossRefPubMed
27.
Baumann M, Spitz E, Guillemin F, Ravaud JF, Choquet M, Falissard B, et al. Associations of social and material deprivation with tobacco, alcohol, and psychotropic drug use, and gender: a population-based study. Int J Health Geogr. 2007;6(1):50.CrossRefPubMedPubMedCentral
28.
Vernay M, Chan Chee C, Szego E, Castetbon K. Maigreur, obésité et perte d’autonomie chez les personnes âgées à domicile en France : l’enquête nationale Handicap-Santé volet « ménages », 2008. Bull Epidémiol Hebd. 2013;(33-34):425–32.
29.
30.
Roskam AJ, Kunst AE, Van Oyen H, Demarest S, Klumbiene J, Regidor E, et al. Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries. Int J Epidemiol. 2010;39(2):392–404.CrossRefPubMed
31.
Berger F, Doussau A, Gautier C, Gros F, Asselain B, Reyal F. Impact du statut socioéconomique sur la gravité du diagnostic initial de cancer du sein. Revue Epidemiol Sante Publique. 2012;60(1):19–29.
32.
Chaix B, Chauvin P. Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: A multilevel analysis of individual and area-level determinants. Eur J Epidemiol. 2002;18(6):531–8.
33.
Clavel-Chapelon F. Cohort profile: the French E3N cohort study. Int J Epidemiol. 2015;44(3):801–9.CrossRefPubMed
34.
Pardo-Crespo MR, Narla NP, Williams AR, Beebe TJ, Sloan J, Yawn BP, et al. Comparison of individual-level versus area-level socioeconomic measures in assessing health outcomes of children in Olmsted County, Minnesota. J Epidemiol Community Health. 2013;67(4):305–10.CrossRefPubMedPubMedCentral
35.
Domínguez-Berjón F. The usefulness of area-based socioeconomic measures to monitor social inequalities in health in southern Europe. Eur J Public Health. 2005;16(1):54–61.CrossRefPubMed
36.
Harper S, Lynch J. Commentary: using innovative inequality measures in epidemiology. Int J Epidemiol. 2007;36(4):926–8.CrossRefPubMed
37.
Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85(3):257–68.PubMed
38.
Bouyer J, Hémon D. Studying the performance of a job exposure matrix. Int J Epidemiol. 1993;22(Supplement 2):S65–71.CrossRefPubMed
39.
McNeish DM. Modeling sparsely clustered data: Design-based, model-based, and single-level methods. Psychol Methods. 2014;19(4):552–63.
40.
McCall SJ, Bhattacharya S, Okpo E, Macfarlane GJ. Evaluating the social determinants of teenage pregnancy: a temporal analysis using a UK obstetric database from 1950 to 2010. J Epidemiol Community Health. 2015;69(1):49–54.
41.
Cesaroni G, Farchi S, Davoli M, Forastiere F, Perucci CA. Individual and area-based indicators of socioeconomic status and childhood asthma. Eur Respir J. 2003;22(4):619–24.CrossRefPubMed
42.
White P. Who lives in deprived areas in British cities ? Géocarrefour. 2000;75:107–16.CrossRef
43.
Diez-Roux AV. A glossary for multilevel analysis. J Epidemiol Community Health. 2002;56(8):588–94.
44.
Jacquemin B, Siroux V, Sanchez M, Carsin AE, Schikowski T, Adam M, et al. Ambient air pollution and adult asthma incidence in six European cohorts (ESCAPE). Environ Health Perspect. 2015;123(6):613–21.PubMedPubMedCentral
45.
Windenberger F, Rican S, Jougla E, Rey G. Spatiotemporal association between deprivation and mortality: trends in France during the nineties. Eur J Pub Health. 2012;22(3):347–53.CrossRef
46.
Padilla CM, Kihal-Talantikite W, Vieira VM, Rossello P, Le Nir G, Zmirou-Navier D, et al. Air quality and social deprivation in four French metropolitan areas—a localized spatio-temporal environmental inequality analysis. Environ Res. 2014;134:315–24. ElsevierCrossRefPubMedPubMedCentral
47.
Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992;82(5):703–10.CrossRefPubMedPubMedCentral
48.
Diez-Roux AV, Kiefe CI, Jacobs DR Jr, Haan M, Jackson SA, Nieto FJ, et al. Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies. Ann Epidemiol. 2001;11(6):395–405.CrossRefPubMed
49.
50.
Berkman LF, Macintyre S. The measurement of social class in health studies: old measures and new formulations. IARC Sci Publ. 1997;138:51–64.
Metadata
Title
Ability of ecological deprivation indices to measure social inequalities in a French cohort
Authors
Sofia Temam
Raphaëlle Varraso
Carole Pornet
Margaux Sanchez
Aurélie Affret
Bénédicte Jacquemin
Françoise Clavel-Chapelon
Grégoire Rey
Stéphane Rican
Nicole Le Moual
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4967-3

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