development of european deprivation indices for public health policy to tackle social inequalities...
TRANSCRIPT
Development of European deprivation indices for public health policy
to tackle social inequalities in health
Carole Pornet
World Research and Innovation Congress - Brussels – 5th June 2013
Socioeconomic status is established as a main determinant for
health and tackling social inequities is a priority for numerous
international and national agencies for health.
How tackling social inequalities in health?
Socioeconomic status is established as a main determinant for
health and tackling social inequities is a priority for numerous
international and national agencies for health.
To be efficient, such policy needs to be based on a well-documented
knowledge of kind and magnitude of social inequalities
and on underlying mechanisms.
How tackling social inequalities in health?
Studying and tackling social disparities in health implies the ability:
to measure them accurately
to compare them between different areas or countries
to follow trends over time (HCSP, 2009).
What is the initial value of ecological indices?
Information required to assess the socioeconomic status is in
routine not available at individual level.
To overcome this lack, socioeconomic characteristic
measureaments at residence area are regularly used
to approximate individual socioeconomic status: ecological
indices.
Addresses or zip codes are required to connect clinical data
to ecological indices (geocoding).
What is the initial value of ecological indices?
Information required to assess the socioeconomic status is in
routine not available at individual level.
Unlike indicators at individual level: availability
for all individuals
To overcome this lack, socioeconomic characteristic
measureaments at residence area are regularly used to
approximate individual socioeconomic status: ecological indices.
Addresses or zip codes are required to connect clinical data to
ecological indices (geocoding).
What is the added value of composite ecological indices?
Compared to basic indicators at geographical level, composite
ecological indices represent:
a more comprehensive approach to deprivation,
a more homogeneous distribution in a whole territory (Gentil C.,
GRELL 2011).
Measure of deprivation of living residence area
« proxy » of individual deprivation
background taken into account (positive and negative
externalities)
A wide variety of ecological deprivation indices in Europe…
Measurement of social inequalities greatly varies in Europe from one
country to another, even from one area to another within a country for
3 main reasons:
1. Determinants of social inequalities depend on the context.
2. The great majority of ecological indices are
opportunistic, i.e. created for a given area or country,
and for a given health topic.
3. Most of the ecological indices are deprivation indices
developed from census data, used as a ‘proxy’ of
individual deprivation measure but without referring to
individual deprivation experience.
The concept of relative deprivation
The poor are “the persons whose resources (material, cultural and
social) are so limited as to exclude them from the minimum acceptable
way of life in the Member State to which they belong” (Council of the
European Union, 1985).
outcome elements: “the exclusion from the minimum
acceptable way of life”, which covers material, cultural and
social aspects
input elements: “...due to a lack of resources”.
The concept of relative deprivation
“Poverty can be defined objectively and applied consistently only in terms of the concept of relative deprivation. […] Individuals, families and groups in the population can be said to be in poverty when they lack the resources to obtain the type of diet, participate in the activities and have the living conditions and amenities which are customary, or at least widely encouraged or approved, in the societies to which they belong. Their resources are so seriously below those commanded by the average individual or family that they are, in effect, excluded from ordinary living patterns, customs or activities.” (Townsend, 1979)
Relative deprivation
depends on context
is defined by a threshold: below the average of the society.
The concept of relative deprivation
The Townsend approach is built on the importance of participation in the society to which the person belongs, i.e. relative deprivation occurs when people “cannot obtain, at all or sufficiently, the conditions of life – that is, the diets, amenities, standards and services – which allow them to play the roles, participate in the relationships and follow the customary behaviour which is expected of them by virtue of their membership of society” (Townsend, 1987, 1993).
In Peter Townsend’s theory of relative deprivation:
poverty can be defined as a lack of sufficient resources
and “deprivation” is an outcome of poverty.
Deprivation: outcome of poverty
The concept of deprivation covers the various conditions, independent of income, experienced by people who are poor (Townsend, 1987).
