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      Area-level Socioeconomic Deprivation Affect Individual Cancer Mortality in Korea

      editorial
      Journal of Korean Medical Science
      The Korean Academy of Medical Sciences

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          Abstract

          Individual socioeconomic status (SES) is one of the important determinants of health. Public health researchers have also been interested in area-level SES, which has led to the development of several regional deprivation indices (1). These tools usually measure both material deprivation and social deprivation. Material deprivation is associated with disadvantages in securing materials, goods, services, resources, amenities, the physical environment, and residential location. And social deprivation is about on disadvantages in the roles, relationships, functions, customs, rights, and responsibilities as the members of society (2). The deprivation indices can be a useful tool for investigating local health inequalities. In Korea, Choi et al. (2) suggested the relationship between the town-level deprivation index and the overall or cause-specific mortality in an ecological study. However, the ecological study is neither able to control for individual SES, nor to present the evidence of the causal relationship between the area-level deprivation and individual health. The recent study by Kwak and Kim (3) overcame these using a multilevel Cox proportional hazard model. They examined the effect of town-level deprivation on individual survival time among major cancer patients in Busan, Korea, and revealed that cancer patients living in more deprived areas had shorter survival time than those in affluent areas. The association between area-level deprivation and cancer survival may be explained in part by health-related behaviors and accessibility to health care service (4 5). For the future study, researchers may focus on identifying the mechanism how area-level SES affects the survival time of cancer patients. In addition to this, there is a need to develop a policy to reduce regional inequalities in cancer survival. The town-level deprivation index can be a good reference for local governments to develop cancer prevention and care strategies.

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          Assessment of the ecological bias of seven aggregate social deprivation indices

          Background In aggregate studies, ecological indices are used to study the influence of socioeconomic status on health. Their main limitation is ecological bias. This study assesses the misclassification of individual socioeconomic status in seven ecological indices. Methods Individual socioeconomic data for a random sample of 10,000 persons came from periodic health examinations conducted in 2006 in 11 French departments. Geographical data came from the 2007 census at the lowest geographical level available in France. The Receiver Operating Characteristics (ROC) curves, the areas under the curves (AUC) for each individual variable, and the distribution of deprived and non-deprived persons in quintiles of each aggregate score were analyzed. Results The aggregate indices studied are quite good “proxies” for individual deprivation (AUC close to 0.7), and they have similar performance. The indices are more efficient at measuring individual income than education or occupational category and are suitable for measuring of deprivation but not affluence. Conclusions The study inventoried the aggregate indices available in France and evaluated their assessment of individual SES.
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            Deprivation and Mortality at the Town Level in Busan, Korea: An Ecological Study

            Objectives Busan is reported to have the highest mortality rate among 16 provinces in Korea, as well as considerable health inequality across its districts. This study sought to examine overall and cause-specific mortality and deprivation at the town level in Busan, thereby identifying towns and causes of deaths to be targeted for improving overall health and alleviating health inequality. Methods Standardized mortality ratios (SMRs) for all-cause and four specific leading causes of death were calculated at the town level in Busan for the years 2005 through 2008. To construct a deprivation index, principal components and factor analysis were adopted, using 10% sample data from the 2005 census. Geographic information system (GIS) mapping techniques were applied to compare spatial distributions between the deprivation index and SMRs. We fitted the Gaussian conditional autoregressive model (CAR) to estimate the relative risks of mortality by deprivation level, controlling for both the heterogeneity effect and spatial autocorrelation. Results The SMRs of towns in Busan averaged 100.3, ranging from 70.7 to 139.8. In old inner cities and towns reclaimed for replaced households, the deprivation index and SMRs were relatively high. CAR modeling showed that gaps in SMRs for heart disease, cerebrovascular disease, and physical injury were particularly high. Conclusions Our findings indicate that more deprived towns are likely to have higher mortality, in particular from cardiovascular disease and physical injury. To improve overall health status and address health inequality, such deprived towns should be targeted.
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              Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years’ Observation on British Women and Systematic Review of Prospective Studies

              Background Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review. Methods And Findings We used data from 4,286 women from the British Women’s Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model. Conclusions Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation.
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                Author and article information

                Journal
                J Korean Med Sci
                J. Korean Med. Sci
                JKMS
                Journal of Korean Medical Science
                The Korean Academy of Medical Sciences
                1011-8934
                1598-6357
                December 2017
                30 October 2017
                : 32
                : 12
                : 1905
                Affiliations
                Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
                Author notes
                Address for Correspondence: Hae-Sung Nam, MD. Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea. hsnam88@ 123456gmail.com
                Author information
                https://orcid.org/0000-0003-0911-4576
                Article
                10.3346/jkms.2017.32.12.1905
                5680484
                29115067
                06a40a32-0e08-43e3-acc3-5a4ca79c40f0
                © 2017 The Korean Academy of Medical Sciences.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 October 2017
                : 26 October 2017
                Categories
                Editorial

                Medicine
                Medicine

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