Calculation of a Surrogate Measure of

Deprivation for use with Patient Centered Care

DeliveryBrad Stephenson

Andrew J Knighton PhD CPA

Lucy Savitz PhD MBA

Tom Belnap MS

Jim Vanderslice PhD

What is the Singh area deprivation index (ADI)?

• Index developed and validated by Singh

(2003) based upon 17 census measures

– Education

– Employment

– Income

– Living Conditions

• Developed at the census block group level

for the state of Utah (Knighton, 2015)

• Patient assigned an ADI score based upon

the census block group they live in

• Surrogate measure for impact of

deprivation/social determinants

Creating the ADI score for a Utah block group

• Used Singh Coefficients

for the 2000 census per

UW- Madison

• Raw score = individual

census measure*Singh

coefficient

• Total raw score =

∑(individual census

measure*coefficient)

• Standardized with mean

100 and SD 20

• Quintiles

3

Utah ADI results

Least Deprived Most Deprived

1 2 3 4 5

Profiling disparities by quintile

5

Knighton, 2015

Application

• Projects utilizing the ADI are being conducted at Intermountain:– Development of a Community Health Needs Assessment

– Identification of high-risk patients for care management interventions.

– Assessing the impact of deprivation on treatment of patients with hypertension.

• Limitations–Ecological Fallacy: Using area-level data as a proxy for individual characteristics

Questions?

References

Singh, GK. Area deprivation and widening inequalities in US mortality, 1969-1998. Am J Public Health. 2003; 93; 1137-1143.

Knighton AJ, Savitz L, Belnap T, Stephenson B, VanDerslice JA. Introduction of an area deprivation index measuring patient socio-economic status in an integrated health system: implications for population health. 2015 (Unpublished).