The local Socio-Economic Health Deprivation Index: methods and results

Introduction. A socio-economic (SE) deprivation index is a measure which aim is to provide an indication of a SE condition of hardship and disadvantage in the population. This study provided ten Socio-Economic and Health Deprivation Indices (SEHDI) calculated with a shared methodology. The peculiar construction method makes them suitable for investigating the relationships between SE inequalities and aspects of health and prevention in the population. Materials and methods. Data on the demographic and SE situation of the populations derived from the 2011 Census at Census Tract (CT) level (2001 for Rome municipality). For the construction of the SEHDIs only the variables statistically significant correlated with the SMRs of general mortality were subjected to a tolerance test of linearity in order to eliminate the collinear ones. On them, a PCA analysis was applied to obtain the factors to be linearly combined into the SEHDI. The final values were scaled from minimum to maximum deprivation, and the quantitative scale was converted in five ordinal normalized population groups. The SEHDIs were validated at the SE level by comparison with the trends of the main synthetic SE indices of the 2011 Census (2001 for Rome municipality). A validation at the health level was made by comparison with the trends of some causes of death. Both comparisons were made by the ANOVA. Regarding the vaccination coverage, the data were collected from the general practitioners, using, as a proxy for coverage, the geo-referencing of medical offices at CT level, in order to estimate the percentage of vaccinated over-65 years on population of the same age. To evaluate the role of SE differences on vaccination coverage, the latter was compared though the deprivation groups, calculating the differences in coverage between groups applying ANOVA testing. Results. The ten considered areas were the municipalities of Cagliari, Ferrara, Florence, Foggia, Genoa, Rome, Palermo, Sassari, Siena, and the ULSS 7 Veneto area. For each one a specific SEHDI was computed and the different variables part of each index stressed the peculiar aspects of the SE and health deprivation at area level. The SEHDIs showed good percentages of explained variance (from 72.2% to 49.1%), and, a linear distribution of the main statistical SE indices and of the general mortality in each area, according with the scientific literature about the relationship among SE condition and health status of population. The analyses about the by-cause mortality distribution through the SEHDIs deprivation clusters were discussed in other articles, which developed the findings of the study in each area.Conclusion. The SEHDIs showed good ability in identifying the elements of SE inequalities that impact on the health conditions of populations, in describing the distribution of death causes sensitive to SE differences for which aspects of the social and family support structure are relevant, in describing the characteristics that underlie the differences in vaccine coverage through the different groups of deprivation. From a public health perspective these results are relevant, because they make it possible to direct the vaccination promotion actions on the basis of the characteristics that define the deprivation groups

Deindustrialisation, demographic decline, aging, economic crisis and social involution in a metropolitan area analysed by applying Socio-Economic and Health Deprivation Indices.

Aims - Genoa is a city hit by a strong economic, demographic and social involution. The changes in the demographic and socio-economic (SE) situation were analysed and the capacity of two Socio-Economic and Health Deprivation Indices (SEHDI) in describing the evolutions of the recent period were verified. Material and Methods – The data about the evolution of demographic and SE situation in Genoa came from publications of Statistics Offices of Genoa Municipality and Liguria Region and from published analyses of Bank of Italy. The two SEHDIs, referring to 2001 and 2011 population, were computed at census tract level by linear regression, factor and clusters analyses and had been already validated and published. Results – Wide transformations in aging and population composition by age groups and gender occurred in Genoa between 1951 and 2016. Internal (from other Italian regions) and external (from other countries) migrations concurred to change the profile of Genoese population. These changes followed the industrial history of city and its deindustrialization occurred since 2001. A progressive SE involution, worsened by the Italian and international crises, carried out the recent impoverishment of the city. Between 2001 and 2011 the population at medium-high deprivation increased and the SEHDIs 2001 and 2011 contributed to describe the population distribution by deprivation groups, either geographically, and by groups of citizenships (Italians and Foreigners). The first identified in 2001 some aspects of a well-off society regarding education, labour market and characteristics of the family and housing structure. The second depicted in 2011 an impoverished society in aging, lack of family support and of property of the main house, diminishing of educational level. Discussion - Genoa city demonstrated an its own specific decline. Starting from the deindustrialization, a worsening of welfare, independently from the national and international economic troubles, was evident. The aging and the changed equilibria among age groups testified the growing difficulties of society in keeping up with the deep social and economic changes. The results demonstrated that specific deprivation indices aid to better define the populations under analysis, because they identify the subpopulations that could have the maximum benefit from investments of resources targeted to the correction of inequalities

