Short reportCross-sectional study of ethnic differences in the utility of area deprivation measures to target socioeconomically deprived individuals
Highlights
► Ethnic minority populations have a higher risk of many diseases associated with socioeconomic deprivation. ► Area deprivation measures offer a tool for targeting public health interventions at socioeconomically deprived individuals. ► Area deprivation measures identify higher proportions of deprived individuals from Pakistani and Black Caribbean groups. ► Area deprivation measures do not misidentify higher proportions of non-deprived individuals in ethnic minority groups. ► Pragmatic use of area deprivation measures to target deprived individuals would not disadvantage ethnic minority groups.
Introduction
Socioeconomic status is a well established and an important determinant of health and health inequalities. Lower individual socioeconomic status, measured by factors such as education, income, occupation, housing and car ownership, has been shown to be associated with poorer health (Macintyre, Ellaway, Der, Ford, & Hunt, 1998; Marmot, 2005; Marmot et al., 1991). Therefore, targeting public health interventions at socioeconomically deprived individuals has the potential to reduce health inequalities, as well as improve overall health. In practice, measuring and recording socioeconomic position for every individual in the general population is resource intensive and impractical, so alternative approaches are often used. A commonly used approach is to target individuals who live in socioeconomically deprived geographical areas using accessible area based measures, which incorporate multiple aspects of deprivation (Demissie, Hanley, Menzies, Joseph, & Ernst, 2000; Galobardes, Shaw, Lawlor, Lynch, & Davey Smith, 2006; Tunstall & Lupton, 2003). These measures classify small areas using aggregated data about the characteristics of residents (Noble et al., 2004). However, the use of area deprivation measures to classify the socioeconomic position of residents is subject to the “ecological fallacy”; aggregated information relating to a group of individuals may not reflect the characteristics of all individuals in that group (Macintyre, Ellaway, & Cummins, 2002). An effective tool should accurately capture the target population, whilst minimising the number of people who are targeted in error. Using area deprivation as a proxy for individual deprivation in a targeting process may, nonetheless, be justified if a sufficiently high proportion of deprived individuals live in deprived areas and the number of non-deprived individuals targeted inappropriately is sufficiently small.
Ethnic minority groups in the UK experience higher levels of socioeconomic deprivation (Barnard & Turner, 2011; Nazroo, 1998; Smaje, 1995), and a higher risk of associated diseases than the White population (Bhopal et al., 2002; Davey Smith, Chaturvedi, Harding, Nazroo, & Williams, 2000; Nazroo, 2003). Area measures of deprivation currently in use are driven by a majority White population and may not therefore be equally applicable across other ethnic groups (Davey Smith, 2000). It is unclear whether the pragmatic use of area measures of deprivation as a tool for targeting prevention at deprived individuals works equally well in non-white populations.
This study therefore asked three questions. First, are there ethnic differences in the extent to which area deprivation measures agree with individual socioeconomic measures? Second, are there ethnic differences in the proportion of socioeconomically deprived individuals that are identified by area deprivation measures? Third, are there ethnic differences in the extent to which people without individual socioeconomic deprivation are inappropriately included using area deprivation measures? The findings are discussed in relation to the practical implications for public health programmes.
Section snippets
Data
The Health Survey for England (HSE) is a large, annual, cross-sectional survey that contains self-reported information on health and individual circumstances. The HSE 2004 contained a boosted sample of the ethnic minority population in England (Sproston & Mindell, 2004). Multi-stage stratified probability sampling was used to recruit representative samples of the general and ethnic minority population living in private households (Sproston & Mindell, 2006). Postal addresses were used to select
Results
The overall unweighted sample comprised 7208 participants, of whom 4377 (60.7%) were White, 1070 (14.8%) Indian, 874 (12.2%) Pakistani and 887 (12.3%) Black Caribbean (Table 1). Each ethnic minority group had a significantly lower mean age than the White group with the lowest mean age in the Pakistani group. There were significantly fewer males in each ethnic minority group compared to the White group, with the lowest proportion in the Black Caribbean group. In comparison to the White group,
Discussion
The study identified differences between the four ethnic groups in how well area deprivation performs as a tool for targeting deprived individuals. In spite of lower agreement between area based and individual measures of socioeconomic position in the Pakistani and Black Caribbean groups, sensitivity was consistently higher compared to the White group and PPV was no worse in the ethnic minority groups. This suggests that if area deprivation is used as a tool for targeting deprived individuals
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