Inequalities in health. Analytic approaches based on life expectancy and suitable for small area comparisons

Study objective-Simple measures of inequalities in health are proposed to f acilitate the work of health policy makers and to build on the understandin g of health differences between populations. In addition, it is aimed to ma ke these measures applicable for comparisons of small populations and subgr oups. Methods-Inequalities in health or health deficiencies were quantified as th e difference between the life expectancy of the subgroup of interest and th at of the national population. Health deficiencies were divided into diseas e specific components by partial application of cause eliminated life table methods. To manage small numbers and to depict time trends, locally weight ed regression smoothing was applied. Confidence intervals were constructed through Monte Carlo simulations. Applications and comparisons-The proposed approaches were applied to the he alth situation in Cape Breton County, Nova Scotia, Canada, and disclosed th e significance of different diseases and distinct patterns between communit ies. The proposed measures were also compared with the traditionally used s tandardised mortality rates and ratios. Here, the proposed measures appeare d beneficial in that they are easier to comprehend and that they provide ti me 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 incor porated in economic evaluations as well as in more sophisticated public hea lth models.