Daily tackling Health Inequalities : French Child Individual-Level Deprivation Index development and validation

Purpose: Deprivation is a known risk factor for many diseases. But the fact it is progressive and multidimensional must be taken in account to assess its impact on health and enhance appropriate access to care. This study aimed to develop and validate a pediatric individual-level index measuring deprivation, usable in clinical practice and in public health. Methods The French Individual Child Deprivation Index (FrenChILD-Index) was designed in 4 phases: items generation then reduction using literature review, expert interviews, and a steering committee; index derivation then validation using a cross-sectional study in two emergency departments. During these last two phases, a blinded evaluation was performed between an expert opinion and FrenChILD-Index to assess its concordance and determine thresholds for two levels of moderate and severe deprivation. Results Generation and reduction phases retained 13 items to be tested. They were administered to 986 children for derivation and validation phases. In the validation phase, the final 12 items FrenChILD-Index showed for moderate deprivation (requiring single specific care for deprived children): sensitivity of 96.0% [92.6; 98.7] and specificity of 68.3% [65.2; 71.4]. For severe deprivation (requiring a multidisciplinary level of care) sensitivity was 96.3% [92.7; 100] and specificity was 91.1% [89.2; 92.9]. FrenChILD-Index met the Terwees validity criterion for screening instruments. Conclusions FrenChILD-Index is the first pediatric individual-level index of deprivation, methodologically validated in Europe. It enables individual appropriate referral of deprived children. Thus, FrenChILD-Index enables clinical practice to meet public health goals by taking into account the social determinants of health.