Primary Submission Category: Structural factors
Gender-based inequities in area-level deprivation
Authors: Alka Dev Lucy Skinner
Presenting Author: Alka Dev*
There is growing recognition of the instrumental role that one’s context plays in determining health outcomes over the life course. Variations in people’s social determinants of health can lead to gross inequities in health outcomes across communities, a policy perspective established in the U.K. decades ago. Twenty years ago in the U.S., Singh constructed a composite area-level deprivation index (ADI) based on 1990 census tract data to measure the multidimensional nature of socioeconomic complexity at the community level that could not be approximated by a single measure alone. Since then, area-level deprivation has been associated with various adverse health outcomes, including preterm birth at the census division level, and cancer patient outcomes, including depression and anxiety, and cardiac readmissions at the zip code level. Recently, researchers have found three distinct dimensions to the measure, the ADI-3, consisting of neighborhood financial strength, economic hardship and inequality, and educational attainment. We aimed to determine whether area-level deprivation has a gender lens among people of reproductive ages. Using two approaches, we analyzed the 2021 American Community Survey 5-year Public Use Microdata Sample to explore male-female differences in area deprivation for people aged 15 – 55 years. In the first approach, we calculated a single score using principal component analysis to compare the overall ADI with those specific to men and women over 982 public use microdata areas (PUMA). In the second approach, we used exploratory factor analysis to determine whether the dimensions for overall, male, and female ADIs were statistically similar. Our preliminary findings show that a global ADI based on one principal component is not consistent by gender. In at least 10% of PUMAs, the ADIs were significantly different across the two groups. We also found three dimensions to the ADI but did not find these dimensions to be stable by gender, i.e., there were compositional differences in factors measuring deprivation across men and women. In the next phase, we plan to test the construct validity of the index with respect to men and women and to present results on the gender-based structural differences at the county level. Our study has implications for whether gender-specific health outcomes are correlated with the level of deprivation experienced by men versus women.