[Regional deprivation and mortality in Bavaria. Development of a community-based index of multiple deprivation].
BACKGROUND
Deprivation indices are valuable instruments for the analysis of regional effects on health. They may also be used as a surrogate when individual socioeconomic data are not available. These regional deprivation indices are integral parts of the public health discussion in the United Kingdom. In Germany, however, the discussion on this topic has just begun. Our aim was to develop a small-area based, multidimensional Index of Multiple Deprivation (IMD) for Germany, based on an established British method.


METHODS
We chose the German state of Bavaria with its n=2 056 communities as a model region. We used official sociodemographic, socioeconomic and environmental data and created a Bavarian Index of Multiple Deprivation (BIMD). In order to test the applicability of the BIMD in epidemiological analyses we then performed a correlation analysis (Spearman's correlation coefficient) as well as a Poisson regression using data on premature mortality (< 65 years) and on total mortality (all age groups).


RESULTS
The correlation analysis showed a positive and significant association between regional deprivation and mortality. The Poisson regression showed a clear gradient, i. e., we found a stepwise increase of mortality risk with increasing regional deprivation. Compared with communities in the lowest deprivation quintile, communities in the highest deprivation quintile showed a clearly higher mortality risk, both for premature mortality [RR 1.49 (95% CI: 1.42 - 1.57)] and for total mortality [RR 1.21 (95% CI: 1.18 - 1.25)].


CONCLUSIONS
Using this new index, we could demonstrate for communities in Bavaria that higher regional deprivation is associated with higher mortality. This Index of Multiple Deprivation is a new and potentially useful tool for epidemiological and public health related studies in Germany.
Institut für Gesundheitsökonomie und Management im Gesundheitswesen. werner.maier@helmholtzmuenchen.de
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Maier
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Fairburn
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Mielck
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003467:Cultural Deprivation; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011204:Poverty Areas; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult