Suchergebnisse

Intro -- Foreword -- Contents -- About the Editors -- Contributors -- Part I: General Considerations and Methodologic Aspects -- Chapter 1: Social Inequities in Cancer: Why Develop Scientific Research? -- References -- Chapter 2: Population-Based Cancer Registries: A Data Stream to Help Build an Evidence-Based Cancer Policy for Europe and for European Countries -- References -- Chapter 3: The European Deprivation Index: A Tool to Help Build an Evidence-Based Cancer Policy for Europe -- References -- Chapter 4: Social Disparities in Cancer Incidence: Methodological Considerations -- Introduction -- General Context -- Methodological Points -- Context of Spatial Analysis -- Bayesian Model for Smoothing Relative Risks -- Distribution of Hyperparameters σ2v and σ2u -- Regression Models with Covariates -- The Data -- The Results -- SIR, Smoothed SIR and Choice of Bayesian Model -- Regression Coefficients for the Explanatory Variables -- Sensitivity Analysis on the Choice of Hyper-Parameters -- Elements of Discussion -- Conclusion -- References -- Chapter 5: Social Disparities in Cancer Survival: Methodological Considerations -- Introduction -- Relative Survival Approaches -- Net Survival -- The Measure of Interest -- Estimation -- Age-Standardisation for Improving Comparability -- Measuring the Socioeconomic Deprivation -- Illustration - Part 1 -- Quantifying the Association between Socioeconomic Deprivation and Excess Mortality -- The Mortality Hazard -- Illustration - Part 2 -- Some Principles for Defining a Hazard-Based Regression Model -- Illustration - Part 3 -- Discussion -- References -- Part II: Social Disparities in Cancer Incidence and Survival - Reports -- Chapter 6: Social Disparities in Cancer Incidence Among Adults in Europe -- Background -- Cancers Associated with Low Socioeconomic Status.

Most ecological indices of deprivation are constructed from census data at the national level, which raises questions about the relevance of their use, and their comparability across a country. We aimed to determine whether a national index can account for deprivation regardless of location characteristics. In Metropolitan France, 43,853 residential census block groups (IRIS) were divided into eight area types based on quality of life. We calculated score deprivation for each IRIS using the French version of the European Deprivation Index (F-EDI). We decomposed the score by calculating the contribution of each of its components by area type, and we assessed the impact of removing each component and recalculating the weights on the identification of deprived IRIS. The set of components most contributing to the score changed according to the area type, but the identification of deprived IRIS remained stable regardless of the component removed for recalculating the score. Not all components of the F-EDI are markers of deprivation according to location characteristics, but the multidimensional nature of the index ensures its robustness. Further research is needed to examine the limitations of using these indices depending on the purpose of the study, particularly in relation to the geographical grid used to calculate deprivation scores.

International audience ; Spatial accessibility to health services is a key factor in terms of public health. Even though some tools are available, establishing accessibility criteria applicable from one geographic scale to another remains difficult. Therefore, we propose a method for creating a health accessibility index applicable on a large geographic scale, based on a methodology that overcomes the limitations of political-administrative divisions and which allows a multi-scalar approach to be implemented. The index highlights, on a national scale, areas of cumulative health disadvantages. This index of accessibility to health care combines accessibility and availability and can be adapted to many geographical scales. As accessibility can be understood in various dimensions, a score could be calculated for various fields such as education and culture. The index can help policymakers to identify under-endowed areas and find optimal locations. In terms of public health, it may be used to understand the mechanisms underlying geographic health disparities.

International audience ; Spatial accessibility to health services is a key factor in terms of public health. Even though some tools are available, establishing accessibility criteria applicable from one geographic scale to another remains difficult. Therefore, we propose a method for creating a health accessibility index applicable on a large geographic scale, based on a methodology that overcomes the limitations of political-administrative divisions and which allows a multi-scalar approach to be implemented. The index highlights, on a national scale, areas of cumulative health disadvantages. This index of accessibility to health care combines accessibility and availability and can be adapted to many geographical scales. As accessibility can be understood in various dimensions, a score could be calculated for various fields such as education and culture. The index can help policymakers to identify under-endowed areas and find optimal locations. In terms of public health, it may be used to understand the mechanisms underlying geographic health disparities.

International audience ; Spatial accessibility to health services is a key factor in terms of public health. Even though some tools are available, establishing accessibility criteria applicable from one geographic scale to another remains difficult. Therefore, we propose a method for creating a health accessibility index applicable on a large geographic scale, based on a methodology that overcomes the limitations of political-administrative divisions and which allows a multi-scalar approach to be implemented. The index highlights, on a national scale, areas of cumulative health disadvantages. This index of accessibility to health care combines accessibility and availability and can be adapted to many geographical scales. As accessibility can be understood in various dimensions, a score could be calculated for various fields such as education and culture. The index can help policymakers to identify under-endowed areas and find optimal locations. In terms of public health, it may be used to understand the mechanisms underlying geographic health disparities.

Introduction: Ecological deprivation indices belong to essential instruments for monitoring and understanding health inequalities. Our aim was to develop the SI-EDI, a newly derived European Deprivation Index for Slovenia. We intend to provide researchers and policy-makers in our country with a relevant tool for measuring and reducing the socioeconomic inequalities in health, and even at a broader level. Methods: Data from the European survey on Income and Living Conditions and Slovenian national census for the year 2011 were used in the SI-EDI construction. The concept of relative deprivation was used where deprivation refers to unmet need(s), which is caused by lack of all kinds of resources, not only material. The SI-EDI was constructed for 210 Slovenian municipalities. Its geographical distribution was compared to the distribution of two existing deprivation scores previously applied in health inequality research in Slovenia. Results: There were 36% of adults recognized as deprived in Slovenia in 2011. SI-EDI was calculated using 10 census variables that were associated with individual deprivation. A clear east-to-west gradient was detected with the most deprived municipalities in the eastern part of the country. The two existing deprivation scores correlate significantly with the SI-EDI. Conclusions: A new deprivation index, the SI-EDI, is grounded on the internationally established scientific concept, can be replicated over time and, crucially, provides an account of the socioeconomic and cultural particularities of the Slovenian population. The SI-EDI could be used by the stakeholders and the governmental and nongovernmental sectors in Slovenia, with the goal of better understanding health inequalities in Slovenia.

Background: Studying social disparities in health implies the ability to measure them accurately, to compare them between different areas or countries and to follow trends over time. This study proposes a method for constructing a French European deprivation index, which will be replicable in several European countries and is related to an individual deprivation indicator constructed from a European survey specifically designed to study deprivation.

Methods and Results: Using individual data from the European Union Statistics on Income and Living Conditions survey, goods/services indicated by individuals as being fundamental needs, the lack of which reflect deprivation, were selected. From this definition, which is specific to a cultural context, an individual deprivation indicator was constructed by selecting fundamental needs associated both with objective and subjective poverty. Next, the authors selected among variables available both in the European Union Statistics on Income and Living Conditions survey and French national census those best reflecting individual experience of deprivation using multivariate logistic regression. An ecological measure of deprivation was provided for all the smallest French geographical units. Preliminary validation showed a higher association between the French European Deprivation Index (EDI) score and both income and education than the Townsend index, partly ensuring its ability to measure individual socioeconomic status.

Conclusion: This index, which is specific to a particular cultural and social policy context, could be replicated in 25 other European countries, thereby allowing European comparisons. EDI could also be reproducible over time. EDI could prove to be a relevant tool in evidence-based policy-making for measuring and reducing social disparities in health issues and even outside the medical domain.

International audience ; Introduction: Ecological deprivation indices belong to essential instruments for monitoring and understanding health inequalities. Our aim was to develop the SI-EDI, a newly derived European Deprivation Index for Slovenia. We intend to provide researchers and policy-makers in our country with a relevant tool for measuring and reducing the socioeconomic inequalities in health, and even at a broader level. Methods: Data from the European survey on Income and Living Conditions and Slovenian national census for the year 2011 were used in the SI-EDI construction. The concept of relative deprivation was used where deprivation refers to unmet need(s), which is caused by lack of all kinds of resources, not only material. The SI-EDI was constructed for 210 Slovenian municipalities. Its geographical distribution was compared to the distribution of two existing deprivation scores previously applied in health inequality research in Slovenia. Results: There were 36% of adults recognized as deprived in Slovenia in 2011. SI-EDI was calculated using 10 census variables that were associated with individual deprivation. A clear east-to-west gradient was detected with the most deprived municipalities in the eastern part of the country. The two existing deprivation scores correlate significantly with the SI-EDI. Conclusions: A new deprivation index, the SI-EDI, is grounded on the internationally established scientific concept, can be replicated over time and, crucially, provides an account of the socioeconomic and cultural particularities of the Slovenian population. The SI-EDI could be used by the stakeholders and the governmental and nongovernmental sectors in Slovenia, with the goal of better understanding health inequalities in Slovenia. ; Uvod: Kazalniki, ki na ravni izbranih geografskih enot prikazujejo socialno-ekonomsko blagostanje oziroma primanjkljaj prebivalstva, so danes temeljno orodje za preučevanje in razumevanje neenakosti v zdravju. V prispevku predstavljamo SI-EDI, novo razvit kazalnik ...

International audience ; Introduction: Ecological deprivation indices belong to essential instruments for monitoring and understanding health inequalities. Our aim was to develop the SI-EDI, a newly derived European Deprivation Index for Slovenia. We intend to provide researchers and policy-makers in our country with a relevant tool for measuring and reducing the socioeconomic inequalities in health, and even at a broader level. Methods: Data from the European survey on Income and Living Conditions and Slovenian national census for the year 2011 were used in the SI-EDI construction. The concept of relative deprivation was used where deprivation refers to unmet need(s), which is caused by lack of all kinds of resources, not only material. The SI-EDI was constructed for 210 Slovenian municipalities. Its geographical distribution was compared to the distribution of two existing deprivation scores previously applied in health inequality research in Slovenia. Results: There were 36% of adults recognized as deprived in Slovenia in 2011. SI-EDI was calculated using 10 census variables that were associated with individual deprivation. A clear east-to-west gradient was detected with the most deprived municipalities in the eastern part of the country. The two existing deprivation scores correlate significantly with the SI-EDI. Conclusions: A new deprivation index, the SI-EDI, is grounded on the internationally established scientific concept, can be replicated over time and, crucially, provides an account of the socioeconomic and cultural particularities of the Slovenian population. The SI-EDI could be used by the stakeholders and the governmental and nongovernmental sectors in Slovenia, with the goal of better understanding health inequalities in Slovenia. ; Uvod: Kazalniki, ki na ravni izbranih geografskih enot prikazujejo socialno-ekonomsko blagostanje oziroma primanjkljaj prebivalstva, so danes temeljno orodje za preučevanje in razumevanje neenakosti v zdravju. V prispevku predstavljamo SI-EDI, novo razvit kazalnik primanjkljaja na ravni slovenskih občin. SI-EDI je slovenska različica evropskega kazalnika primanjkljaja (European Deprivation Index – EDI), ki ga v javnozdravstvenih raziskavah že uspešno uporabljajo v Franciji, Španiji, Italiji, Angliji in na Portugalskem. Namen raziskave je tudi preveriti veljavnost SI-EDI in ga tako kot ustrezno orodje ponuditi raziskovalcem in odločevalcem. Metode: Za izdelavo SI-EDI smo uporabili podatke za leto 2011 iz dveh virov: (1) podatke slovenske različice Ankete o življenjskih pogojih, ki jo na zahtevo Eurostata na reprezentativnem vzorcu posameznikov letno izvaja nacionalni statistični urad, in (2) podatke iz popisa prebivalstva. Izračun temelji na konceptu relativnega primanjkljaja, ki ga je prvi opisal Townsend, danes pa se v nekoliko prilagojeni obliki uporablja tudi v izračunu kazalnikov primanjkljaja na ravni Evropske unije. V konceptu relativnega primanjkljaja so pomanjkanju podvrženi posamezniki, ki jim ni omogočeno zadovoljevanje različnih vrst potreb, ne samo materialnih. SI-EDI za 210 slovenskih občin smo izračunali po enaki metodi, kot se uporablja za EDI. Njegovo veljavnost smo preizkušali s primerjavo z dvema obstoječima kazalnikoma, ki sta se v slovenskem prostoru v zadnjem obdobju uporabljala v raziskavah in prikazih socialno-ekonomske neenakosti v zdravju po občinah: koeficientom razvitosti občin, ki ga uporablja NIJZ, ter kazalnikom primanjkljaja, ki ga je v dosedanjih analizah bremena raka uporabljala naša raziskovalna skupina. Rezultati: Med štirimi temeljnimi življenjskimi potrebami (dostopnost počitnic, zmožnost ogrevati bivališče, osebnega računalnika in avtomobila), ki so se v raziskavi izkazale za povezane z objektivno ali subjektivno revščino, vsaj ene izmed njih ni zadovoljilo 36 % odraslih. Ti so bili opredeljeni kot prikrajšani na individualni ravni. Njihove lastnosti so bile prenesene na populacijsko raven v agregirani obliki, tako da smo za izračun SI-EDI uporabili 10 ustreznih popisnih spremenljivk. Na zemljevidu SI-EDI po občinah je jasno viden trend večanja socialno-ekonomskega primanjkljaja od zahoda proti vzhodu države. Največje vrednosti SI-EDI imajo področja na skrajnem severovzhodu in jugovzhodu države. Povezava SI-EDI z dvema obstoječima kazalnikoma primanjkljaja je bila statistično značilna. Zaključki: Nov kazalnik primanjkljaja SI-EDI je zasnovan na mednarodno priznanem znanstvenem konceptu, lahko se replicira v času in prostoru, ter kar je najpomembnejše, odraža socialno-ekonomske in kulturne posebnosti populacije. Prepričani smo, da lahko služi kot ustrezno orodje pri razumevanju socialno-ekonomskih razlik v zdravju, zagotovo pa je lahko uporaben tudi drugod, ne samo na javnozdravstvenem področju.

