Lillini R, Vercelli M
Department of Health Sciences (DISSAL), University of Genova, Italy.
Analytical Epidemiology & Health Impact, Fondazione IRCCS "Istituto Nazionale Tumori" Milan, Italy.
J Prev Med Hyg. 2019 Feb 28;59(4 Suppl 2):E3-E10. doi: 10.15167/2421-4248/jpmh2018.59.4s2.1170. eCollection 2018 Dec.
A socio-economic (SE) deprivation index is a measure that aims to provide an indication of SE hardship and disadvantage in the population. Our aim was constructing 10 Socio-Economonic and Health Deprivation Indexes (SEHDI) by means of the same method. This particular method enables these indexes to be used to investigate the relationships between SE inequalities and aspects of health and prevention in the population.
Data on the demographic and SE situation of the populations were taken from the 2011 Census at the Census Tract (CT) level (2001 for Rome municipality). To construct the SEHDIs, variables displaying a statistically significant correlation with the SMRs of overall mortality were subjected to a tolerance test of linearity, in order to eliminate collinear variables. The variables selected underwent PCA factor analysis, in order to obtain the factors to be linearly combined into the SEHDI. The final values were scaled from minimum to maximum deprivation, and the quantitative scale was converted into five ordinal normalized population groups. The SEHDIs were validated at the SE level by comparing them with the trends of the main SE indexes used in the 2011 Census (2001 for Rome municipality), and at the health level by comparing them with the trends of some causes of death. Both comparisons were made by means of ANOVA.
The 10 areas considered were: the municipalities of Cagliari, Ferrara, Florence, Foggia, Genoa, Rome, Palermo, Sassari, Siena, and the ULSS 7 Veneto area. For each one, a specific SEHDI was computed and the different variables comprising each index focused on particular aspects of SE and health deprivation at the area level. The SEHDIs showed good percentages of explained variance (from 72.2% to 49.1%) and a linear distribution of the main statistical SE indices and of overall mortality in each area; these findings were in line with the literature on the relationship between the SE condition and health status of the population. The distribution of cause-specific mortality across the SEHDIs deprivation clusters is analyzed in other articles, which deal with the findings of the study in each area.
The SEHDIs showed good ability to identify the elements of SE inequalities that impact on the health conditions of populations; to depict the distribution of causes of death that are sensitive to SE differences concerning aspects of the social and family support structure. From a public health perspective, these results are relevant because they enable interventions of health promotion and prevention to be implemented on the basis of the characteristics that define deprivation groups.
社会经济剥夺指数是一种旨在表明人群中社会经济困境和不利状况的衡量指标。我们的目标是通过相同方法构建10个社会经济与健康剥夺指数（SEHDI）。这种特定方法使这些指数能够用于调查社会经济不平等与人群健康及预防方面之间的关系。
人口的人口统计学和社会经济状况数据取自人口普查区（CT）层面的2011年人口普查（罗马市为2001年）。为构建SEHDI，对与总体死亡率标准化死亡比（SMR）显示出统计学显著相关性的变量进行线性容忍度检验，以消除共线变量。所选变量进行主成分分析（PCA）因子分析，以获得要线性组合到SEHDI中的因子。最终值按剥夺程度从最小到最大进行缩放，定量尺度转换为五个序数标准化人群组。通过将SEHDI与2011年人口普查（罗马市为2001年）中使用的主要社会经济指数趋势进行比较，在社会经济层面验证SEHDI，并通过将其与某些死因趋势进行比较，在健康层面验证SEHDI。这两种比较均通过方差分析（ANOVA）进行。
所考虑的10个地区为：卡利亚里、费拉拉、佛罗伦萨、福贾、热那亚、罗马、巴勒莫、萨萨里、锡耶纳市以及威尼托大区ULSS 7地区。对于每个地区，计算了特定的SEHDI，构成每个指数的不同变量聚焦于地区层面社会经济和健康剥夺的特定方面。SEHDI显示出良好的方差解释百分比（从72.2%到49.1%），并且每个地区主要社会经济指数和总体死亡率呈线性分布；这些发现与关于人群社会经济状况与健康状况之间关系的文献一致。特定死因死亡率在SEHDI剥夺集群中的分布在其他文章中进行了分析，这些文章涉及每个地区的研究结果。
SEHDI显示出很强的能力，能够识别影响人群健康状况的社会经济不平等因素；描绘对社会和家庭支持结构方面的社会经济差异敏感的死因分布。从公共卫生角度来看，这些结果具有相关性，因为它们能够根据定义剥夺群体的特征实施健康促进和预防干预措施。
