Publicado

2008-12-01

Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002

Capacidad de estimadores epidemiológicos para medir disparidades en salud en países OCDE de alto Ingreso, 1998-2002

Palabras clave:

Health status indicator, world health, health inequality, developed country (en)
Indicadores de salud, salud mundial, desigualdades en la salud, países desarrollados (es)

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Autores/as

  • Javier Eslava-Schmalbach National University of Colombia, Clinical Research Institute.
  • Helman Alfonso University of Western Australia, School of Public Health.
  • Hernando Gaitán National University of Colombia, Clinical Research Institute.
  • Carlos Agudelo National University of Colombia. Institute of Public Health, School of Medicine.

Objective. Examining the power (ability) of classical epidemiological estimators to rate inequality in health in univariate and composite ways.
Methods. Ecological study. Ratio, excess risk, attributable risk (AR) and relative difference were the estimators used for showing disparities; all of them were weighted by population size. Kappa concordance coefficient was used between weighted estimators and weighted Gini coefficients for each health outcome used. Cumulative variance at first factor in principal component analysis was used for determining the estimators’ suitability for use in a composite index. 24 high-income OECD (Organisation for Economical Cooperation and Development) countries’ data for 1998-2002 were included. Such data was obtained from OECD health data for 2004 (3rd edition). Data concerning child mortality and gross domestic product (GDP) was obtained from World Development Indicators for 2005 on CD-ROM.The main outcomes compared amongst countries were: maternal mortality, child mortality, infant mortality, low birth-weight, life-expectancy, measles’ immunisation and DTP immunisation.
Results. Ratio and AR ranked maternal mortality as being the condition having the most disparity; risk excess ranked vaccination programmes and relative difference ranked low birth-weight as being the worst conditions. There was concordance in the ranking of inequities amongst ratio, AR and Gini coefficients (p<0.05). Cumulative variance in the first factor was higher for ratio and AR when they were used for constructing a composite index. Conclusions Ratio and AR were better than risk excess and relative difference for measuring disparities in health and constructing composite inequity in health indexes.

Objetivo. Evaluar la capacidad de la Razón (R), exceso de riesgo (ER), fracción atribuible (FA) y diferencia relativa (DR) para medir las desigualdades en salud.
Métodos. Estudio ecológico. Se ponderó por el tamaño de la población. La concordancia por indicador entre estimadores y coeficiente de Gini (Gini) se evaluó con coeficiente Kappa. La varianza acumulada en el primer factor (análisis de componentes principales) fue utilizada para evaluar la capacidad de los estimadores para ser utilizados en un índice compuesto. 24 Países de Alto Ingreso (según Banco Mundial) entre 1998 y 2002, fueron incluidos. Los datos se obtuvieron del OECD Health Data, 2004 y del World Development Indicators-2005. Los indicadores comparados entre los países fueron: Mortalidad materna, mortalidad en niños menores de 5 años, mortalidad infantil, bajo peso al nacer, expectativa de vida al nacer, inmunización contra sarampión y contra DTP.
Resultados. R y FA posicionaron la mortalidad materna como la condición de mayor disparidad, ER posicionó los programas de vacunación y DR posicionó el bajo peso al nacer como la peor condición. Hubo concordancia en el posicionamiento de las desigualdades entre R, FA y Gini (p<0.05). La varianza acumulada en el primer factor fue mayor para R y FA, cuando ellos se utilizaron para construir un indicador compuesto.
Conclusiones. R y la FA atribuible son mejores que el ER y la DR para medir desigualdades en salud entre países y para construir un indicador de inequidad en salud compuesto.

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Cómo citar

APA

Eslava-Schmalbach, J., Alfonso, H., Gaitán, H. & Agudelo, C. (2008). Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002. Revista de Salud Pública, 10(SUPLEMENTO 1), 3–14. https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/96648

ACM

[1]
Eslava-Schmalbach, J., Alfonso, H., Gaitán, H. y Agudelo, C. 2008. Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002. Revista de Salud Pública. 10, SUPLEMENTO 1 (dic. 2008), 3–14.

ACS

(1)
Eslava-Schmalbach, J.; Alfonso, H.; Gaitán, H.; Agudelo, C. Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002. Rev. salud pública 2008, 10, 3-14.

ABNT

ESLAVA-SCHMALBACH, J.; ALFONSO, H.; GAITÁN, H.; AGUDELO, C. Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002. Revista de Salud Pública, [S. l.], v. 10, n. SUPLEMENTO 1, p. 3–14, 2008. Disponível em: https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/96648. Acesso em: 12 feb. 2026.

Chicago

Eslava-Schmalbach, Javier, Helman Alfonso, Hernando Gaitán, y Carlos Agudelo. 2008. «Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002». Revista De Salud Pública 10 (SUPLEMENTO 1):3-14. https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/96648.

Harvard

Eslava-Schmalbach, J., Alfonso, H., Gaitán, H. y Agudelo, C. (2008) «Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002», Revista de Salud Pública, 10(SUPLEMENTO 1), pp. 3–14. Disponible en: https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/96648 (Accedido: 12 febrero 2026).

IEEE

[1]
J. Eslava-Schmalbach, H. Alfonso, H. Gaitán, y C. Agudelo, «Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002», Rev. salud pública, vol. 10, n.º SUPLEMENTO 1, pp. 3–14, dic. 2008.

MLA

Eslava-Schmalbach, J., H. Alfonso, H. Gaitán, y C. Agudelo. «Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002». Revista de Salud Pública, vol. 10, n.º SUPLEMENTO 1, diciembre de 2008, pp. 3-14, https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/96648.

Turabian

Eslava-Schmalbach, Javier, Helman Alfonso, Hernando Gaitán, y Carlos Agudelo. «Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002». Revista de Salud Pública 10, no. SUPLEMENTO 1 (diciembre 1, 2008): 3–14. Accedido febrero 12, 2026. https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/96648.

Vancouver

1.
Eslava-Schmalbach J, Alfonso H, Gaitán H, Agudelo C. Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002. Rev. salud pública [Internet]. 1 de diciembre de 2008 [citado 12 de febrero de 2026];10(SUPLEMENTO 1):3-14. Disponible en: https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/96648

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