Association of a new Czech Index of Multiple Deprivation with mortality
Y Pan, D Szabo, H Pikhart, M BobakAbstract
Background
Various versions of Index of Multiple Deprivation (IMD) measuring levels of deprivation in small geographical areas are increasingly used in Western Europe but no such index with sufficient geographical resolution is available in Central and Eastern Europe. We tested a preliminary version of IMD in Czechia and examined association with individual level socioeconomic status (SES) and mortality from all causes and cancer.
Methods
The IMD combines administrative data on six domains: housing and services, crime, education, employment, living environment, and income. We linked the IMD with geocoded participants of the Czech HAPIEE cohort based in 7 towns (baseline survey in 2002-05, mean age 58 years). Cox proportional hazards models were used to estimate hazard ratios (HRs) of death from all causes and from cancer with IMD and with individual SES (based on combination of education, occupation, and household amenities).
Results
The IMD was strongly associated with individual SES. Among 7,389 participants, 2,564 deaths (840 from cancer) occurred during an average 18-year follow-up. HRs per 1SD of IMD, adjusted for age and sex, were 1.17 (1.13-1.21) for all-cause mortality and 1.15 (1.08-1.23) for cancer deaths. For individual SES, the corresponding HRs were 2.02 (1.79-2.29) and 1.86 (1.50-2.30). We found no interaction between IMD and individual SES, and both measures remained statistically significant when mutually adjusted (HRs per 1SD of IMD, adjusted for age, sex and SES, were 1.18 (1.04-1.32) for all-cause mortality and 1.23 (1.01-1.49) for cancer deaths).
Conclusions
Both IMD and individual SES predicted all-cause and cancer mortality in the cohort, suggesting that in absence of individual data, the IMD is suitable alternative measure of socioeconomic deprivation. Since the IMD covers the whole country, it can be used for nationwide studies of inequalities in routinely collected health outcomes.