Canadian Journal of Public Health

, Volume 104, Issue 4, pp e311–e316 | Cite as

Should We Enhance the Commonly Used Deprivation Index for a Regional Context?

  • Mikiko TerashimaEmail author
  • Daniel G. C. Rainham
  • Adrian R. Levy
Quantitative Research


Background/Objectives: Versions of deprivation indices have been increasingly used to monitor patterns and magnitudes of inequality in health. For policy-makers, it is of interest to assess whether they need to construct regionally tailored indices, or whether the existing indices perform sufficiently in detecting inequalities in their respective jurisdiction. Few studies have explored the benefits of constructing a more tailored index for a regional context.

METHODS: The study examined, in linear regression models, the proportion of variance (adjusted R2) explained in age-standardized cardiovascular disease (CVD) incidence rate ratios by an index emulating a now-widely-used multiple deprivation index created in Quebec (INSPQI), and a newly created index for Nova Scotia with additional census variables. The magnitudes of inequality were compared by the differences between mean incidences of most and least deprived groups.

RESULTS: The newly created deprivation index did not explain as well as the INSPQI-like index the community-level variability in CVD incidences. The gap in mean CVD incidences between the most and least deprived groups was somewhat narrower with the new index, indicating that the new index is not necessarily more sensitive to the inequality attributed to community social disadvantages.

CONCLUSIONS: Complicating the indices may not necessarily be of benefit when used for surveillance of population health inequalities. For public health practitioners and decision makers who need to make quick decisions in provisions of services and programs, a generic, well-established deprivation index such as INSPQI can serve well in a regional context.

Key Words

Deprivation indices population health surveillance small-area variation analysis geographic context 


CONTEXTE/OBJECTIFS: On utilise de plus en plus des versions des indices de défavorisation pour surveiller les grandes tendances dans les inégalités de santé et l’ampleur de ces inégalités. Pour les responsables des politiques, il est intéressant de pouvoir évaluer s’ils ont besoin de construire des indices régionaux ou si les indices existants réussissent suffisamment bien à détecter les inégalités sur leur territoire respectif. Peu d’études se sont attachées aux avantages de construire un indice mieux adapté à un contexte régional.

MÉTHODE: Nous avons examiné, dans les modèles de régression linéaire, la part de la variance expliquée par ces modèles (critère R2 ajusté) dans les rapports de taux d’incidence des maladies cardiovasculaires (MCV) standardisés pour l’âge avec un indice émulant un indice de défavorisation multiple créé au Québec (l’INSPQI), aujourd’hui très utilisé, et un indice nouvellement créé pour la NouvelleÉcosse avec des variables supplémentaires du Recensement. L’ampleur des inégalités a été comparée selon les différences entre les incidences moyennes dans les groupes les plus et les moins défavorisés.

RÉSULTATS: L’indice de défavorisation nouvellement créé n’a pas expliqué aussi bien que l’indice semblable à l’INSPQI la variabilité au niveau communautaire dans les incidences de MCV. L’écart dans les incidences moyennes de MCV entre les groupes les plus et les moins défavorisés était un peu plus faible avec le nouvel indice, ce qui montre que celui-ci n’est pas nécessairement plus sensible aux inégalités imputées à la défavorisation sociale des communautés.

CONCLUSIONS: Compliquer les indices n’est pas nécessairement un avantage quand ces indices servent à la surveillance des inégalités de santé des populations. Pour les praticiens et les décideurs de la santé publique qui doivent prendre des décisions rapides sur l’organisation des services et des programmes, un indice de défavorisation général bien établi, comme l’INSPQI, peut très bien faire l’affaire dans un contexte régional.

Mots Clés

indices de défavorisation surveillance de population analyse des variations régionales contexte géographique 


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Copyright information

© The Canadian Public Health Association 2013

Authors and Affiliations

  • Mikiko Terashima
    • 1
    • 2
  • Daniel G. C. Rainham
    • 1
  • Adrian R. Levy
    • 2
  1. 1.Environmental Science ProgramDalhousie UniversityHalifaxCanada
  2. 2.Department of Community Health & EpidemiologyDalhousie UniversityHalifaxCanada

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