Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 3;16(1):117.
doi: 10.1186/s12939-017-0613-z.

Area-level socioeconomic deprivation and mortality differentials in Thailand: results from principal component analysis and cluster analysis

Suchunya Aungkulanon  1   2 , Viroj Tangcharoensathien  2 , Kenji Shibuya  3 , Kanitta Bundhamcharoen  2 , Virasakdi Chongsuvivatwong  4
Affiliations

Area-level socioeconomic deprivation and mortality differentials in Thailand: results from principal component analysis and cluster analysis

Suchunya Aungkulanon et al. Int J Equity Health. .

Abstract

Background: Despite achievement of universal health coverage in Thailand, socioeconomic inequality in health has been a major policy concern. This study examined mortality patterns across different socioeconomic strata in Thailand.

Methods: We conducted a cross-sectional analysis of the 2010 Population and Housing Census on area-level socioeconomic deprivation against the 2010 mortality from the vital registration database at the super-district level. We used principal components analysis to construct a socioeconomic deprivation index and K-mean cluster analysis to group socioeconomic status and cause-specific mortality.

Results: Excess mortality rates from all diseases, except colorectal cancer, were observed among super-districts with low socioeconomic status. Spatial clustering was evident in the distribution of socioeconomic status and mortality rates. Cluster analysis revealed that super-districts which were predominantly urban tended to have low all-cause standardize mortality ratio but a high colorectal cancer-specific mortality rate. Deaths due to liver cancer, diabetes, and renal diseases were common in the low socioeconomic super-districts which hosted one third of the total Thai population.

Conclusion: Socially deprived areas have an excess of overall and cause specific deaths. Populations living in more affluent areas, despite low general mortality, still have many preventable deaths such as colorectal cancer. These findings warrant future epidemiological studies investigating various causes of excessive deaths in non-deprived areas and implementation of policies to reduce the mortality gap between rich and poor areas.

Keywords: Health inequality; Mortality; Socioeconomic status; Thailand.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was obtained from the Ethics Committee of the Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (reference no. EC 58–299–18-5)

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Methodology flowchart
Fig. 2
Fig. 2
Geographical distribution of deprivation index
Fig. 3
Fig. 3
Cause-specific mortality for each mortality cluster (The color/hue of each cell indicates the level of SMR, higher value in dark pink and lower value in dark green)
Fig. 4
Fig. 4
Geographical distribution of mortality clusters
Fig. 5
Fig. 5
Average z-scores of socioeconomic and demographic characteristics for each socioeconomic cluster (The color/hue of each cell indicates the level of SES, higher values in dark red and lower values in dark blue)
Fig. 6
Fig. 6
Geographical distribution of socioeconomic clusters
See this image and copyright information in PMC

References

    1. Cook S, Pincus J. Poverty, inequality and social protection in Southeast Asia: An introduction. J Southeast Asian Econ (JSEAE) 2014;31:1–17. doi: 10.1355/ae31-1a. - DOI
    1. Bird K, Hattel K, Sasaki E, Attapich L. Poverty, income inequality, and microfinance in Thailand. Manila: ADB Southeast Asia Working Paper Series Asian Development Bank; 2011.
    1. Faramnuayphol P, Chongsuvivatwong V, Pannarunothai S. Geographical variation of mortality in Thailand. J Med Assoc Thail. 2008;91:1455–1460. - PubMed
    1. Aungkulanon S, Tangcharoensathien V, Shibuya K, Bundhamcharoen K, Chongsuvivatwong V. Post universal health coverage trend and geographical inequalities of mortality in Thailand. Int J Equity Health. 2016;15:190. doi: 10.1186/s12939-016-0479-5. - DOI - PMC - PubMed
    1. Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001;91:1783–1789. doi: 10.2105/AJPH.91.11.1783. - DOI - PMC - PubMed

MeSH terms