Ulster University

Academic Institute

This study will be conducted as part of a Strategic Impact Programme (SIP) being undertaken by the ADRC-NI which was established to facilitate the use of linked administrative datasets in a safe manner for projects of this type.

Yes

E100

Small-area deprivation measures based on Super Output Areas have been widely used in the UK to understand inequalities in health since the 1980s (Carstairs & Morris, 1991; Jarman, 1983; Townsend et al., 1988; as cited in Allik et al., 2020). In Northern Ireland (NI), the current measure used to capture area level deprivation based in Super Output Areas is the NI Multiple Deprivation Measure (NIMDM, 2017). The NIMDM 2017 has been widely used by researchers and policy makers alike to better understand and attend to the social, educational, health and economic needs of the NI population for some time (Fraser & Fraser, 2020; Jo et al., 2020). The NIMDM attempts to capture both overall deprivation and deprivation across seven distinct domains (Income, Employment, Health & Disability, Education, Skills & Training, Access to Services, Living Environment and Crime & Disorder). Notably, there are few studies which have sought to determine whether the NIMDM 2017 measures what it purports to measure. In particular, no study has validated the NIMDM 2017 against health outcomes. Therefore, this study seeks to test the predictive utility of the NIMDM 2017 with respect to service usage (i.e., hospital services) and a range of physical and mental health outcomes. Specifically, the current study sought to examine (1) the association between NIMDM 2017 domain, and overall scores and number of hospital admissions and duration of hospital stays, (2) the association between NIMDM 2017 domain and overall scores and a range of physical and mental health morbidities, and (3) the association between NIMDM 2017 domain and overall scores and health trajectories, controlling for age, sex, and changes in deprivation status.

