How Other Countries Use Deprivation Indices—And Why The United States Desperately Needs One

Abstract

Integrating public health and medicine to address social determinants of health is essential to achieving the Triple Aim of lower costs, improved care, and population health. There is intense interest in the United States in using social determinants of health to direct clinical and community health interventions, and to adjust quality measures and payments. The United Kingdom and New Zealand use data representing aspects of material and social deprivation from their censuses or from administrative data sets to construct indices designed to measure socioeconomic variation across communities, assess community needs, inform research, adjust clinical funding, allocate community resources, and determine policy impact. Indices provide these countries with comparable data and serve as a universal language and tool set to define organizing principles for population health. In this article we examine how these countries develop, validate, and operationalize their indices; explore their use in policy; and propose the development of a similar deprivation index for the United States.

Neighborhood disadvantage and chronic disease management

“…11,14 The relationship between neighborhood disadvantage and achievement of control varied across the three outcomes. The difference in outcome control between the most (ventiles [16][17][18][19][20] and least (ventiles 1-5) disadvantaged quintiles of neighborhood disadvantage was largest for the cholesterol and diabetes cohorts, and smaller in the blood pressure cohort. Only the top 10 percent (ventiles 19 and 20) most disadvantaged neighborhoods were significantly associated with worse blood pressure control after adjustment, indicating that this relationship is different for the most disadvantaged neighborhoods compared to the rest of the population (Table 2).…”

“…Quantifying the effect of neighborhood disadvantage is further challenged by the lack of an accepted, accessible indicator. Although patient‐level measures of neighborhood disadvantage are often unavailable in health data, some health agencies outside the United States have developed and validated geographic indices of neighborhood disadvantage to identify socioeconomic disparities and target quality improvement efforts . The Area Deprivation Index (ADI) is a validated indicator of neighborhood disadvantage that may be used similarly in the United States .…”

“…Although patient-level measures of neighborhood disadvantage are often unavailable in health data, some health agencies outside the United States have developed and validated geographic indices of neighborhood disadvantage to identify socioeconomic disparities and target quality improvement efforts. 16 The Area Deprivation Index (ADI) is a validated indicator of neighborhood disadvantage that may be used similarly in the United States. 10,17 A composite index created from individual socioeconomic factors not only better captures the multidimensional construct of neighborhood disadvantage, but has greater validity and explanatory power than single individual measures.…”

Detecting Risk of Low Health Literacy in Disadvantaged Populations Using Area-based Measures

“…The ADI is a geographic area-based measure of the disadvantaged position of residents relative to the society [12]. The ADI was calculated for the state of Utah using a measure developed by Singh [13] based upon 17 U.S. Census measures associated with mortality, including living conditions, income, unemployment and education listed in Table 1.…”

Driving Improvement in Health and Health Care

“…To define quality of care, we will start with measures that have already been vetted by North Carolina's clinicians and professional groups during the development of the 1115 waiver, in addition to comprehensive primary care plus and other recent work, including the 2016 Medicaid core measures for adults and children, the Patient Protection and Affordable Care Act measures, the patient-centered medical home measures, and the Institute for Healthcare Improvement's "Whole Systems Measures 2.0" [7]. As much as possible, we will consider benchmarks for quality of care from other Medicaid programs, adjusted for eligibility and case mix, and target those benchmarks that have the greatest performance gaps for North Carolina.…”