Neighbourhood Health Inequalities between Ethnic Groups in England: An Application of Ecological Inference

Ecological inference has had primarily political science applications, but this study considers an application to assess variations in neighbourhood mental health between population sub-groups. The methodology used has particular utility when neighbourhood health data are available only in aggregate form, without disaggregation (e.g. by ethnic or socioeconomic group). The ecological inference approach is shown to provide insights into contextual effects, where neighbourhood features influence disease variations between sub-groups (e.g. the ethnic density effect on psychosis among non-white groups). The present study also highlights important issues raised by the data’s geographic framework, namely strong spatial clustering in the outcome, and compares spatial error and spatial lag methods to represent this spatial patterning appropriately. The study considers neighbourhood variations in psychosis between four ethnic groups, with a spatial framework provided by 32,844 small areas (Lower Super Output Areas, LSOAs) in England.