Abstract
BackgroundRelative deprivation has previously been discussed as a possible mechanism underlying the income-health relation. The idea is that income matters to the individual’s health, over and above the increased command over resources, as the basis of social comparisons between a person and his or her reference group. The following study aimed to analyze the role of individual-level relative deprivation for all-cause mortality in the Swedish population. The Swedish context, characterized by relatively small income inequalities and promoting values as egalitarianism and equality, together with a large data material provide unique possibilities for analyzing the hypothesized mechanism.MethodsThe data used are prospective longitudinal data from the Swedish population and based on a linkage of registers. Restricting selection to individuals 25–64 years, alive January 1st 1990, gave 4.7 million individuals, for whom a mortality follow-up was done over a 16-year period. The individual level relative deprivation was measured using the Yitzhaki index, calculating the accumulated shortfall between the individual’s income and the income of all other’s in the person’s reference group. All-cause mortality was used as the outcome measure.ResultsRelative deprivation, generated through social comparisons, is one possible mechanism within the income and health relation. The present study analyzed different types of objectively defined reference groups, all based on the idea that people compare themselves to similar others. Results show relative deprivation, when measured by the Yitzhaki index, to be significantly associated with mortality. Also, we found a stronger effect among men than among women. Analyzing the association within different income strata, the effect was shown to be weak among the poorest. Revealing the importance of relative deprivation for premature mortality, over and above the effect of absolute income, these results resemble previous findings.ConclusionRelative deprivation, based on social comparisons of income, is significantly associated with premature mortality in Sweden, over and above the effect of absolute income. Also, it was found to be more important among men, but weak among the poorest.
Highlights
Relative deprivation has previously been discussed as a possible mechanism underlying the income-health relation
The goal of the present study was to conduct an empirical test of relative deprivation and mortality in Sweden – a society that is characterized by a strong egalitarian ethos, as well as a relatively flat degree of income dispersion [18]
The primary findings of the present study are that relative income deprivation was significantly associated with premature mortality, irrespective of sociodemographic status, including individual income, and that this association was stronger among men than women
Summary
Relative deprivation has previously been discussed as a possible mechanism underlying the income-health relation. Lack of income (or income poverty) is associated with worse health status [1] Beyond this direct relationship between income and command over resources, researchers have posed the question of whether an individual’s income relative to other people’s income might influence his/her level of health. A 0.05 unit increase in the Gini coefficient (a standard measure of income inequality) is associated with roughly an 8\% increase in the risk of mortality [3] How these studies should be interpreted continues to be debated, owing to the possibility of residual confounding by the unobserved characteristics of societies that have high or low income dispersion
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