Poverty: Income poverty = household whose total equivalised income is
< 60% median national equivalised household income*
Subjective poverty = « Ability to make ends meet »1. With great difficulty 2. With difficulty3. With some difficulty4. Fairly easily5. Easily6. Very easily
*as defined by EUROSTATThe equivalent scale is the so-called “OECD-modified equivalence scale” which assigns a value of:- 1 to the household head,- 0.5 to each additional
adult member - 0.3 to each child.
Deprivation: outcome of poverty
Poverty: Income poverty = household whose total equivalised income
is < 60% median national equivalised household income In France, in 2006: “Poor” households = 14.2%
Subjective poverty = « Ability to make ends meet »1. With great difficulty 2. With difficulty3. With some difficulty4. Fairly easily5. Easily6. Very easily
= 16%
Deprivation: outcome of poverty
Poverty: Income poverty = household whose total equivalised income
is < 60% median national equivalised household income In Portugal, in 2006: “Poor” households:
20.7%
Subjective poverty = « Ability to make ends meet »
1. With great difficulty = 15.7%2. With difficulty3. With some difficulty4. Fairly easily5. Easily6. Very easily
Current difficulties in analyses of social inequalities in health
No gold standard of deprivation
Multiplicity of deprivation indices
Current difficulties in analyses of social inequalities in health
No gold standard of deprivation
Multiplicity of deprivation indices
Comparison of kind and magnitude of social inequalities
in health and a-fortiori comparison of underlying mechanisms
between different areas or countries in Europe are thus
prevented.
How overcoming the lack of comparability and appropriateness?
The first step of a consistent European public health policy aimed for
tackling social inequalities consists in creating a ‘homogenous’
reliable, relevant and accurate tool for measuring social deprivation.
How overcoming the lack of comparability and appropriateness?
The first step of a consistent European public health policy aimed for
tackling social inequalities consists in creating a ‘homogenous’
reliable, relevant and accurate tool for measuring social deprivation.
Using deprivation indices based on:- a shared mode of construction- a shared concept of relative deprivation- the same database (same questionnaire)
could overcome the lack of comparability and appropriateness
Objectives and principles of construction
Built from data available in census Best reflects the different dimensions of social deprivation,
including the perceived poverty
Replicable in (European) space and over the time
Replicable in (European) space Indices would not be composed of the same elements in different
European countries BUT will be built according the same principles in all countries
Replicable over the time Indices will be continually updated according evolutions of
modalities and national census data, BUT always according the same principles
Objectives and principles of construction
Census Population
Objectives and principles of construction
First step: Construction of an individual deprivation indicator
Individual deprivation indicator used as gold standard
Census Population
From a European survey specifically designed to study deprivation: the EU-SILC* survey
Individual deprivation indicator used as gold standard
EU-SILC*
Europeanindividualsurveyof deprivation
Objectives and principles of construction
*European Union-Statistics on Income Living Conditions
First step: Construction of an individual deprivation indicator
EU-27:AustriaBelgium
CyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourg
NetherlandsPolandPortugal
SlovakiaSloveniaSpainSwedenUnited Kingdom
Romania
Malta
Bulgaria
EU-SILC
+ Iceland
+ Norway
The EU-SILC 2006
22
26 COUNTRIES
Developed by Eurostat (the Statistical Office of the European Union)
Standardised questionnaire involving annual interviewing of a representative panel of households and individuals:
• 60 500 households • ≈130 000 individuals aged ≥16 yrs
Designed to study deprivation and covers a wide range of domains:
• income (including various social benefits), • health, • education, • housing, • perceived poverty,• demographics, • employment characteristics.
EU-SILCThe EU-SILC survey
23
Individual deprivation indicator used as gold standard
EU-SILC*
Europeanindividualsurveyof deprivation
First step: Construction of an individual indicator
Objectives and principles of construction
*European Union-Statistics on Income Living Conditions
Individual deprivation indicator used as gold standard
EU-SILC*
Europeanindividualsurveyof deprivation
First step: Construction of an individual indicator
Objectives and principles of construction
*European Union-Statistics on Income Living Conditions
Individual deprivation indicator is composed of “enforced lacks”, i.e. lacks due to insufficient resources and thus problems of affordability, rather than lacks resulting from choices or lifestyle preferences (Mack and Lansley, 1985).
