Can an Ecological Index of Deprivation Be Used at the Country Level? The Case of the French Version of the European Deprivation Index (F-EDI)

Most ecological indices of deprivation are constructed from census data at the national level, which raises questions about the relevance of their use, and their comparability across a country. We aimed to determine whether a national index can account for deprivation regardless of location characteristics. In Metropolitan France, 43,853 residential census block groups (IRIS) were divided into eight area types based on quality of life. We calculated score deprivation for each IRIS using the French version of the European Deprivation Index (F-EDI). We decomposed the score by calculating the contribution of each of its components by area type, and we assessed the impact of removing each component and recalculating the weights on the identification of deprived IRIS. The set of components most contributing to the score changed according to the area type, but the identification of deprived IRIS remained stable regardless of the component removed for recalculating the score. Not all components of the F-EDI are markers of deprivation according to location characteristics, but the multidimensional nature of the index ensures its robustness. Further research is needed to examine the limitations of using these indices depending on the purpose of the study, particularly in relation to the geographical grid used to calculate deprivation scores

Functional forms of socio-territorial inequities in breast cancer screening - A French cross-sectional study using hierarchical generalised additive models

To reduce the breast cancer burden, the French National Organised Breast Cancer Screening Programme (FNOBCSP) was implemented in 2004. The recommended participation rate has never been achieved and socio-territorial inequities in participation have been reported on several occasions. We investigated the functional forms and consistency of the relationships between neighbourhood deprivation, travel time to the nearest accredited radiology centre and screening uptake. We used two-level hierarchical generalised additive models in 8 types of territories classified by socio-demographic and economic factors. The first level was 368,201 women aged 50-72 invited to the 2013-2014 screening campaign in metropolitan France. They were nested in 41 départements, the level of organisation of the FNOBCSP. The effect of travel time showed two main patterns: it was either linear (with participation decreasing as travel time increased) or participation first increased with increasing travel time to a peak around 5-15 min and decreased afterward. In nearly all types and départements, the probability of participation decreased linearly with increasing deprivation. Territorial inequities in participation were more context-dependent and complex than social inequities. Inequities in participation represent a loss of opportunity for individuals who already have the worst cancer outcomes. Evidence-based public health policies are needed to increase the effectiveness and equity of breast cancer screening

Is the Social Gradient in Net Survival Observed in France the Result of Inequalities in Cancer-Specific Mortality or Inequalities in General Mortality?

BACKGROUND: In cancer net survival analyses, if life tables (LT) are not stratified based on socio-demographic characteristics, then the social gradient in mortality in the general population is ignored. Consequently, the social gradient estimated on cancer-related excess mortality might be inaccurate. We aimed to evaluate whether the social gradient in cancer net survival observed in France could be attributable to inaccurate LT. METHODS: Deprivation-specific LT were simulated, applying the social gradient in the background mortality due to external sources to the original French LT. Cancer registries' data from a previous French study were re-analyzed using the simulated LT. Deprivation was assessed according to the European Deprivation Index (EDI). Net survival was estimated by the Pohar-Perme method and flexible excess mortality hazard models by using multidimensional penalized splines. RESULTS: A reduction in net survival among patients living in the most-deprived areas was attenuated with simulated LT, but trends in the social gradient remained, except for prostate cancer, for which the social gradient reversed. Flexible modelling additionally showed a loss of effect of EDI upon the excess mortality hazard of esophagus, bladder and kidney cancers in men and bladder cancer in women using simulated LT. CONCLUSIONS: For most cancers the results were similar using simulated LT. However, inconsistent results, particularly for prostate cancer, highlight the need for deprivation-specific LT in order to produce accurate results

Ecological measurement of material and social deprivation in the study of social inequalities in health : limitations and prospects

Afin de réduire les inégalités sociales de santé (ISS) entre et au sein des pays, il est crucial d’avoir à disposition des outils adaptés et validés. Différents indicateurs du statut socio-économique (SSE), sont utilisés pour étudier les ISS. Ils sont complémentaires et comportent chacun leurs limites d’utilisation. Dans ce travail de thèse, nous nous sommes plus spécifiquement intéressés aux indices écologiques de désavantage en nous focalisant sur la version française de l’European Deprivation Index (F-EDI). Dans un premier temps, nous avons évalué les performances de l’indice dans différents types de territoires de vie en interrogeant sa composition mais également le plus petit maillage géographique utilisé. Dans un second temps, nous avons mesuré, avec le F-EDI appliqué à une échelle géographique infra-communale, le gradient social de mortalité toute cause dans la population française adulte en produisant une table de mortalité spécifique pour la période 2016-2018. Ce nouvel outil devrait notamment faciliter la mesure de la contribution relative des inégalités sociales à la mortalité pour différentes pathologies. Dans le cadre d’une collaboration avec l’INED*, nous avons également étudié le gradient de mortalité selon le SSE en utilisant un indicateur à l’échelle individuelle : la catégorie socio-professionnelle (CSP). Plusieurs tables de mortalité spécifiques à la CSP ont été produites permettant d’analyser l’évolution des inégalités de mortalité en France sur une période récente (2011 à 2019). La documentation des limites d’utilisation d’un indice de désavantage de dimension européenne et la mise à disposition de tables de mortalité françaises spécifiques au SSE, réactualisables dans le temps et avec différents indicateurs, s’inscrivent dans une démarche de lutte contre les ISS.In order to reduce social inequalities in health (SIH) between and within countries, it is crucial to have appropriate and validated tools. Various socio-economic status (SES) indicators are used to study SIH. They are complementary and each has its own limitations. In this thesis, we took a more specific interest in ecological indices of deprivation, focusing on the French version of the European Deprivation Index (F-EDI). First, we assessed the performance of the index in different types of area by questioning its composition and the smallest geographical grid used. Secondly, using the F-EDI applied at a sub-municipal geographical level, we measured the social gradient of all-cause mortality in the French adult population by producing a specific life table for the period 2016-2018. This new tool should facilitate the measurement of the relative contribution of social inequalities to mortality for different pathologies. As part of a collaboration with INED*, we have also studied the mortality gradient according to SES using an individual level indicator: occupational categories (OCs). Several OC-specific life tables have been produced to analyse changes in mortality inequalities in France over a recent period (2011 to 2019). Documenting the limits of use of a deprivation index with a European dimension and the provision of French SES-specific life tables, which can be updated over time and with different indicators, are embedded in a process of tackling SIH

