title: Individual Income, Area Deprivation, and Health: Do Income-Related Health Inequalities Vary by Small Area Deprivation?
abstract: This paper aims to explore potential associations between health inequalities related to socioeconomic deprivation at the individual and the small area level. We use German cross-sectional survey data for the years 2002 and 2006, and measure small area deprivation via the German Index of Multiple Deprivation. We test the differences between concentration indices of income-related and small area deprivation related inequalities in obesity, hypertension, and diabetes. Our results suggest that small area deprivation and individual income both yield inequalities in health favoring the better-off, where individual income-related inequalities are significantly more pronounced than those related to small area deprivation. We then apply a semiparametric extension of Wagstaff's corrected concentration index to explore how individual-level health inequalities vary with the degree of regional deprivation. We find that the concentration of obesity, hypertension, and diabetes among lower income groups also exists at the small area level. The degree of deprivation-specific income-related inequalities in the three health outcomes exhibits only little variations across different levels of multiple deprivation for both sexes.
authors.affiliation: Berlin Centre of Health Economics Research (BerlinHECOR), Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.|Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Germany.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0001-8219-8986
authors.initials: M
authors.lastname: Siegel
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Maier
mesh_terms: D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology; D007182:Income; D008297:Male; D009765:Obesity / Q000191:economics / Q000453:epidemiology; D011203:Poverty; D017062:Small-Area Analysis; D012923:Social Class
keywords: concentration index; health inequalities; income; regional deprivation