STUDY OBJECTIVE Simple measures of inequalities in health are proposed to facilitate the work of health policy makers and to build on the understanding of health differences between populations. In addition, it is aimed to make these measures applicable for comparisons of small populations and subgroups.
METHODS Inequalities in health or health deficiencies were quantified as the difference between the life expectancy of the subgroup of interest and that of the national population. Health deficiencies were divided into disease specific components by partial application of cause eliminated life table methods. To manage small numbers and to depict time trends, locally weighted regression smoothing was applied. Confidence intervals were constructed through Monte Carlo simulations.
APPLICATIONS AND COMPARISONS The proposed approaches were applied to the health situation in Cape Breton County, Nova Scotia, Canada, and disclosed the significance of different diseases and distinct patterns between communities. The proposed measures were also compared with the traditionally used standardised mortality rates and ratios. Here, the proposed measures appeared beneficial in that they are easier to comprehend and that they provide time trends and more robust estimates.
CONCLUSIONS The above advantages make the proposed approaches beneficial to health policy makers and epidemiologists. The approaches may also be incorporated in economic evaluations as well as in more sophisticated public health models.
- epidemiological methods
- health status indicators
- chronic diseases
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Funding: financial support for this study is provided to Dr Paul J Veugelers through a Dalhousie Faculty of Medicine Research Committee Intramural Grant and by the Canadian Foundation for Innovation, with matching funding from the Dalhousie Medical Research Foundation, the Dalhousie University Medical Research Services, and the Nova Scotia Government. Dr Judith Read Guernsey receives funding by Electric Power Research Institute, Inc, Palo Alto, California, USA (contract no WO5305–01).
Conflicts of interest: none.