How does area-level deprivation depress an individual\u2019s self-rated health and life satisfaction? Evidence from a nationwide population-based survey in Japan

Takashi Oshio,Takashi Omori,Hiromi Kimura,Toshimi Nishizaki

doi:10.1186/s12889-021-10578-2

Abstract

BackgroundArea-level deprivation is well known to have an adverse impact on mortality, morbidity, or other specific health outcomes. This study examined how area-level deprivation may affect self-rated health (SRH) and life satisfaction (LS), an issue that is largely understudied.MethodsWe used individual-level data obtained from a nationwide population-based internet survey conducted between 2019 and 2020, as well as municipality-level data obtained from a Japanese government database (N = 12,461 living in 366 municipalities). We developed multilevel regression models to explain an individual’s SRH and LS scores using four alternative measures of municipality-level deprivation, controlling for individual-level deprivation and covariates. We also examined how health behavior and interactions with others mediated the impact of area-level deprivation on SRH and LS.ResultsParticipants in highly deprived municipalities tended to report poorer SRH and lower LS. For example, when living in municipalities falling in the highest tertile of municipality-level deprivation as measured by the z-scoring method, SRH and LS scores worsened by a standard deviation of 0.05 (p < 0.05) when compared with those living in municipalities falling in the lowest tertile of deprivation. In addition, health behavior mediated between 17.6 and 33.1% of the impact of municipality-level deprivation on SRH and LS, depending on model specifications.ConclusionResults showed that area-level deprivation modestly decreased an individual’s general health conditions and subjective well-being, underscoring the need for public health policies to improve area-level socioeconomic conditions.

Highlights

Area-level deprivation is well known to have an adverse impact on mortality, morbidity, or other specific health outcomes
We obtained the data of the survey with the permission of the Cabinet Office (CAO); ethics approval was not required for the current study
12.9% of the participants had an income below the poverty line, 2.7% had not graduated from high school or above, 3.2% were unemployed, and 25.8% had no spouse

Summary

Introduction

Area-level deprivation is well known to have an adverse impact on mortality, morbidity, or other specific health outcomes. To capture small-area socioeconomic deprivation, a variety of deprivation measures have been developed [18, 19] These measures generally cover multiple dimensions of deprivation, such as income, employment, education, social class, and housing conditions. To avoid normative judgment that is inevitably involved in any weighting, the principal component and factor analysis approaches, which assign a set of weights that statistically best explain the variation in the data, have been often used [23,24,25] Because all of these approaches are known to have both advantages and disadvantages and have no clear theoretical background [18], it may be useful to compare their results and assess their robustness

Methods

Results

Conclusion