"Do alternative weighting approaches for an Index of Multiple Deprivation change the association with mortality? A sensitivity analysis from Germany."

ABSTRACT Objectives: This study aimed to assess the impact of using different weighting procedures for the German Index of Multiple Deprivation (GIMD) investigating their link to mortality rates. Design and setting: In addition to the original (normative) weighting of the GIMD domains, four alternative weighting approaches were applied: equal weighting, linear regression, maximization algorithm and factor analysis. Correlation analyses to quantify the association between the differently weighted GIMD versions and mortality based on district-level official data from Germany in 2010 were applied (N=412 districts). Outcome measures: Total mortality (all age groups) and premature mortality (< 65 years). Results: All correlations of the GIMD versions with both total and premature mortality were highly significant (p < 0.001). The comparison of these associations using Williams’s t-test for paired correlations showed significant differences, which proved to be small in respect to absolute values of Spearman’s rho (total mortality: between 0.535 and 0.615; premature mortality: between 0.699 and 0.832). Conclusions: The association between area deprivation and mortality proved to be stable, regardless of different weighting of the GIMD domains. The theory-based weighting of the GIMD should be maintained, due to the stability of the GIMD scores and the relationship to mortality. Keywords: Area deprivation, German Index of Multiple Deprivation, domains, weighting, mortalit