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

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

Development of a cross-cultural deprivation index in five European countries.

BACKGROUND: Despite a concerted policy effort in Europe, social inequalities in health are a persistent problem. Developing a standardised measure of socioeconomic level across Europe will improve the understanding of the underlying mechanisms and causes of inequalities. This will facilitate developing, implementing and assessing new and more effective policies, and will improve the comparability and reproducibility of health inequality studies among countries. This paper presents the extension of the European Deprivation Index (EDI), a standardised measure first developed in France, to four other European countries-Italy, Portugal, Spain and England, using available 2001 and 1999 national census data. METHODS AND RESULTS: The method previously tested and validated to construct the French EDI was used: first, an individual indicator for relative deprivation was constructed, defined by the minimal number of unmet fundamental needs associated with both objective (income) poverty and subjective poverty. Second, variables available at both individual (European survey) and aggregate (census) levels were identified. Third, an ecological deprivation index was constructed by selecting the set of weighted variables from the second step that best correlated with the individual deprivation indicator. CONCLUSIONS: For each country, the EDI is a weighted combination of aggregated variables from the national census that are most highly correlated with a country-specific individual deprivation indicator. This tool will improve both the historical and international comparability of studies, our understanding of the mechanisms underlying social inequalities in health and implementation of intervention to tackle social inequalities in health

Déterminants sociogéographiques de la participation aux dépistages organisés des cancers du sein et du colon-rectum

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF

Socioeconomic Determinants for Compliance to Colorectal Cancer Screening. A Multilevel Analysis.

International audienceBACKGROUND: Compliance in cancer screening among socially disadvantaged persons is known to be lower than among more socially advantaged persons. However, most of the studies regarding compliance proceed via a questionnaire and are thus limited by self reported measures of participation and by participation bias. This study aimed at investigating the influence of socioeconomic characteristics on compliance to an organised colorectal cancer screening programme on an unbiased sample based on data from the entire target population within a French geographical department, Calvados (N=180,045). METHODS: Individual data of participation and aggregate socioeconomic data, from respectively the structure responsible for organising screening and the French census, were analysed simultaneously by a multilevel model. RESULTS: Uptake was significantly higher in women than in men; odds ratio (OR=1.33; 95%CI: 1.21-1.45); and significantly lower in the youngest (50-59 years) and in the oldest (70-74 years) persons, compared with intermediate ages 60-69 years with respectively OR=0.70 (95%CI: 0.63-0.77) and OR=0.82 (95%CI: 0.72-0.93). Uptake fell with increasing level of deprivation, there was a significant difference of uptake probability between the least deprived and the most deprived areas (OR=0.68; 95%CI: 0.59-0.79). No significant influence of the general practitioners density was found. CONCLUSION: Multilevel analysis allowed to detect areas of weak uptake linked to areas of strong deprivation. These results suggest that targeting populations with a risk of low compliance, as identified both socially and geographically in our study, could be adopted to minimise inequalities in screening

Construction of an adaptable European transnational ecological deprivation index: the French version

Background: Studying social disparities in health implies the ability to measure them accurately, to compare them between different areas or countries and to follow trends over time. This study proposes a method for constructing a French European deprivation index, which will be replicable in several European countries and is related to an individual deprivation indicator constructed from a European survey specifically designed to study deprivation. Methods and Results: Using individual data from the European Union Statistics on Income and Living Conditions survey, goods/services indicated by individuals as being fundamental needs, the lack of which reflect deprivation, were selected. From this definition, which is specific to a cultural context, an individual deprivation indicator was constructed by selecting fundamental needs associated both with objective and subjective poverty. Next, the authors selected among variables available both in the European Union Statistics on Income and Living Conditions survey and French national census those best reflecting individual experience of deprivation using multivariate logistic regression. An ecological measure of deprivation was provided for all the smallest French geographical units. Preliminary validation showed a higher association between the French European Deprivation Index (EDI) score and both income and education than the Townsend index, partly ensuring its ability to measure individual socioeconomic status. Conclusion: This index, which is specific to a particular cultural and social policy context, could be replicated in 25 other European countries, thereby allowing European comparisons. EDI could also be reproducible over time. EDI could prove to be a relevant tool in evidence-based policy-making for measuring and reducing social disparities in health issues and even outside the medical domain

Inégalités sociales, de santé du constat à l’action – Intérêt de la mise en place d’un accompagnement personnalisé pour la réduction des inégalités sociales en cancérologie

International audienceThe impact of social factors on healthcare inequality is well-recognized in many industrialized countries and involves a wide range of pathological conditions (cardiovascular disease, cancer, etc.). In general, the poorest indicators of health are observed in socially disadvantaged populations. Beyond this observation is the question of actions taken to prevent the formation ofsocial inequality in healthcare. The purpose of this work was to evaluate the potential contribution of an intervention tool called the ‘‘patient navigator’’, used in English-speaking countries and to determine its feasibility in FranceDes inégalités sociales de santé ont été rapportées dans l’ensemble des pays industrialisés et pour un très grand nombre de pathologies (maladies cardiovasculaires, cancers, etc...). Les patients issus des milieux les plus défavorisés présentent généralement les plus mauvais indicateurs de santé. Au-delà du constat se pose dès lors la question des moyens d’action permettant de lutter efficacement contre la formation des inégalités sociales de santé. L’objectif de cet article est d’étudier l’intérêt potentiel d’une méthode de lutte contre les inégalités sociales en cancérologie, couramment dénommée « patient navigator » dans les pays anglosaxons (accompagnateur d’un patient en français) et d’évaluer la faisabilité de sa mise en place en France

Assessment of the ecological bias of seven aggregate social deprivation indices

International audienceAbstractBackgroundIn aggregate studies, ecological indices are used to study the influence of socioeconomic status on health. Their main limitation is ecological bias. This study assesses the misclassification of individual socioeconomic status in seven ecological indices.MethodsIndividual socioeconomic data for a random sample of 10,000 persons came from periodic health examinations conducted in 2006 in 11 French departments. Geographical data came from the 2007 census at the lowest geographical level available in France. The Receiver Operating Characteristics (ROC) curves, the areas under the curves (AUC) for each individual variable, and the distribution of deprived and non-deprived persons in quintiles of each aggregate score were analyzed.ResultsThe aggregate indices studied are quite good “proxies” for individual deprivation (AUC close to 0.7), and they have similar performance. The indices are more efficient at measuring individual income than education or occupational category and are suitable for measuring of deprivation but not affluence.ConclusionsThe study inventoried the aggregate indices available in France and evaluated their assessment of individual SES