Can an Ecological Index of Deprivation Be Used at the Country Level? The Case of the French Version of the European Deprivation Index (F-EDI)

Most ecological indices of deprivation are constructed from census data at the national level, which raises questions about the relevance of their use, and their comparability across a country. We aimed to determine whether a national index can account for deprivation regardless of location characteristics. In Metropolitan France, 43,853 residential census block groups (IRIS) were divided into eight area types based on quality of life. We calculated score deprivation for each IRIS using the French version of the European Deprivation Index (F-EDI). We decomposed the score by calculating the contribution of each of its components by area type, and we assessed the impact of removing each component and recalculating the weights on the identification of deprived IRIS. The set of components most contributing to the score changed according to the area type, but the identification of deprived IRIS remained stable regardless of the component removed for recalculating the score. Not all components of the F-EDI are markers of deprivation according to location characteristics, but the multidimensional nature of the index ensures its robustness. Further research is needed to examine the limitations of using these indices depending on the purpose of the study, particularly in relation to the geographical grid used to calculate deprivation scores

Les ouvriers vivent moins longtemps que les cadres : combien de temps passent-ils à la retraite et en (in)activité ?

En 2018, l’espérance de vie à 35 ans des hommes cadres est de près de 50 ans, contre 44 ans pour les ouvriers, soit presque 6 ans d’écart. Ces écarts d’espérance de vie sont encore importants à 62 ans : 3 ans et 6 mois ans chez les hommes, 2 ans et 8 mois chez les femmes. En dépit d’un départ à la retraite plus précoce, les ouvriers passent 2 années de moins à la retraite que les cadres et 3,4 années de plus au chômage ou en inactivité. Par ailleurs, les années de chômage ou d’inactivité sont fréquentes dans les années précédant l’âge légal pour les ouvriers. Les femmes passent de 3 à 4 ans de plus à la retraite que les hommes de catégorie sociale similaire, mais aussi plus d’années qu’eux en inactivité

Employees in higher-level occupations outlive manual workers. How long do they live in retirement or (in)activity?

In 2018, life expectancy at age 35 was almost 50 years for men in higher-level occupations versus 44 years for manual workers, a gap of nearly 6 years. These differences remain large at age 62: 3 years 6 months for men and 2 years 8 months for women. Despite a younger retirement age, male manual workers spend 2 fewer years in retirement than men in higher-level occupations and almost 3.5 more years unemployed or inactive. Moreover, manual workers frequently experience years of unemployment or inactivity before reaching legal retirement age. Women spend 3 to 4 more years in retirement than men of the same occupational category but also have more years of inactivity

School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand

Background Adolescents living with perinatal HIV often experience difficult living circumstances that can impact educational achievement and thus their transition to adult life. We explored their school trajectories and evaluated the contribution of perinatal HIV-infection, in Thailand, where education is free and compulsory until the age of 15. Methods We used data from the Teens Living with Antiretrovirals (TEEWA) study, a cross-sectional case-control study conducted from 2011 to 2014 in Thailand. Participants were 707 adolescents living with perinatal HIV (ALPHIV, cases) aged 12–19 receiving antiretroviral therapy in 19 hospitals throughout Thailand and 689 HIV-uninfected adolescents (controls) living in the same institutions or, for those living in family settings, randomly selected from the general population and individually matched for sex, age, and place of residence. School trajectory disruption was defined as ≥1 year of academic delay or as early school dropout (before 15 years of age). Logistic regression models were used to assess factors independently associated with disrupted school trajectory and to estimate the proportion of school disruption attributable to HIV-infection. We used multivariate imputations by chained equations (MICE) to manage missing data and performed two sensitivity analyses to evaluate the main model’s reliability. Results The study population’s median age was 14.5 years (58% female). School trajectory disruption was experienced by 37% of ALPHIV and 12% of the controls. After adjusting for sociodemographic factors, ALPHIV were 5 times more likely to experience disruption than controls (ORA =5.2 [3.7–7.2]). About 50% of school trajectory disruption was attributable to HIV-infection. Males and adolescents living in institutions were more likely to experience school trajectory disruption (ORA =1.8 [1.3–2.4] and ORA =11.0 [7.7–15.8], respectively). Among ALPHIV, neurocognitive difficulties and growth delay were significantly associated with disruption (ORA =3.3 [2.1–5.2] and ORA =1.8 [1.3–2.6], respectively). For those living in families, disruption was also associated with having a caregiver who had less than a secondary-level education (ORA =2.1 [1.1–3.9]) or having experienced stigmatization (ORA =1.9 [1.2–3.1]). Conclusions HIV and contextual factors combine to aggravate the educational disadvantage among ALPHIV. The impact of this disadvantage on their life prospects, especially regarding access to higher education and professional achievement, should be further explored