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Questioning the discriminatory accuracy of broad migrant categories in public health: self-rated health in Sweden

Mulinari, Shai LU ; Bredström, Anna and Merlo, Juan LU (2015) In European Journal of Public Health 25(6). p.911-917
Abstract
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... (More)
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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
discriminatory accuracy, sensitivity and specificity, ethnicity, public health, self-rated health, migration
in
European Journal of Public Health
volume
25
issue
6
pages
911 - 917
publisher
Oxford University Press
external identifiers
  • wos:000367163900004
  • scopus:84958176922
ISSN
1101-1262
DOI
10.1093/eurpub/ckv099
language
English
LU publication?
yes
id
89a76857-e105-42f3-a313-8d5205fdf32e (old id 7357660)
date added to LUP
2015-06-16 10:57:47
date last changed
2017-09-24 03:18:25
@article{89a76857-e105-42f3-a313-8d5205fdf32e,
  abstract     = {BACKGROUND:<br/><br>
<br/><br>
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.<br/><br>
DESIGN, SETTING AND PARTICIPANTS:<br/><br>
<br/><br>
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.<br/><br>
RESULTS:<br/><br>
<br/><br>
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.<br/><br>
CONCLUSIONS:<br/><br>
<br/><br>
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.},
  author       = {Mulinari, Shai and Bredström, Anna and Merlo, Juan},
  issn         = {1101-1262},
  keyword      = {discriminatory accuracy,sensitivity and specificity,ethnicity,public health,self-rated health,migration},
  language     = {eng},
  number       = {6},
  pages        = {911--917},
  publisher    = {Oxford University Press},
  series       = {European Journal of Public Health},
  title        = {Questioning the discriminatory accuracy of broad migrant categories in public health: self-rated health in Sweden},
  url          = {http://dx.doi.org/10.1093/eurpub/ckv099},
  volume       = {25},
  year         = {2015},
}