The NIMDM 2017 is frequently used by policy makers to address the social, education, economic, and health needs of the NI population (Fraser & Fraser, 2020; Jo et al., 2020). Although the design and development of the NIMDM 2017 have been extensively discussed in the literature, there has been no known validation of the measure in relation to health outcomes. Although it has been noted that a measure performs well in capturing deprivation if it can accurately account for changes in health (Allik et al., 2019), no study to date has sought to test this hypothesis with respect to the NIMDM 2017. This is problematic given that it is widely established that living in deprived areas is linked to an increased number of hospital admissions and time spent in hospital (Luben et al., 2019), as well as susceptibility to a wide range of chronic health conditions including but not limited to diabetes and obesity (Maier et al., 2014), cancer (Ingleby et al., 2020), heart disease, stroke, and cardiovascular disease (Singh et al., 2015), depression (Dowdall et al., 2017), and dementia (Cadar et al., 2018). Moreover, living in deprived areas is linked to multi-morbidity which currently represents a major health and social care challenge (Knies & Kumari, 2022). This project will benefit the public hugely by ensuring the integrity of the measure that is currently used by NI Departments and others to inform vital policy decisions and to determine the allocation of funding to areas considered to be in greatest need. If the findings of this project indicate that the NIMDM 2017 fails to predict health outcomes in the anticipated direction, this would suggest that the measure may have contributed to an underestimation of socioeconomic disparities and an inappropriate allocation of resources. A worst-case implication of using the NIMDM 2017 if it lacks predictive utility is that decisions made based on this measure may have unintentionally maintained or worsened preventable disparities in NI. Moreover, the geography of NI was restricted for Census 2021 by NISRA. NISRA have introduced Super Output Zones (SOZs) to replace the previous Super Output Areas (SOAs) (there were ~890 SOAs – this has been reduced to ~850 SOZs). The current study will be operating under the NIMDM 2017 which works with SOAs. Given that the NIMDM was based on the previous SOA geography, NIMDM 2017 will need to be revised. This work therefore will be important in informing the design of any new measures. The objectives of this project align with the NI Draft Programme for Government (Northern Ireland Executive, 2016) which seeks to achieve 14 main outcomes which are represented by 42 indicators. One of these 14 main outcomes is to “have a more equal society”. This outcome aims The NIMDM 2017 is frequently used by policy makers to address the social, education, economic, and health needs of the NI population (Fraser & Fraser, 2020; Jo et al., 2020). Although the design and development of the NIMDM 2017 have been extensively discussed in the literature, there has been no known validation of the measure in relation to health outcomes. Although it has been noted that a measure performs well in capturing deprivation if it can accurately account for changes in health (Allik et al., 2019), no study to date has sought to test this hypothesis with respect to the NIMDM 2017. This is problematic given that it is widely established that living in deprived areas is linked to an increased number of hospital admissions and time spent in hospital (Luben et al., 2019), as well as susceptibility to a wide range of chronic health conditions including but not limited to diabetes and obesity (Maier et al., 2014), cancer (Ingleby et al., 2020), heart disease, stroke, and cardiovascular disease (Singh et al., 2015), depression (Dowdall et al., 2017), and dementia (Cadar et al., 2018). Moreover, living in deprived areas is linked to multi-morbidity which currently represents a major health and social care challenge (Knies & Kumari, 2022). This project will benefit the public hugely by ensuring the integrity of the measure that is currently used by NI Departments and others to inform vital policy decisions and to determine the allocation of funding to areas considered to be in greatest need. If the findings of this project indicate that the NIMDM 2017 fails to predict health outcomes in the anticipated direction, this would suggest that the measure may have contributed to an underestimation of socioeconomic disparities and an inappropriate allocation of resources. A worst-case implication of using the NIMDM 2017 if it lacks predictive utility is that decisions made based on this measure may have unintentionally maintained or worsened preventable disparities in NI. Moreover, the geography of NI was restricted for Census 2021 by NISRA. NISRA have introduced Super Output Zones (SOZs) to replace the previous Super Output Areas (SOAs) (there were ~890 SOAs – this has been reduced to ~850 SOZs). The current study will be operating under the NIMDM 2017 which works with SOAs. Given that the NIMDM was based on the previous SOA geography, NIMDM 2017 will need to be revised. This work therefore will be important in informing the design of any new measures. The objectives of this project align with the NI Draft Programme for Government (Northern Ireland Executive, 2016) which seeks to achieve 14 main outcomes which are represented by 42 indicators. One of these 14 main outcomes is to “have a more equal society”. This outcome aims to prevent diversity from acting as a barrier to social justice and to acknowledge and promote diversity within society. Several of the key tasks considered to assist in achieving this outcome include reducing health inequality, education inequality, poverty, and increasing economic opportunities. Ensuring the integrity of a measure designed to both identify diversity and used to guide policy decisions related to the key tasks listed above (e.g., reducing health inequality, reducing education inequality) is an imperative research endeavour. References Cadar, D., Lassale, C., Davies, H., Llewellyn, D. J., Batty, G. D., & Steptoe, A. (2018). Individual and area-based socioeconomic factors associated with dementia incidence in England: evidence from a 12-year follow-up in the English longitudinal study of ageing. JAMA Psychiatry, 75(7), 723-732. Knies, G., & Kumari, M. (2022). Multimorbidity is associated with the income, education, employment and health domains of area-level deprivation in adult residents in the UK. Scientific Reports, 12(1), 7280. https://doi.org/10.1038/s41598-022-11310-9 Luben, R., Hayat, S., Khawaja, A., Wareham, N., Pharoah, P. P., & Khaw, K. T. (2019). Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort. BMJ open, 9(12), e031251. Maier, W., Scheidt-Nave, C., Holle, R., Kroll, L. E., Lampert, T., Du, Y., ... & Mielck, A. (2014). Area level deprivation is an independent determinant of prevalent type 2 diabetes and obesity at the national level in Germany. Results from the National Telephone Health Interview Surveys ‘German Health Update’GEDA 2009 and 2010. PloS One, 9(2), e89661. Northern Ireland Executive. (2016). (rep.). Programme for Government Consultation Document. Singh, G. K., Siahpush, M., Azuine, R. E., & Williams, S. D. (2015). Increasing area deprivation and socioeconomic inequalities in heart disease, stroke, and cardiovascular disease mortality among working age populations, United States, 1969-2011. International Journal of MCH and AIDS, 3(2), 119.

21/06/2024

TRE