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Article

Estimation of the Ecological Fallacy in the Geographical Analysis of the Association of Socio-Economic Deprivation and Cancer Incidence

1
Institute of Oncology Ljubljana, Epidemiology and Cancer Registry, 1000 Ljubljana, Slovenia
2
Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(3), 296; https://doi.org/10.3390/ijerph16030296
Received: 14 December 2018 / Revised: 16 January 2019 / Accepted: 19 January 2019 / Published: 22 January 2019
(This article belongs to the Special Issue Time-Space Modeling of the Health Effects of Environment)
Ecological deprivation indices at the level of spatial units are often used to measure and monitor inequalities in health despite the possibility of ecological fallacy. For the purpose of this study, the European Deprivation Index (EDI) was used, which is based on Townsend theorization of relative deprivation. The Slovenian version of EDI (SI-EDI) at the aggregated level (SI-EDI-A) was calculated to the level of the national assembly polling stations. The SI-EDI was also calculated at the individual level (SI-EDI-I) by the method that represents a methodological innovation. The degree of ecological fallacy was estimated with the Receiver Operating Characteristics (ROC) curves. By calculating the area under the ROC curve, the ecological fallacy was evaluated numerically. Agreement between measuring deprivation with SI-EDI-A and SI-EDI-I was analysed by graphical methods and formal testing. The association of the socio-economic status and the cancer risk was analysed in all first cancer cases diagnosed in Slovenia at age 16 and older in the period 2011–2013. Analysis was done for each level separately, for SI-EDI-I and for SI-EDI-A. The Poisson regression model was implemented in both settings but adapted specifically for aggregated and individual data. The study clearly shows that ecological fallacy is unavoidable. However, although the association of cancer incidence and socio-economic deprivation at individual and aggregated levels was not the same for all cancer sites, the results were very similar for the majority of investigated cancer sites and especially for cancers associated with unhealthy lifestyles. The results confirm the assumptions from authors’ previous research that using the level of the national assembly polling stations would be the acceptable way to aggregate data when explaining inequalities in health in Slovenia in ecological studies. View Full-Text
Keywords: ecological fallacy; European deprivation index; spatial units; agreement analysis; cancer incidence; public health ecological fallacy; European deprivation index; spatial units; agreement analysis; cancer incidence; public health
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MDPI and ACS Style

Lokar, K.; Zagar, T.; Zadnik, V. Estimation of the Ecological Fallacy in the Geographical Analysis of the Association of Socio-Economic Deprivation and Cancer Incidence. Int. J. Environ. Res. Public Health 2019, 16, 296. https://doi.org/10.3390/ijerph16030296

AMA Style

Lokar K, Zagar T, Zadnik V. Estimation of the Ecological Fallacy in the Geographical Analysis of the Association of Socio-Economic Deprivation and Cancer Incidence. International Journal of Environmental Research and Public Health. 2019; 16(3):296. https://doi.org/10.3390/ijerph16030296

Chicago/Turabian Style

Lokar, Katarina; Zagar, Tina; Zadnik, Vesna. 2019. "Estimation of the Ecological Fallacy in the Geographical Analysis of the Association of Socio-Economic Deprivation and Cancer Incidence" Int. J. Environ. Res. Public Health 16, no. 3: 296. https://doi.org/10.3390/ijerph16030296

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