International audience ; Introduction: Ecological deprivation indices belong to essential instruments for monitoring and understanding health inequalities. Our aim was to develop the SI-EDI, a newly derived European Deprivation Index for Slovenia. We intend to provide researchers and policy-makers in our country with a relevant tool for measuring and reducing the socioeconomic inequalities in health, and even at a broader level. Methods: Data from the European survey on Income and Living Conditions and Slovenian national census for the year 2011 were used in the SI-EDI construction. The concept of relative deprivation was used where deprivation refers to unmet need(s), which is caused by lack of all kinds of resources, not only material. The SI-EDI was constructed for 210 Slovenian municipalities. Its geographical distribution was compared to the distribution of two existing deprivation scores previously applied in health inequality research in Slovenia. Results: There were 36% of adults recognized as deprived in Slovenia in 2011. SI-EDI was calculated using 10 census variables that were associated with individual deprivation. A clear east-to-west gradient was detected with the most deprived municipalities in the eastern part of the country. The two existing deprivation scores correlate significantly with the SI-EDI. Conclusions: A new deprivation index, the SI-EDI, is grounded on the internationally established scientific concept, can be replicated over time and, crucially, provides an account of the socioeconomic and cultural particularities of the Slovenian population. The SI-EDI could be used by the stakeholders and the governmental and nongovernmental sectors in Slovenia, with the goal of better understanding health inequalities in Slovenia. ; Uvod: Kazalniki, ki na ravni izbranih geografskih enot prikazujejo socialno-ekonomsko blagostanje oziroma primanjkljaj prebivalstva, so danes temeljno orodje za preučevanje in razumevanje neenakosti v zdravju. V prispevku predstavljamo SI-EDI, novo razvit kazalnik ...

Background: Describing the relationship between socioeconomic inequalities and cancer survival is important but methodologically challenging. We propose guidelines for addressing these challenges and illustrate their implementation on French population-based data.
Methods: We analyzed 17 cancers. Socioeconomic deprivation was measured by an ecological measure, the European Deprivation Index (EDI). The Excess Mortality Hazard (EMH), ie, the mortality hazard among cancer patients after accounting for other causes of death, was modeled using a flexible parametric model, allowing for nonlinear and/or time-dependent association between the EDI and the EMH. The model included a cluster-specific random effect to deal with the hierarchical structure of the data.
Results: We reported the conventional age-standardized net survival (ASNS) and described the changes of the EMH over the time since diagnosis at different levels of deprivation. We illustrated nonlinear and/or time-dependent associations between the EDI and the EMH by plotting the excess hazard ratio according to EDI values at different times after diagnosis. The median excess hazard ratio quantified the general contextual effect. Lip–oral cavity–pharynx cancer in men showed the widest deprivation gap, with 5-year ASNS at 41% and 29% for deprivation quintiles 1 and 5, respectively, and we found a nonlinear association between the EDI and the EMH. The EDI accounted for a substantial part of the general contextual effect on the EMH. The association between the EDI and the EMH was time dependent in stomach and pancreas cancers in men and in cervix cancer.
Conclusion: The methodological guidelines proved efficient in describing the way socioeconomic inequalities influence cancer survival. Their use would allow comparisons between different health care systems.