A multi-criteria spatial deprivation index to support health inequality analyses

Abstract

BackgroundDeprivation indices are useful measures to analyze health inequalities. There are several methods to construct these indices, however, few studies have used Geographic Information Systems (GIS) and Multi-Criteria methods to construct a deprivation index. Therefore, this study applies Multi-Criteria Evaluation to calculate weights for the indicators that make up the deprivation index and a GIS-based fuzzy approach to create different scenarios of this index is also implemented.MethodsThe Analytical Hierarchy Process (AHP) is used to obtain the weights for the indicators of the index. The Ordered Weighted Averaging (OWA) method using linguistic quantifiers is applied in order to create different deprivation scenarios. Geographically Weighted Regression (GWR) and a Moran’s I analysis are employed to explore spatial relationships between the different deprivation measures and two health factors: the distance to health services and the percentage of people that have never had a live birth. This last indicator was considered as the dependent variable in the GWR. The case study is Quito City, in Ecuador.ResultsThe AHP-based deprivation index show medium and high levels of deprivation (0,511 to 1,000) in specific zones of the study area, even though most of the study area has low values of deprivation. OWA results show deprivation scenarios that can be evaluated considering the different attitudes of decision makers. GWR results indicate that the deprivation index and its OWA scenarios can be considered as local estimators for health related phenomena. Moran’s I calculations demonstrate that several deprivation scenarios, in combination with the ‘distance to health services’ factor, could be explanatory variables to predict the percentage of people that have never had a live birth.ConclusionsThe AHP-based deprivation index and the OWA deprivation scenarios developed in this study are Multi-Criteria instruments that can support the identification of highly deprived zones and can support health inequalities analysis in combination with different health factors. The methodology described in this study can be applied in other regions of the world to develop spatial deprivation indices based on Multi-Criteria analysis.

Deprivation, Healthcare Accessibility and Satisfaction: Geographical Context and Scale Implications

“…Indeed, there is broad experience in showing the relationships of deprivation and different kinds of health outcomes (Boyle et al 2001;Cabrera-Barona et al 2015;Carstairs 1995;Havard et al 2008;Lalloué et al 2013). The importance of studying contextual social disadvantages also lies in the fact that deprived neighborhoods foster negative views or low satisfaction in individuals living there (Gambaro et al 2015).…”

“…The CR evaluates the likelihood that the judgments were obtained randomly (Saaty 1977): The random index (RI) is the consistency index of a randomly generated matrix and depends of the number of indicators used (Cabrera-Barona et al 2015;Boroushaki and Malczewski 2008). In this case a value of 1.49 was assigned to RI (Boroushaki and Malczewski 2008) because ten indicators were used to construct the deprivation index.…”

“…These indicators were extracted from the 2010 Ecuadorean Population and Housing Census, represent social and material disadvantages in Quito, and can be related to health issues (CabreraBarona et al 2016b). The conceptual reference for selecting the indicators used to construct the deprivation index (Table 1) is based on the human-rights approach of the good living standards (Cabrera-Barona et al 2015;Mideros 2012). A good living that includes a healthy life is achieved when basic human rights are ensured through the access to basic services and welfare conditions, such as access to clean water or education.…”

“…These indices are useful for identifying inequalities in health outcomes (Cabrera-Barona et al 2015;Boyle et al 2001;Havard et al 2008;Pampalon et al 2009;Townsend 1987). Because deprivation indices are commonly based on census areas, these indices are also place-specific measures related to health .…”

“…Health analyses with implications in decision making have widely used measures of healthcare accessibility and social deprivation Bissonnette et al 2012;Boyle et al 2001;Cabrera-Barona et al 2015;Carstairs 1995;Crooks and Schuurman 2012;Delamater 2013;Havard et al 2008;Hiscock et al 2008;Lalloué et al 2013;Luo 2014;Wan et al 2013). There are different indicators that can be used to represent deprivation and health.…”