Fundamental needs: goods/services for which < 50% of households did not possess/realize because they could not afford (but would like to have, i.e. a lack is an “enforced lack” and does not simply reflect a choice, but a renonciation) and their lack reflects deprivation.
1.1 Selection of fundamental needs
EU-SILC
European IndividualSurvey of Deprivation
1st step: construction of an individual deprivation indicator
1st step: construction of an individual deprivation indicatorEU-SILC
Individual deprivation
indicator
1.1 Selection of fundamental needs
Fundamental needs: goods/services for which < 50% of households did not possess/realize because they could not afford (but would like to have, i.e. a lack is an “enforced lack” and does not simply reflect a choice, but a renonciation) and their lack reflects deprivation.
In France, in 2006
Financial incapacity to possess/realize
Fundamental need
Swimming-pool 95% No
Meat or fish 7% Yes
28
EU-SILC
Census
Individual deprivation
indicator
EDI
Current steps: « …. in space»Construction of 5 European deprivation indices
May 2012 : Steps 1 and 2 of construction of 5 EDI:- France- Italy- Portugal- Spain- UK
29
EU-SILC
Individual deprivation
indicator
Fundamental needs for people France Italy Portugal Spain UK
Meat or fish or vegetarian equivalent x x x x x
One week annual holidays x x x x
Unexpected financial expenses* x x x x x
Keep home adequately warm x x x x x
Phone (including mobile phone) x x x x x
TV x x x x x
Computer x x x
Washing machine x x x x x
Car x x x x x
1.1 Identification of people’s fundamental needs
1st step: construction of an individual deprivation indicator
*of amount = poverty threshold per one consumption unit independently of the size and structure of the household for a country, e.g.: in France €800
30
EU-SILC
Individual deprivation
indicator
In France (N=10,036)* Income poverty OR (95% CI)
Subjective poverty OR (95% CI)
Use your own means to cover a necessary yet unplanned expense of €800 1.4 (1.27-1.53) 2.6 (2.35-2.87)
One week annual holiday away from home 1.67 (1.51-1.83) 2.1 (1.91-2.3)
Have a computer 1.0 (0.89-1.12) 1.54 (1.38-1.72)
Eat a meal containing some meat or some fish or the vegetarian equivalent once every two days
1.21 (1.08-1.37) 1.78 (1.58-2.01)
Keep home adequately warm 1.19 (1.06-1.34) 1.28 (1.12-1.47)
Have a car 1.47 (1.28-1.68) 1.11 (0.94-1.31)
Have a washing machine 1.77 (1.39-2.26) 1.09 (0.84-1.4)
Have a phone (including mobile) 1.02 (0.77-1.35) 1.42 (1.04-1.94)
Have a colour TV 0.94 (0.59-1.5) 1.01 (0.68-1.5)
*Data weighted on non-response and adjusted on sample design of the French EU-SILC survey 2006 . In bold, selected fundamental needs because they were associated with income poverty and with subjective poverty . in italic: p>0.05.
1.2 Selection of fundamental needs associated with both income poverty and subjective poverty by multivariate logistic regression
1st step: construction of an individual deprivation indicator
1st step: construction of an individual deprivation indicator
31
EU-SILC
Individual deprivation
indicator
Fundamental needs France Italie Portugal Espagne UK
Meat or fish or vegetarian equivalent x x x
One week annual Holidays x x x x
Unexpected financial expenses x x x x x
Keep home adequately warm x x x
Phone (including mobile phone) x
TV
Computer x x
Washing machine
Car x x x
1.2 Selection of fundamental needs associated with both income poverty and subjective poverty
32
EU-SILC
Individual deprivation
indicator In France, for income poverty and subjective poverty, best fit =
model 2
In France: households are defined as deprived if they cannot afford at least 2 fundamental needs among the 4 retained, as
not deprived in all other cases.
