Comparison of small-area deprivation measures as predictors of chronic disease burden in a low-income population

Abstract

BackgroundMeasures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators.MethodsTo derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of census indicators most highly correlated with a set of five chronic disease conditions among South Carolina Medicaid enrollees. In separate validation studies, we used both logistic and spatial regression methods to assess the ability of Palmetto SADI to predict chronic disease burden among state Medicaid recipients relative to four alternative small-area socioeconomic deprivation measures: the Townsend index of material deprivation; a single-variable poverty indicator; and two small-area designations of health care resource deprivation, Primary Care Health Professional Shortage Area and Medically Underserved Area/Medically Underserved Population.ResultsPalmetto SADI was the best predictor of chronic disease burden (presence of at least one condition and presence of two or more conditions) among state Medicaid recipients compared to all alternative deprivation measures tested.ConclusionsA low-cost, regionally optimized socioeconomic deprivation index, Palmetto SADI can be used to identify areas in South Carolina at high risk for chronic disease burden among Medicaid recipients and other low-income Medicaid-eligible populations for targeted prevention, screening, diagnosis, disease self-management, and care coordination activities.

How does area-level deprivation depress an individual’s self-rated health and life satisfaction? Evidence from a nationwide population-based survey in Japan

“…Key results were consistent with those obtained in previous studies, and provided evidence of the contextual, adverse impact of area-level deprivation on health outcomes [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The current study showed that municipality-level deprivation impacted general health conditions, which were measured by SRH as well as SWB, which was represented by LS.…”

“…It is well known that area-level socioeconomic conditions have a contextual association with an individual's health outcomes [1][2][3]. Many studies have indicated that area-level deprivation, which re ects various aspects of an area's socioeconomic positions, can affect the health outcomes of its residents, including mortality [4][5][6][7], morbidity [8][9][10][11], mental health [12,13], poor birth outcomes [14][15][16], and health risk behavior [17,18]. The impact of area-level deprivation on health matters for not only public health policies but also macroeconomic and social policies, which are committed to income redistribution, labor market regulations, and other issues related to social welfare.…”

“…Regarding the association between area-level deprivation and health, two issues have remained to be addressed. First, the impact on self-rated health (SRH), which represents overall health conditions [27,28], or subjective well-being (SWB), which is often expressed by life satisfaction (LS) [29,30], has been relatively understudied, compared to the impact of area-level deprivation on mortality, morbidity, or other speci c health outcomes [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Meanwhile, many studies have examined the association between arealevel income inequality or poverty and an individual's SRH or SWB [31][32][33].…”

Creating small-area deprivation indices: a guide for stages and options

“…Testing deprivation indicators and the final measures against health outcomes might be one of the best approaches for validation. This is most useful when the relationships between the different indicators and the health outcomes are compared 39 40. It could be argued that indicators that are best at distinguishing between the different levels of deprivation are those that are also best at describing the variation in health.…”

Acculturation and selected birth defects among non‐Hispanic Blacks in a population‐based case–control study

“…Additionally, a recent systematic review and meta‐analysis examining neighborhood deprivation ratings across different studies found that cleft lip with/without palate was associated with living in more deprived neighborhoods (Deguen, Kihal, Jeanjean, Padilla, & Zmirou‐Navier, ). As neighborhood deprivation ratings are highly related to poverty scales (Lòpez‐De Fede, Stewart, Hardin, et al, ), it is also interesting to note that across all immigrant groups in the United States, recent immigrants, again defined as those having arrived in the country within the past 5 years, experience higher rates of poverty compared to non‐recent immigrants (arriving 6+ years ago) (Raphael & Smolensky, ). Paradoxically, despite the findings that immigrants are more likely to reside in these “disadvantaged” environments, previous birth defects examinations have found a diminished risk for a range of defects among less acculturated mothers having spent ≤5 years in the United States (Hoyt et al, ; Khodr et al, ; Salemi et al, ; Vu et al, ).…”