Shai Mulinari
Associate Professor | Senior Lecturer
Questioning the discriminatory accuracy of broad migrant categories in public health: self-rated health in Sweden
Author
Summary, in English
BACKGROUND:
Differences between natives and migrants in average risk for poor self-rated health (SRH) are well documented, which has lent support to proposals for interventions targeting disadvantaged minority groups. However, such proposals are based on measures of association that neglect individual heterogeneity around group averages and thereby the discriminatory accuracy (DA) of the categories used (i.e. their ability to discriminate the individuals with poor and good SRH, respectively). Therefore, applying DA measures rather than only measures of association our study revisits the value of broad native and migrant categorizations for predicting SRH.
DESIGN, SETTING AND PARTICIPANTS:
We analyzed 27 723 individuals aged 18-80 who responded to a 2008 Swedish public health survey. We performed logistic regressions to estimate odds ratios (ORs), predicted risks and the area under the receiver operating characteristic curve (AU-ROC) as a measure of epidemiological DA.
RESULTS:
Being born abroad was associated with higher odds of poor SRH (OR = 1.75), but the AU-ROC of this variable only added 0.02 units to the AU-ROC for age alone (from 0.53 to 0.55). The AU-ROC increased, but remained unsatisfactorily low (0.62), when available social and demographic variables were included.
CONCLUSIONS:
Our results question the use of broad native/migrant categorizations as instruments for forecasting individual SRH. Such simple categorizations have a very low DA and should be abandoned in public health practice. Measures of association and DA should be reported together whenever an intervention is being considered, especially in the area of ethnicity, migration and health.
Differences between natives and migrants in average risk for poor self-rated health (SRH) are well documented, which has lent support to proposals for interventions targeting disadvantaged minority groups. However, such proposals are based on measures of association that neglect individual heterogeneity around group averages and thereby the discriminatory accuracy (DA) of the categories used (i.e. their ability to discriminate the individuals with poor and good SRH, respectively). Therefore, applying DA measures rather than only measures of association our study revisits the value of broad native and migrant categorizations for predicting SRH.
DESIGN, SETTING AND PARTICIPANTS:
We analyzed 27 723 individuals aged 18-80 who responded to a 2008 Swedish public health survey. We performed logistic regressions to estimate odds ratios (ORs), predicted risks and the area under the receiver operating characteristic curve (AU-ROC) as a measure of epidemiological DA.
RESULTS:
Being born abroad was associated with higher odds of poor SRH (OR = 1.75), but the AU-ROC of this variable only added 0.02 units to the AU-ROC for age alone (from 0.53 to 0.55). The AU-ROC increased, but remained unsatisfactorily low (0.62), when available social and demographic variables were included.
CONCLUSIONS:
Our results question the use of broad native/migrant categorizations as instruments for forecasting individual SRH. Such simple categorizations have a very low DA and should be abandoned in public health practice. Measures of association and DA should be reported together whenever an intervention is being considered, especially in the area of ethnicity, migration and health.
Department/s
- Social Epidemiology
- EpiHealth: Epidemiology for Health
Publishing year
2015
Language
English
Pages
911-917
Publication/Series
European Journal of Public Health
Volume
25
Issue
6
Full text
- Available as PDF - 167 kB
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Document type
Journal article
Publisher
Oxford University Press
Topic
- Public Health, Global Health, Social Medicine and Epidemiology
Keywords
- discriminatory accuracy
- sensitivity and specificity
- ethnicity
- public health
- self-rated health
- migration
Status
Published
Project
- Swedish genes?
- Multilevel analysis of individual heterogeneity
Research group
- Social Epidemiology
ISBN/ISSN/Other
- ISSN: 1101-1262