0 1 2 3 40
200
400
600
800
1000
1200
1400
1600
Univariate logistic regression model chi² values, EU-SILC 2006 in France N=9,930
Objective poverty
Subjective poverty
Minimal number of fundamental needs lacking through financial incapacity
Logi
stic r
egre
ssio
n m
odel
chi²
valu
es
1.3 Definition of an individual deprivation indicator
Legend of axis models:1: 'poor‘= lack of at least 1 item among the 4 vs no item lacking 2: ‘poor'= lack of at least 2 items among the 4 vs lack at max 1 item 3: 'poor'= lack of at least 3 items among the 4 vs lack at max 2 items 4: 'poor'= lack all the 4 items
1st step: construction of an individual deprivation indicator
33
EU-SILC
Individual deprivation
indicatorFundamental needs for people France Portugal Spain UK
Meat or fish or vegetarian equivalent x x x
One week annual holidays x x x xUnexpected financial expenses x x x x xKeep home adequately warm x x x
Phone (including mobile phone) xComputer x xWashing machine
Car x x xTV
Minimal number of lacking fundamental needs
2 2 2 2 2
1st step: construction of an individual deprivation indicator
1.3 Definition of an individual deprivation indicator
34
EU-SILC
Individual deprivation
indicatorFundamental needs for people France Portugal Spain UK
Meat or fish or vegetarian equivalent x x x
One week annual holidays x x x xUnexpected financial expenses x x x x xKeep home adequately warm x x x
Phone (including mobile phone) xComputer x xWashing machine
Car x x xTV
Minimal number of fundamental needs lacking
2 2 2 2 2
% of deprived households in 2006 25.1 23.2 22.6 26.9 19.8Unemployment rate in 2006 (OECD) 9.4% 6.8% 7.7% 8.1% 5.3%
1st step: construction of an individual deprivation indicator
1.3 Definition of an individual deprivation indicator
pays 1
2 enforced lacks among:- Holidays- Unplanned expense- Meat, fish or vegetarian equivalent- Keeping house sufficiently warm
Objectives and principles of construction
EU-SILC*
Europeanindividualsurveyof deprivation
*European Union-Statistics on Income Living Conditions
1st step: Construction of an individual indicator
pays 1
2 enforced lacks among:- Holidays- Unplanned expense- Car- Keeping house sufficiently warm
Objectives and principles of construction
EU-SILC*
Europeanindividualsurveyof deprivation
*European Union-Statistics on Income Living Conditions
1st step: Construction of an individual indicator
pays 1
2 enforced lacks among:- Holidays- Unplanned expense- Computer
Objectives and principles of construction
EU-SILC*
Europeanindividualsurveyof deprivation
*European Union-Statistics on Income Living Conditions
1st step: Construction of an individual indicator
pays 1
2 enforced lacks among:- Meat or fish or vegetarian equivalent- Unplanned expense- Car- Keeping house sufficiently warm- Phone (including mobile phone)
Objectives and principles of construction
EU-SILC*
Europeanindividualsurveyof deprivation
*European Union-Statistics on Income Living Conditions
1st step: Construction of an individual indicator
Objectives and principles of construction
pays 1
2 enforced lacks among:- Holidays- Unplanned expense- Car- Keeping house sufficiently warm- Computer
1st step: Construction of an individual indicator
EU-SILC*
Europeanindividualsurveyof deprivation
*European Union-Statistics on Income Living Conditions
Census Population
Objectives and principles of construction
EU-SILC
Europeanindividualsurveyof deprivation
Individual deprivation indicator used as gold standard
2nd step: Research of common data in EU-SILC / Census
EU-SILC
Europeanindividualsurveyof deprivation
Population census
Identical variables in both datasets
Objectives and principles of construction
Individual deprivation indicator used as gold standard
2nd step: Research of common data in EU-SILC / Census
EU-SILC
EuropeanIndividualSurvey of Deprivation
Census Population
country 1
Identical variablesin both datasets
Individual deprivation indicator used as gold standard
2nd step: Research of common data in EU-SILC / Census
Objectives and principles of construction
EU-SILC