Application of Socio-Economic and Health Deprivation Indices to study the relationships between socio-economic status and disease onset and outcome in a metropolitan area subjected to aging, demographic fall and socio-economic crisis.

Aims - Genoa is a city hit by a deep economic, demographic and social involution. The association between disease onset and outcome and socioeconomic status (SES) was assessed in the mortality by cause in two periods, using indices referred to the distribution of deprivation in the population ten years apart. Material and Methods – Two Socio-Economic and Health Deprivation Indices (SEHDIs), computed at census tract level (2001 and 2011 Censuses), were applied to analyse the SMRs by cause, age (0-64 and 65+ years) and gender of the five normalised groups of deprivation individuated in the two population distribution. The associations between SES and onset of disease was described in the mortality 2008-11 using the index referred to 2001 population, while the second, referred to 2011 population, described the associations between SES and disease outcomes in the mortality 2009-13. Two ANOVAs evaluated the statistical significance (p<0.05) of differences in death distribution among groups. Results – The population at medium-high deprivation increased in Genoa between 2001 and 2011. The mortality by age and gender showed different trends. Not significant trends (NS) in both periods regarded only the younger (respiratory diseases in both sexes, prostate cancer, diabetes in women). Linearly positives (L↑) trends in both periods were observed only in men (all cancers and lung cancers, overall mortality and cardiovascular diseases in younger, diabetes in older). Not linear trends (NL) in both periods interested both sexes for flu and pneumonia, women for lung cancer, old women for overall mortality and respiratory diseases, old men for colorectal cancers. Instead, L↑ trends in the final phases of disease interest all cancers in the elderly (NS trend at the disease onset), all cancers and breast cancer in young women, diabetes and colorectal cancers in young men (NL trends at the disease onset). On the contrary, L↑ trends at the disease onset and NL trends in the final phases regarded cardiovascular diseases in elderly, overall mortality, respiratory diseases and prostate cancer in old men, diabetes and colorectal cancers in old women. Finally, NL trends at the disease onset regarded colorectal cancers in young women (NS trend in the final phases) and breast cancer in the older (linearly negative trend, L↓, in the final phases). Discussion - Deprivation trends confirmed the literature about populations lapsing towards poverty. Ageing-linked social risks were revealed, reflecting the weakening of social-health care, which worsened in elderly if alone. Serious problems in younger singles or in the single-parent families arose. Cardiovascular diseases, all cancers and colorectal cancers trends confirmed the advantage of less deprived when diseases are preventable and curable. Prostate and breast cancers trends reflected the rising incidence and increasing problems in care. The need of corrective interventions in social and health policies is emerging, adequate to support in a targeted way a population in an alarming condition of socio-economic deterioration

Regional indices of socio-economic and health inequalities: a tool for public health programming

Abstract OBJECTIVES. The aim was to provide an affordable method for computing socio-economic deprivation indices at regional level, to reveal the specific aspects of the relationship between socio-economic (SE) inequalities and health outcomes. The Umbria region Socio-Health Index (USHI) was computed and compared to the Italian National Deprivation Index at Umbria region level (NDI-U).METHODS. The USHI was computed by applying factor analysis to census tract SE variables correlated to the general mortality and validated in comparison with the NDI-U.RESULTS. Overall mortality presented linear positive USHI trends, while trends for NDI-U resulted non-linear or not-significant. Similar and relevant results were obtained for specific causes of death by deprivation groups, gender and age.CONCLUSIONS. The USHI better describes a local population by SE health-related status. Therefore, policy makers could adopt this method to obtain a better picture of SE-associated health conditions in regional population and target strategies for reducing inequalities in health

