Area based measures of social and economic circumstances: cause specific mortality patterns depend on the choice of index

Indices of deprivation based upon the characteristics of areas of residence are widely used in epidemiology and public health, and have a number of possible applications. Firstly, they may be used when data describing a person's socioeconomic circumstances have not been, or cannot be, collected directly.1 Secondly, they may inform the distribution of health service resources, for primary care, community health services and hospital services.2 Thirdly, in ecological studies examining the effects of local environmental conditions on health they allow investigators to control for possible socioeconomic confounding.3 Lastly, they can be used when the main analytic interest lies in the effects of characteristics of place of residence on health.4 5 As the particular socioeconomic and demographic characteristics of areas that are related to ill health could differ for different diseases we have compared how two indices—the Townsend index of deprivation and a measure developed by Congdon, which has been referred to as an anomie index5 6—relate to cause specific mortality. The first of these indices was developed as a measure of deprivation; the second as a …