EuropeanIndividualSurvey of Deprivation
Census Population
country 2Individual deprivation indicator used as gold standard
Identical variablesin both datasets
Objectives and principles of construction
2nd step: Research of common data in EU-SILC / Census
Individual deprivation indicator used as gold standard
EU-SILC
European IndividualSurvey of Deprivation
Census Population
country 3
Identical variables in both datasets
2nd step: Research of common data in EU-SILC / Census
Objectives and principles of construction
EU-SILC
European IndividualSurvey of Deprivation
Individual deprivation indicator used as gold standard
Census Population
Identical variables in both datasets
3rd step: Construction of the index used at aggregated level
Objectives and principles of construction
EU-SILC
IRIS
Individual deprivation
indicator
EDI
Census 1999
3rd step: Construction of the « French EDI »
3.1. Selection of those variables associated with the individual deprivation indicator by multivariate binary logistic regression*
In France ß 95% CI P-value
Overcrowding 0.11 0.02-0.20 0.0171
No access to a system of central or electric heating 0.34 0.25-0.43 <.0001
Non-owner 0.55 0.50-0.60 <.0001
Foreign nationality 0.23 0.13-0.32 <.0001
No access to a car 0.52 0.46-0.58 <.0001
Single-parent household 0.41 0.33-0.48 <.0001
Household with ≥6 persons 0.45 0.34-0.56 <.0001
Low level of education 0.19 0.13-0.25 <.0001
Unemployment 0.47 0.38-0.55 <.0001
Unskilled worker-farm worker 0.37 0.27-0.46 <.0001
N =19 253 *Data weighted on non-response and adjusted on sample design of the French EU-SILC survey 2006.
EU-SILC
IRIS
Individual deprivation
indicator
EDI
Census 1999
3rd step: Construction of the « French EDI »
3.2. Weighting of selected variables which compose the aggregate deprivation index*
In France ß 95% CI P-value
Overcrowding 0.11 0.02-0.20 0.0171
No access to a system of central or electric heating 0.34 0.25-0.43 <.0001
Non-owner 0.55 0.50-0.60 <.0001
Foreign nationality 0.23 0.13-0.32 <.0001
No access to a car 0.52 0.46-0.58 <.0001
Single-parent household 0.41 0.33-0.48 <.0001
Household with ≥6 persons 0.45 0.34-0.56 <.0001
Low level of education 0.19 0.13-0.25 <.0001
Unemployment 0.47 0.38-0.55 <.0001
Unskilled worker-farm worker 0.37 0.27-0.46 <.0001
N =19 253 *Data weighted on non-response and adjusted on sample design of the French EU-SILC survey 2006.
EU-SILC
European Union-Statistics on Income Living Conditions
Individual deprivation indicator used as gold standard
CensusPopulation
Geographical deprivation index:
the European Deprivation Index
EDI
Identical variables in both datasets
3rd step: Construction of the index used at aggregated level
Objectives and principles of construction
12
3
49
EU-SILC
IRIS
Individual deprivation
indicator
EDI
0.1107 x % overcrowdingi + 0.3401 x % no access to a system of central or electric heatingi + 0.2285 x % foreign nationalityi + 0.5185 x % no access to a cari + 0.3682 x % unskilled worker-farm workeri + 0.4056 x % single-parent householdi + 0.4513 x % household with ≥6 personsi + 0.1906 x % low level of educationi + 0.4662 x % unemploymenti + 0.5508 x % non-owneri.
Census 1999
50
EU-SILC
Census
Individual deprivation
indicator
EDI
Mini Maxi Mean SDQuintile 1
Quintile 2
Quintile 3
Quintile 4
Quintile 5
-5.33 20.52 01.847
-5.332; -1.323
-1.323; -0.649
-0.649;-0.007
-0.007;0.948
0.948;20.520
Distribution of the EDI score in France (N = 49,989 IRIS) :
Census 1999
Geographical department of Calvados (n=829 IRISes)
51
EU-SILC
Census
Individual deprivation
indicator
EDI
Construction of the « French EDI »
Producer: Insee; diffusor: CMH
50 Km
Census 1999
Score of the EDI in France for each IRISi :
Scorei = 0.13 x % overcrowdingi +
0.33 x % no exclusive use of bath or showeri +
0.16 x % foreign nationalityi +
0.29 x % no cari + 0.57 x % no business leaders-company managers/intermediate
occupationsi +
0.57 x % single-parent householdi +
0.46 x % households with ≥6 personsi +
0.14 x % low level of educationi +
0.56 x % unemployedi +
0.54 x % non-owneri.
