A Monte Carlo method to estimate the confidence intervals for the concentration index using aggregated population register data

Lumme, S., Sund, R., Leyland, A. H. and Keskimäki, I. (2015) A Monte Carlo method to estimate the confidence intervals for the concentration index using aggregated population register data. Health Services and Outcomes Research Methodology, 15(2), pp. 82-98. (doi:10.1007/s10742-015-0137-1) (PMID:25983615) (PMCID:PMC4426159)

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Abstract

In this paper, we introduce several statistical methods to evaluate the uncertainty in the concentration index (C) for measuring socioeconomic equality in health and health care using aggregated total population register data. The C is a widely used index when measuring socioeconomic inequality, but previous studies have mainly focused on developing statistical inference for sampled data from population surveys. While data from large population-based or national registers provide complete coverage, registration comprises several sources of error. We simulate confidence intervals for the C with different Monte Carlo approaches, which take into account the nature of the population data. As an empirical example, we have an extensive dataset from the Finnish cause-of-death register on mortality amenable to health care interventions between 1996 and 2008. Amenable mortality has been often used as a tool to capture the effectiveness of health care. Thus, inequality in amenable mortality provides evidence on weaknesses in health care performance between socioeconomic groups. Our study shows using several approaches with different parametric assumptions that previously introduced methods to estimate the uncertainty of the C for sampled data are too conservative for aggregated population register data. Consequently, we recommend that inequality indices based on the register data should be presented together with an approximation of the uncertainty and suggest using a simulation approach we propose. The approach can also be adapted to other measures of equality in health.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Leyland, Professor Alastair
Authors: Lumme, S., Sund, R., Leyland, A. H., and Keskimäki, I.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Health Services and Outcomes Research Methodology
Publisher:Springer Verlag
ISSN:1387-3741
ISSN (Online):1572-9400
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in Health Services and Outcomes Research Methodology 15(2):82-98
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
656601Measuring Health, Variations in Health and Determinants of HealthAlastair LeylandMedical Research Council (MRC)MC_UU_12017/5IHW - MRC/CSO SPHU