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A method for measuring spatial effects on socioeconomic inequalities using the concentration index
Sung Wook Kim1, Hassan Haghparast-Bidgoli2, Jolene Skordis-Worrall3
1Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
International Journal for Equity in Health
|January 16, 2020
Summary
Spatial effects significantly explain inequalities in HIV testing uptake in Malawi, particularly for men from lower socioeconomic groups. This novel method improves equity analysis by incorporating neighbourhood effects, impacting health service delivery recommendations.
Area of Science:
- Health Economics
- Spatial Analysis
- Public Health
Background:
- Spatial effects influence healthcare access and outcomes in low- and middle-income countries.
- Previous equity analyses using concentration indices have not incorporated neighbourhood effects.
- This study addresses the gap by examining spatial effects on HIV testing inequalities in Malawi.
Purpose of the Study:
- To develop and apply a novel method for incorporating spatial effects into concentration index-based equity analyses.
- To estimate and decompose the contribution of spatial effects to inequalities in HIV testing uptake in Malawi.
- To understand how neighbourhood effects influence HIV testing disparities among men and women.
Main Methods:
- A new methodology was developed to integrate spatial effects into the concentration index using a spatial weight matrix and a spatial lag model.
- Data from the Malawi Demographic Health Survey (n=24,562) were utilized.
- The analysis controlled for need (e.g., STIs) and non-need (e.g., education, wealth) variables to estimate inequalities in HIV testing uptake.
Main Results:
- For women, spatial effects were found to increase estimated inequalities in HIV uptake, with non-need variables showing a pro-rich distribution.
- For men, inequalities due to non-need variables were estimated, and the spatial model indicated that men from lower socioeconomic groups are more likely to be tested for HIV.
- The spatial model altered the direction of inequality for specific subgroups and locations, highlighting the impact of spatial considerations.
Conclusions:
- A significant portion of inequalities in HIV uptake in Malawi, driven by non-need factors, is explained by spatial effects.
- The developed methodological approach offers a robust way to incorporate spatial effects into equity analyses for health services.
- Findings suggest that spatial effects are crucial for understanding and addressing health service use inequalities, informing targeted interventions and policy recommendations.
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