Distribution of the score in France (N = 49,989 IRIS): Mini Maxi Mean SDQuintile 1
Quintile 2
Quintile 3
Quintile 4
Quintile 5
-8.72 25.40 0 2.07-8.719; -1.465
-1.465; -0.717
-0.717;-0.006
-0.005;1.035
1.035;25.400
EU-SILC
Census
Individual deprivation
indicator
EDI Census 2007
Construction of the « French EDI »
Geographical department of Calvados (n=830 IRISes)
53
EU-SILC
Census
Individual deprivation
indicator
EDI
Construction of the « French EDI »
Producer: Insee; diffusor: CMH50 Km
Producer: Insee; diffusor: CMH
54
EU-SILC
LSOA
Individual deprivation
indicator
EDI
EDI score in UK for each LSOAi of census 2001*:
0.53 x % overcrowdingi + 0.43 x % no detached housei + 0.73 x % social rentedi + 0.42 x % no cari + 0.68 x % single-parent householdi + 0.23 x % no marriedi + 0.49 x % permanently disabled or/and unfit to worki + 0.16 x % no high education leveli + 0.19 x % elementary occupationsi .
Construction of the « UK EDI »
Census 2001
N =15 756 *Data weighted on non-response and adjusted on sample design of the UK EU-SILC survey 2006.
55
EU-SILC
LSOA
Individual deprivation
indicator
EDI
Mini Maxi Mean SDQuintile 1
Quintile 2
Quintile 3
Quintile 4
Quintile 5
-5.66 11.36 0 2.99-5.663; -2.665
-2.665; -1.392
-1.392;0.243
0.243;2.605
2.605;11.361
Distribution of the EDI score in UK for census 2001 (N = 34,378 LSOA) :
Census 2001
Construction of the « UK EDI »
56
EU-SILC
Individual deprivation
indicator
EDI
May 2013 : Steps 2-3 of EDI construction for:- Portugal- Spain- Italy
Current steps: « …. in space»End of construction of 3 other EDI
BelgiumCzech Republic
DenmarkFinlandFrance
GermanyItaly
LuxembourgPortugal
SpainSlovenia
SwitzerlandUK
OK
OK
OK
OK
OK O
KOK O
KOK
OK
OK
OK
OK
Future steps: « …. in space»Improvement and construction of 13 EDI
Multidisciplinary network of experts: - economists,- epidemiologists, - geographers, - physicians, - sociologists,- statisticians.
Future steps: « …. in space»Improvement and construction of 13 EDI
What is the Expected Impact?
- to develop innovative methods to measure and monitor
social inequalities
- to provide a useful tool for policy makers and researchers
in Europe.
59
EU-SILC
Individual deprivation
indicator
EDI
Application for the open call for COST:
- March 2013: 2nd preliminary proposal
- June 5th: results?