Analysis of influenza vaccination coverage among the elderly in Genoa (Italy) based on a deprivation index, 2009-2013

IntroductionElderly use to develop more complications after influenza and the 90% of deaths for influenza regards them. Indeed, they are among the major target of vaccination campaigns. The use of deprivation indices can help to identify subgroups with lower vaccine uptake. This work was aimed to analyze vaccination coverage of elderly living in Genoa using a local Index of Socio-Economic and Health Deprivation (SEHDI) in order to identify subgroups of population needing specific actions to improve vaccination coverage.MethodsThe target population was the population aged ≥65 years living in Genoa in the 2009-2013 period. Information about vaccination coverage derived from general practitioners. A combination of linear regression, factor analysis and cluster analysis was used to build the SEHDI at Census Tract (CT) level, deriving data from the 2011 Italian census.ResultsIn Genoa, in 2011, people aged ≥65 years represented the 27.7% of the population. The majority of elderly belonged to medium (45.3%) and medium-high (32%) deprivation groups, while the percentages in the extreme tails were low (3.6% high deprived; 1.3% low deprived). Significant not linear (p<0.05 NL) relationships were observed in both sexes for all respiratory diseases (RD) and COPD mortality, with the highest SMRs values in the high deprivation group of women (1.81, p<0.05 RD; 1.79, p<0.05 COPD). The SMRs for influenza and pneumonia showed a linear positive trend in women (p<0.05), with the highest value in the high deprived (1.97, p<0.05), while in men the trend was NL (p<0.05). A positive linear trend (p<0.05) was found for vaccination coverage, weakly growing at deprivation increase until the medium-high deprived group (from 34.6% to 44.4%), but the high deprivation group showed the lowest value (33,3%).ConclusionsThe results displayed a positive relationship between deprivation and vaccination coverage. This finding should be taken into account in the organization of vaccination campaigns and should call for differentiated actions in each small areas

Identifying people at risk for influenza with low vaccine uptake based on deprivation status: a systematic review

Background: Influenza vaccination is an important public health intervention for controlling disease burden, but coverage rates are still low also in risk groups. In order to identify non-vaccinating subgroups, deprivation and socio-economic indices, i.e. measures used to synthetically describe people\u2019s socio-economic status while taking into account several dimensions, may be used. We aimed to synthetize evidence from studies investigating association between deprivation/socio-economic indices and influenza vaccination coverage in population at risk\u2014 persons 65 years of age, individuals with comorbidities, pregnant women and health-care workers. Methods: We searched PubMed, ISI WoS, CINAHL and Scopus to identify observational studies published up to October 10th 2017 in English or Italian. Studies reporting quantitative estimates of the association between deprivation/socioeconomic indices and influenza vaccination coverage in populations at risk were included. Results: A total of 1474 articles were identified and 12 were eventually included in the final review. Studies were mostly cross-sectional, performed in European countries, from 2004 to 2017. Seven studies focussed on deprivation and five on socioeconomic indices. Studies on deprivation indices and vaccination coverage showed that people from the most deprived areas had lower coverage. Regarding socio-economic condition, results were contrasting, even though it may also be concluded that people from lower groups have lower vaccination coverage. Conclusions: Our work supports the possibility to identify people likely to have lower influenza vaccination coverage based on deprivation/socio-economic indices. Efforts should be performed in order to further strengthen robustness, transferability and suitability of these indices in addressing public health problems

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

Application of socio-economic-health deprivation index, analysis of mortality and influenza vaccination coverage in the elderly population of Tuscany.

