Assessment of the concordance between individual-level and area-level measures of socio-economic deprivation in a cancer patient cohort in England and Wales

• Published in: BMJ open 2020-11, Vol.10 (11), p.e041714-e041714
• Main Authors: Ingleby, Fiona C, Belot, Aurélien, Atherton, Iain, Baker, Matthew, Elliss-Brookes, Lucy, Woods, Laura M
• Format: Article
• Language: English
• Subjects: Cancer; Censuses; Classification; Codes; Education; England - epidemiology; Epidemiology; Female; Health disparities; Humans; Longitudinal Studies; Male; Neoplasms; Population; Public health; Reproducibility of Results; Socioeconomic Factors; Trends; Wales - epidemiology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-041714

ObjectivesMost research on health inequalities uses aggregated deprivation scores assigned to the small area where the patient lives; however, the concordance between aggregate area-level deprivation measures and personal deprivation experienced by individuals living in the area is poorly understood. Our objective was to examine the agreement between individual and ecological deprivation. We tested the concordance between metrics of income, occupation and education at individual and area levels, and assessed the reliability of area-based deprivation measures to predict individual deprivation circumstances.SettingEngland and Wales.ParticipantsA cancer patient cohort of 9547 individuals extracted from the Office for National Statistics Longitudinal Study.OutcomesWe quantified the concordance between measures of income, occupation and education at individual and area level. In addition, we used ROC (receiver operating characteristic) curves and the area under the curve (AUC) to assess the reliability of area-based deprivation measures to predict individual deprivation circumstances.ResultsWe found low concordance between individual-level and area-level indicators of deprivation (Cramer’s V statistics range between 0.07 and 0.20). The most commonly used indicator in health inequalities research, area-based income deprivation, was a poor predictor of individual income status (AUC between 0.56 and 0.59), whereas education and occupation were slightly better predictors (AUC between 0.62 and 0.65). The results were consistent across sexes and across six major cancer types.ConclusionsOur results indicate that ecological deprivation measures capture only part of the relationship between deprivation and health outcomes, especially with respect to income measurement. This has important implications for our understanding of the relationship between deprivation and health, and, as a consequence, healthcare policy. The results have a wide-reaching impact for the way in which we measure and monitor inequalities, and in turn, fund and organise current UK healthcare policy aimed at reducing them.