Comparison of the Association of Area-Based Deprivation Indices With Hypertension and Diabetes Control Outcomes

Area-based deprivation indices have been linked to hypertension and diabetes outcomes, but limited information exists about their relative performance. We compared 2 area-based deprivation measures (Area Deprivation Index and Yost Index) as risk factors for hypertension and diabetes control.

This cohort study identified adults with hypertension or diabetes in a 19-county region of Southeast Minnesota covered by the Rochester Epidemiology Project. The deprivation indices were operationalized as quintiles for state and national ranks. We assessed agreement using the weighted kappa statistic. We used modified Poisson regression to evaluate associations of the deprivation indices with blood pressure or diabetes control in 2022. We compared relative model fit using the area under the receiver operating characteristic curve.

We identified 67 386 individuals with hypertension and 30 435 with diabetes. There was moderate to substantial agreement between indices, but the agreement was higher for the state rank (weighted kappa 0.68 for both cohorts) than the national rank (0.54 for both). Although the indices were not associated with hypertension control, greater deprivation was associated with worse diabetes control for the Yost Index (relative risk [RR], 1.21 [95% CI, 1.07-1.38]) and Area Deprivation Index (RR, 1.39 [95% CI, 1.12-1.73]) national ranks. The full-model area under the receiver operating characteristic curve was similar across indices but differed across cohorts with worse fit for hypertension (0.53 for both) than diabetes (0.63 for both).

Two common area-based deprivation indices had similar strength of association with diabetes control, suggesting that either index would be appropriate for researching and developing interventions for diabetes control.