Ability of municipality-level deprivation indices to capture social inequalities in perinatal health in France: A nationwide study using preterm birth and small for gestational age to illustrate their relevance

Abstract

Background Evidence-based policy-making to reduce perinatal health inequalities requires an accurate measure of social disparities. We aimed to evaluate the relevance of two municipality-level deprivation indices (DIs), the French-Deprivation-Index (FDep) and the French-European-Deprivation-Index (FEDI) in perinatal health through two key perinatal outcomes: preterm birth (PTB) and small-for-gestational-age (SGA). Methods We used two data sources: The French National Perinatal Surveys (NPS) and the French national health data system (SNDS). Using the former, we compared the gradients of the associations between individual socioeconomic characteristics (educational level and income) and “PTB and SGA” and associations between municipality-level DIs (Q1:least deprived; Q5:most deprived) and “PTB and SGA”. Using the SNDS, we then studied the association between each component of the two DIs (census data, 2015) and “PTB and SGA”. Adjusted odds ratios (aOR) were estimated using multilevel logistic regression with random intercept at the municipality level. Results In the NPS (N = 26,238), PTB and SGA were associated with two individual socioeconomic characteristics: maternal educational level (≤ lower secondary school vs. ≥ Bachelor’s degree or equivalent, PTB: aOR = 1.43 [1.22–1.68], SGA: (1.31 [1.61–1.49]) and household income (< 1000 € vs. ≥ 3000 €, PTB: 1.55 [1.25–1.92], SGA: 1.69 [1.45–1.98]). For both FDep and FEDI, PTB and SGA were more frequent in deprived municipalities (Q5: 7.8% vs. Q1: 6.3% and 9.0% vs. 5.9% for PTB, respectively, and 12.0% vs. 10.3% and 11.9% vs. 10.2% for SGA, respectively). However, after adjustment, neither FDep nor FEDI showed a significant gradient with PTB or SGA. In the SNDS (N = 726,497), no FDep component, and only three FEDI components were significantly associated (specifically, the % of the population with ≤ lower secondary level of education with both outcomes (PTB: 1.5 [1.15–1.96]); SGA: 1.25 [1.03–1.51]), the % of overcrowded (i.e., > 1 person per room) houses (1.63 [1.15–2.32]) with PTB only, and unskilled farm workers with SGA only (1.52 [1.29–1.79]). Conclusion Some components of FDep and FEDI were less relevant than others for capturing ecological inequalities in PTB and SGA. Results varied for each DI and perinatal outcome studied. These findings highlight the importance of testing DI relevance prior to examining perinatal health inequalities, and suggest the need to develop DIs that are suitable for pregnant women.

Environmental and social inequities in continental France: an analysis of exposure to heat, air pollution and lack of vegetation

“…The differences observed between the two deprivation indices, which have already been discussed in other studies (33,34), can be explained by several reasons related to their construction methods. First, the EDI was built to allow comparability between European countries (30), whereas the FDep was created to characterize spatial socioeconomic heterogeneity in France (31).…”

“…Finally, the components included in the two indices also differ. For example, the EDI includes "the proportion of non-homeowners," "the proportion of households without a car," and "the proportion of primary residences with more than one person per room," although these items do not reflect socioeconomic deprivation in the same way in rural and urban areas (33,34,41). For example, urban areas often have well-developed public transport systems, which limits the need to own a car.…”

“…We considered both indicators, because a clear concordance between them has not yet been demonstrated (33,34), and there is currently no recommendation favoring one of them (32).…”

Impact of COVID-19 epidemic on antihypertensive drug treatment disruptions: results from a nationwide interrupted time-series analysis

“…Because a patient could contribute to multiple quarterly subcohorts, the characteristics of eligible patients were described on an annual basis beginning with the March-May 2018, 2019, and 2020 quarter. This description took into account age, gender, the existence of a severe long-term condition, socioeconomic vulnerability assessed using the French deprivation index (FDep), a composite indicator that characterizes the socioeconomic status of families to account for territorial disparities ( Rey et al, 2009 ; Barry et al, 2022 ). Because drug use was not measurable during hospital stays and its rate potentially varied over the period ( Suissa, 2008 ; Bezin et al, 2017 ), the occurrence of hospitalizations was assessed over the 1-month and 3-month period preceding antihypertensive drug breaks.…”

Weight telemonitoring of heart failure versus standard of care in a real‐world setting: Results on mortality and hospitalizations in a 6‐month nationwide matched cohort study

“…16,17 The selection process of the covariates included in the hdPS and their characteristics are detailed in online supplementary Method S5. Predefined covariates were age, gender, the French social deprivation index, 18,19 year and quarter of inclusion to account for HF seasonality, density of general practitioners and cardiologists in the department of residence, cardiac implant (defibrillator/pacemaker) status, time between the last HF hospitalization and the index date (30 days or less and 30 days-1 year), medical history and comorbidities, HF-related drugs (online supplementary Method S6), and risk of HF rehospitalization. Risk of HF rehospitalization was used as a proxy of HF severity and defined from a previous work on HF conducted using the SNDS database.…”