ObjectiveThe aim of this paper is to describe the results obtained from the application of a specific local deprivation index, calculated on the basis of 2011 Census sections, to general and cause-specific mortality and influenza vaccination coverage among elderly people of the municipality of Florence.MethodsGeneral and cause-specific mortality data (2009-2013) and influenza vaccination coverage data (2015/16 and 2016/17) have been collected for subjects aged ≥65 years residing in the municipality of Florence (Tuscany), at the 2011 Census section level. Socio-Economic and Health Deprivation Index (SEHDI) has been constructed and validated by using socio-economic indicators and mortality ratios.ResultsHalf the Florence population belongs to the medium deprivation group; about 25% belongs to the two most deprived groups, and the remaining 25% is wealthy. Elderly people mostly belong to the high deprivation group. All-cause mortality and cause-specific mortality (cancer and respiratory diseases) reach the highest values in the high deprivation group.Influenza vaccination coverage (VC) is 54.7% for the seasons 2015/16 and 2016/17, combined. VC shows a growing linear trend as deprivation increases. VC appears to be correlated with different factors in the different deprivation groups.ConclusionsSocio-economic deprivation plays an important role in health choices, so the application of SEHDI allows to identify the characteristics of the main sub-groups of the population with a low adherence to influenza vaccination. Results of the present study should be spread to General Practitioners in order to help them to promote influenza vaccination to their patients

Incident Use of Hydroxychloroquine for the Treatment of Rheumatoid Arthritis and Systemic Lupus Erythematosus During the COVID-19 Pandemic

Objective: We studied whether the use of hydroxychloroquine (HCQ) for COVID-19 resulted in supply shortages for patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Methods: We used US claims data (IQVIA PHARMETRICS® Plus for Academics [PHARMETRICS]) and hospital electronic records from Spain (Institut Municipal d'Assistència Sanitària Information System [IMASIS]) to estimate monthly rates of HCQ use between January 2019 and March 2022, in the general population and in patients with RA and SLE. Methotrexate (MTX) use was estimated as a control. Results: More than 13.5 million individuals (13,311,811 PHARMETRICS, 207,646 IMASIS) were included in the general population cohort. RA and SLE cohorts enrolled 135,259 and 39,295 patients, respectively, in PHARMETRICS. Incidence of MTX and HCQ were stable before March 2020. On March 2020, the incidence of HCQ increased by 9- and 67-fold in PHARMETRICS and IMASIS, respectively, and decreased in May 2020. Usage rates of HCQ went back to prepandemic trends in Spain but remained high in the United States, mimicking waves of COVID-19. No significant changes in HCQ use were noted among patients with RA and SLE. MTX use rates decreased during HCQ approval period for COVID-19 treatment. Conclusion: Use of HCQ increased dramatically in the general population in both Spain and the United States during March and April 2020. Whereas Spain returned to prepandemic rates after the first wave, use of HCQ remained high and followed waves of COVID-19 in the United States. However, we found no evidence of general shortages in the use of HCQ for both RA and SLE in the United States.</p

Cancer survival in the elderly: Effects of socio-economic factors and health care system features (ELDCARE project)

The purpose of the ELDCARE project is to study differences in cancer survival for elderly patients by country, taking into account the socio-economic conditions and the characteristics of health care systems at the ecological level. Fifty-three European cancer registries, from 19 countries, participating in the EUROCARE 3 programme, collected information to compute relative survival on patients aged 65-84 years, diagnosed over the period 1990-1994. National statistics offices provided the macro-economic and labour force indicators (gross domestic product, total health expenditure, and proportion of people employed in the agriculture sector) as well as the features of national health care systems. Survival for several of the cancer sites had high positive Pearson's correlations (r) with the affluence indicators (usually r > 0.7), but survival for the poor prognosis cancers (lung, ovary, stomach) and for cervix uteri was not so well correlated. Among the medical resources considered, the number of computed tomography scanners was the variable most related to survival in the elderly; the number of total health practitioners in the country did not show any relationship. Survival was related to the marital status of elderly women more strongly than for men and younger people. The highest correlations of survival with the percentage of married elderly women in the population were for cancers of the rectum (r = 0.79) and breast (r = 0.66), while survival correlated negatively with the proportion of widows for most cancers. Being married or widowed is for elderly people, in particular elderly women, an important factor influencing psychological status, life habits and social relationships. Social conditions could play a major role in determining health outcomes, particularly in the elderly, by affecting access to health care and delay in diagnosis