Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK.
NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
J Epidemiol Community Health. 2018 Feb;72(2):140-147. doi: 10.1136/jech-2017-209999. Epub 2017 Dec 20.
Socioeconomic deprivation is a key determinant for health. In England, the Index of Multiple Deprivation (IMD) is a widely used composite measure of deprivation. However, little is known about its spatial clustering or persistence across time.
Data for overall IMD and its health domain were analysed for 2004-2015 at a low geographical area (average of 1500 people). Levels and temporal changes were spatially visualised for the whole of England and its 10 administrative regions. Spatial clustering was quantified using Moran's I, correlations over time were quantified using Pearson's r.
Between 2004 and 2015 we observed a strong persistence for both overall (r=0.94) and health-related deprivation (r=0.92). At the regional level, small changes were observed over time, but with areas slowly regressing towards the mean. However, for the North East, North West and Yorkshire, where health-related deprivation was the highest, the decreasing trend in health-related deprivation reversed and we noticed increases in 2015. Results did not support our hypothesis of increasing spatial clustering over time. However, marked regional variability was observed in both aggregate deprivation outcomes. The lowest autocorrelation was seen in the North East and changed very little over time, while the South East had the highest autocorrelation at all time points.
Overall and health-related deprivation patterns persisted in England, with large and unchanging health inequalities between the North and the South. The spatial aspect of deprivation can inform the targeting of health and social care interventions, particularly in areas with high levels of deprivation clustering.
社会经济剥夺是健康的一个关键决定因素。在英国，多维度剥夺指数（IMD）是一种广泛使用的剥夺综合衡量指标。然而，关于其空间聚类或随时间的持续性，知之甚少。
对 2004-2015 年整个英格兰及其 10 个行政区的总体 IMD 及其健康领域的数据进行了分析。对整个英格兰及其 10 个行政区的水平和时间变化进行了空间可视化。使用 Moran's I 量化空间聚类，使用 Pearson's r 量化时间相关性。
在 2004 年至 2015 年期间，我们观察到整体（r=0.94）和与健康相关的剥夺（r=0.92）的强烈持续性。在区域层面，随着时间的推移，观察到了较小的变化，但随着地区逐渐向平均值回归。然而，对于东北地区、西北地区和约克郡，这些地区的与健康相关的剥夺程度最高，与健康相关的剥夺程度下降的趋势发生了逆转，我们注意到 2015 年有所增加。结果不支持我们关于随时间推移空间聚类增加的假设。然而，在总体剥夺结果中观察到明显的区域变异性。在东北和西北地区，自相关系数最低，随时间变化很小，而东南地区在所有时间点的自相关系数最高。
英格兰的整体和与健康相关的剥夺模式持续存在，北部和南部之间存在着巨大且不变的健康不平等。剥夺的空间方面可以为卫生和社会保健干预措施的目标定位提供信息，特别是在剥夺程度聚类较高的地区。
