title: [Qualitative and quantitative comparisons of three individual deprivation scores for outpatients attending a free hospital care clinic in Paris].
abstract: BACKGROUND
  Inequality in health care is a growing problem, leading to the development of different tools for the assessment of individual deprivation. In France, three tools are mainly used: Epices (which stands for "score for the evaluation of social deprivation and health inequities among the centers for medical examination"), a score called "Handicap social" and a screening tool built for medical consultations by Pascal et al. at Nantes' hospital. The purpose of this study was to make a metrological assessment of those tools and a quantitative comparison by using them on a single deprived population.
  
  
  METHODS
  In order to assess the metrological properties of the three scores, we used the quality criteria published by Terwee et al. which are: content validity, internal consistency, criterion validity, construct validity, reproducibility (agreement and reliability), responsiveness, floor and ceiling effects and interpretability. For the comparison, we used data from the patients who had attended a free hospital outpatient clinic dedicated to socially deprived people in Paris, during one month in 2010. The "Handicap social" survey was first filled in by the 721 outpatients before being recoded to allow the comparison with the other scores.
  
  
  RESULTS
  While the population of interest was quite well defined by all three scores, other quality criteria were less satisfactory. For this outpatient population, the "Handicap social" score classed 3.2% as non-deprived (class 1), 32.7% as socially deprived (class 2) and 64.7% as very deprived (class 3). With the Epices score, the rates of deprivation varied from 97.9% to 100% depending on the way the score was estimated. For the Pascal score, rates ranged from 83.4% to 88.1%. On a subgroup level, only the Pascal score showed statistically significant associations with gender, occupation, education and origin.
  
  
  CONCLUSIONS
  These three scores have very different goal and meanings. They are not interchangeable. Users should be aware of their advantages and disadvantages in order to use them wisely. Much remains to be done to fully assess their metrological performances.
authors.affiliation: Inserm, UMRS 1136, équipe de recherche en épidémiologie sociale, 27, rue de Chaligny, 75012 Paris, France; Sorbonne universités, UPMC université Paris 06, UMRS 1136, site hôpital St-Antoine, 75012 Paris, France. Electronic address: arnaud.fouchard@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Fouchard
authors.affiliation: Institut droit et santé - Inserm UMR S 1145, université Paris-Descartes, chaire santé à sciences Po et École des hautes études en santé publique (EHESP), département des politiques de santé, Sorbonne Paris-Cité, 75270 Paris, France; Hôpital Saint-Antoine, AP-HP, policlinique Baudelaire, Paris, France.
authors.forename: P-H
authors.initials: PH
authors.lastname: Bréchat
authors.affiliation: Université Paris-Nord 13, UFR santé, médecine et biologie humaine, 74, rue Marcel-Cachin, 93017 Bobigny cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Castiel
authors.affiliation: Département d'informatique médicale, Hôtel-Dieu, CHU de Toulouse, 2, rue de la Viguerie, 31059 Toulouse, France.
authors.forename: J
authors.initials: J
authors.lastname: Pascal
authors.affiliation: Centre technique d'appui et de formation des centres d'examens de santé (Cetaf), 42100 Saint-Étienne, France.
authors.forename: C
authors.initials: C
authors.lastname: Sass
authors.affiliation: Inserm, UMRS 1136, équipe de recherche en épidémiologie sociale, 27, rue de Chaligny, 75012 Paris, France; Hôpital Saint-Antoine, AP-HP, policlinique Baudelaire, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Lebas
authors.affiliation: Inserm, UMRS 1136, équipe de recherche en épidémiologie sociale, 27, rue de Chaligny, 75012 Paris, France; Sorbonne universités, UPMC université Paris 06, UMRS 1136, site hôpital St-Antoine, 75012 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Chauvin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006305:Health Status Indicators; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D010297:Paris / Q000453:epidemiology; D011610:Psychosocial Deprivation; D012107:Research Design; D064876:Safety-net Providers; D035862:Vulnerable Populations / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Assessment; Comparaison; Comparison; Outils; Précarité sociale; Scores; Social deprivation; Tools; Évaluation