title: Should we enhance the commonly used deprivation index for a regional context?
abstract: OBJECTIVE
  Versions of deprivation indices have been increasingly used to monitor patterns and magnitudes of inequality in health. For policy-makers, it is of interest to assess whether they need to construct regionally tailored indices, or whether the existing indices perform sufficiently in detecting inequalities in their respective jurisdiction. Few studies have explored the benefits of constructing a more tailored index for a regional context.
  
  
  METHODS
  The study examined, in linear regression models, the proportion of variance (adjusted R2) explained in age-standardized cardiovascular disease (CVD) incidence rate ratios by an index emulating a now-widely-used multiple deprivation index created in Quebec (INSPQI), and a newly created index for Nova Scotia with additional census variables. The magnitudes of inequality were compared by the differences between mean incidences of most and least deprived groups.
  
  
  RESULTS
  The newly created deprivation index did not explain as well as the INSPQI-like index the community-level variability in CVD incidences. The gap in mean CVD incidences between the most and least deprived groups was somewhat narrower with the new index, indicating that the new index is not necessarily more sensitive to the inequality attributed to community social disadvantages.
  
  
  CONCLUSIONS
  Complicating the indices may not necessarily be of benefit when used for surveillance of population health inequalities. For public health practitioners and decision makers who need to make quick decisions in provisions of services and programs, a generic, well-established deprivation index such as INSPQI can serve well in a regional context.
authors.affiliation: Health Geomatics Laboratory Environmental Science Programme Department of Community Health & Epidemiology Dalhousie University. mikiko.terashima@dal.ca.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Terashima
authors.forename: Daniel G C
authors.initials: DG
authors.lastname: Rainham
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Levy
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D009674:Nova Scotia / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D015203:Reproducibility of Results; D017062:Small-Area Analysis; D012959:Socioeconomic Factors
keywords: Deprivation indices; geographic context; population health surveillance; small-area variation analysis
references.citation: Gut. 2012 Apr;61(4):514-20
references.pmid: 21757448
references.citation: Soc Sci Med. 2008 Oct;67(8):1269-81
references.pmid: 18639966
references.citation: J Epidemiol Community Health. 2000 May;54(5):375-80
references.pmid: 10814659
references.citation: J Public Health Med. 1991 Nov;13(4):318-26
references.pmid: 1764290
references.citation: Can J Public Health. 2012 Apr 30;103(8 Suppl 2):S12-6
references.pmid: 23618065
references.citation: Health Place. 2006 Dec;12(4):421-35
references.pmid: 15955720
references.citation: CMAJ. 2008 Sep 23;179(7):653-8
references.pmid: 18809896
references.citation: Am J Public Health. 2000 Jul;90(7):1064-73
references.pmid: 10897184
references.citation: Chronic Dis Can. 2000;21(3):104-13
references.pmid: 11082346
references.citation: Health Place. 2007 Jun;13(2):299-309
references.pmid: 16516531
references.citation: J Epidemiol Community Health. 1995 Dec;49 Suppl 2:S57-64
references.pmid: 8594136
references.citation: N Engl J Med. 2001 Jul 12;345(2):99-106
references.pmid: 11450679
references.citation: Soc Sci Med. 2007 Apr;64(8):1651-64
references.pmid: 17287059
references.citation: J Epidemiol Community Health. 2010 Aug;64(8):705-13
references.pmid: 19828513
references.citation: Health Place. 2010 Mar;16(2):416-20
references.pmid: 20022551
references.citation: Age Ageing. 2008 Jul;37(4):403-10
references.pmid: 18487260
references.citation: Soc Sci Med. 2004 Oct;59(7):1485-94
references.pmid: 15246176
references.citation: Soc Sci Med. 2007 Nov;65(9):1953-64
references.pmid: 17719709
references.citation: Can J Public Health. 2012 Jan-Feb;103(1):65-8
references.pmid: 22338331
references.citation: Chronic Dis Can. 2009;29(4):178-91
references.pmid: 19804682
references.citation: Health Rep. 2009 Dec;20(4):85-94
references.pmid: 20108609