- July 2013: full proposal
- December 2013: Results
Duration: 48 months
Future steps: « …. in space»Improvement and construction of 13 EDI
60
EU-SILC
Individual deprivation
indicator
EDI
Other funding sources are required:
Horizon 2020 (for 2014-2020)
Future steps: « …. in space»Construction of 29 EDI
61
EU-SILC
IRIS
Individual deprivation
indicator
EDI
Current and future steps: « …over the time » Continous updating of indices
Current applications
Cancer registries Pascale Grosclaude (Toulouse) Anne Marie Bouvier (Dijon) Karine Ligier (Lille) Julie Gentil (Dijon) Sandra Leguyader (Bordeaux) Simona Bara (Cherbourg) Olivier Ganry (Amiens)Florence Molinié (Nantes) Anne Valérie Guizard (Caen) Marc Colonna (Grenoble) Michel Robaszkiewicz (Brest) Brigitte Tretarre (Montpellier)
Implementation of a "national methodological platform"
Management structures of screeningChantal de Seze (Laon) Marie Christine Quertier (Saint-Lô) Hélène Delattre-Massy (Amiens) Jérôme Peng (Beauvais) Bernard Denis - Gastroenterologist Hôpital Pasteur- ADECA68 – (Colmar) Gérard Durand – ADECI35 – (Rennes)
Research teams labelled INSERM, CNRS Véronique Christophe (Lille)Claire Bonithon-Kopp (Dijon) Thierry Lang, Cyrille Delpierre (Toulouse)
Nadine Bossard (Lyon) Hospices civils de Lyon Franck Chauvin (HCSP), Sophie Rousseau (Villejuif-Institut Gustave Roussy) Rachel Bavdek - PRES-Lille Nord de France, IRENI (Dunkerque)Delobel Malika - Registre des Handicaps de l'Enfant de la Haute-Garonne RHE 31 INSERM U1027 (Toulouse)Marion Llaty - Institut de chimie des milieux et matériaux de Poitiers (IC2MP) - Unité Mixte de Recherche CNRS N°7285 (Poitiers)Nonna Mayer - Centre d'études européennes de Sciences Po-CNRS (programme de recherche POLINE - Politics of Inequalities) (Paris)Carine Bellera - Institut Bergonié – CRLC de Bordeaux et du Sud Ouest - INSERM CIC-EC 7 et CTD/INCA Bénedicte Jacquemin (CREAL-Centre for Research in Environmental Epidemiology, Barcelona)Nicole Le moual (Inserm CESP/UMRS 1018 , Paris)
EU-SILC
IRIS
Individual deprivation
indicator
EDI
Current and future steps: « …over the time » Continous updating of indices
Implementation of a “national methodological platform"
Cohorts :CANTO cohort - Patrick Arveux (Dijon) ARDCO cohort - Jean- Claude Pairon (Créteil) AGRICAN cohort – Pierre Lebailly (Caen)E3N cohort – Nicole Le Moual (Paris) CliniciansJean Claude Barbare (Amiens) Isabelle Ray-Coquard (Lyon)OthersHenri Clavaud (ARS PACA)
64
EU-SILC
Census
Individual deprivation
indicator
EDI
Thanks to
All co-authors: Cyrille Delpierre, Olivier Dejardin, Lydia Guittet,Ludivine Launay (+ programming), Pascale Grosclaude, Thierry Lang and Guy LaunoyFatima Maria de Pina, Marie-Jo Lucas (research of funding)Isabelle Salomez (organisation Workshop Portugal, logistics)Ana Miranda and Claudia Brito (organisation in Lisbon)Maria José Bento and Luis Antunes (organisation in Porto)Helena Cordeiro (INE, Portugues census questionnaire)Carme Borrell, Marc Mari Dell’Olmo (Spanish census questionnaire)Roberto Lillini, Nicola Caranci, Marina Vercelli (Italian census questionnaire)Bernard Rachet (UK census questionnaire)Alexandre Kych, Benoît Tudoux (CMH, French census data)Karien Reinig (EUROSTAT, all EU-SILC files)EPAAC (funding)And all participants at the Workshops 2012-2013
Current and future steps: « …. in space»Construction of 13 European indices
Carte de l’indice
Map of the French EDI in Normandy in 1999
Example of application
Data from the regional federation of cancer registries of Basse-Normandie
Relative survival of patients diagnoosed with cancer between 1997-2004 in Low-Normandy (all cancers – N=40,297) – J. Bryère, O. Dejardin, et al.
Carte des cas de cancer
Map of cancers incidence
Joséphine Bryère
Incidence rate for 100,000 inhabitants
Incidence of cancers and social deprivation.Geographical approach
Manche-Calvados1997-2006 (n = 47,699)
Incidence rate for 100,000 inhabitants
Quintiles of EDI: 1=the least deprived 5=the most deprived
Incidence rate for 100,000 inhabitants
Quintiles of EDI: 1=the least deprived 5=the most deprived