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A comparison of individual and area-based socio-economic data for monitoring social inequalities in health
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by Robert Pampalon, Denis Hamel and Philippe Gamache
Abstract
Keywords
Findings
Authors
What is already known on this subject?
What does this study add?
Abstract
Background
Area-based indicators are commonly used to measure and track health outcomes by socio-economic group. This is largely because of the absence of socio-economic information about individuals in health administrative databases. The literature shows that the magnitude of differences in health outcomes varies depending on whether the socio-economic indicators are at the individual level or are area-based. This study compares the two types of indicators.
Data and methods
The data are from a file linking the results of the 1991 Census with deaths that occurred from 1991 to 2000―a 15% sample of the Canadian population aged 25 or older. The socio-economic indicator used for comparison is a material and social deprivation index, in individual and area-based versions. The health indicators are life expectancy and disability-free life expectancy, and risks of mortality and disability.
Results
The individual version of the deprivation index yields wider gaps in life expectancy and disability-free life expectancy than does the area-based version. These gaps vary by sex and geographic setting. However, both versions are associated with inequalities in mortality and disability, independent of each other.
Interpretation
Despite some limitations, area-based socio-economic indicators are useful in assessing inequalities in health. The inequalities that they identify are significant, consistent and reliable and can be tracked through time and for different geographic settings.
Keywords
area-based measure, deprivation, disability-free life expectancy, geography, life expectancy, social inequalities
Findings
Indicators of health status and the health care system in Canada are available in publications such as the Federal Report on Comparable Health Indicators (2002, 2004 and 2006) and the annual online series, Health Indicators, which has been produced since 2002. These sources provide more than one hundred indicators, by sex, age group, province and health region, but only one indicator, health-adjusted life expectancy, is connected to a socio-economic measure—average neighbourhood income. Therefore, it is not surprising that participants in a recent conference recommended that health indicators take the concept of equity into account, specifi cally, that they incorporate socioeconomic status and place of residence (urban or rural). [Full text]
Authors
Robert Pampalon (1-418-650-5115, ext. 5719, robert.pampalon@inspq.qc.ca), Denis Hamel (denis.hamel@inspq.qc.ca) and Philippe Gamache (philippe.gamache@inspq.qc.ca) are with the Unité des études et analyses de l’état de santé de la population, Institut national de santé publique du Québec, 945 Wolfe Avenue, Quebec, Quebec, G1V 5B3.
What is already known on this subject?
- In Canada, social inequalities in health are monitored mainly with the use of area-based socio-economic indicators.
- The size of these inequalities can vary depending on whether the socio-economic indicator is area-based or at the individual level.
What does this study add?
- This study uses a Canadian index of material and social deprivation as a socio-economic indicator to examine differences in Canada as a whole and in selected geographic settings.
- Inequalities in life expectancy, with or without disability, are greater when measured at the individual level, especially in certain geographic settings.
- Both the individual and the area-based versions of the deprivation index are associated with inequalities in mortality and disability.
- Despite their limitations, area-based indicators continue to be appropriate measures for monitoring social inequalities in health.
