A publicly well-accepted measure versus an academically desirable measure of health inequality: Cross-sectional comparison of the difference between income quintiles with the slope index of inequality

Abstract

Objectives The difference between income quintiles in health is relatively well accepted by the general public as a measure of health inequality. However, the slope index of inequality (SII) in health reflects the patterns of all social groups, including the middle 60%, and it could therefore be considered more academically desirable. If these two measures are closely correlated, the widespread use of the difference between income quintiles in health would be better supported. This study was conducted to compare differences between income quintiles in life expectancy (LE) and healthy life expectancy (HLE) with the SII. Design Cross-sectional comparison using correlational analysis of district level income differences in LE and HLE with associated SII. Setting All 252 subnational districts of Korea. Participants A total of 342 439 895 subjects (171 287 729 men, 171 152 166 women) and 1 753 476 deaths (970 928 men, 782 548 women) between 2008 and 2014 were analysed. Primary and secondary outcome measures Difference in LE and HLE by income quintile and associated SII. Results The Pearson correlation coefficients between differences between income quintiles and the SII were generally high: 0.97 (95% CI 0.96 to 0.98) for LE in men and women combined and 0.96 (95% CI 0.94 to 0.97) for HLE in men and women combined. In most districts, the SII was greater than the difference between income quintiles. Conclusion Differences between income quintiles were closely correlated with the SII. The widespread use of differences between income quintiles in health as a measure of health inequality may be preferable for communicating results of health inequality measurements to the public.