Abstract
Most studies have evaluated poverty in terms of income status, but this approach cannot capture the diverse and complex aspects of poverty. To develop commodity-based relative deprivation indicators and evaluate their associations with mortality, we conducted a 6-year follow-up of participants in the Japan Gerontological Evaluation Study (JAGES), a population-based cohort of Japanese adults aged 65 and older. We analyzed mortality for 7614 respondents from 2010 to 2016. Cox regression models with multiple imputation were used to estimate hazard ratios (HRs) for mortality. Seven indicators were significantly associated with mortality: no refrigerator, no air conditioner, cut-off of essential services in the past year for economic reasons, and so on. Among participants, 12.0% met one item, and 3.3% met two items or more. The HRs after adjusting for relative poverty and some confounders were 1.71 (95%CI: 1.18–2.48) for relative deprivation, and 1.87 (95%CI: 1.14–3.09) for a combination of relative poverty and deprivation. Relative deprivation was attributable to around 27,000 premature deaths (2.3%) annually for the older Japanese. Measurement of relative deprivation among older adults might be worthwhile in public health as an important factor to address for healthy aging.
Highlights
Several studies have shown that relative poverty based on low income is significantly associated with poor health [1]
The crude hazard ratios (HRs) showed that the seven relative deprivation indicators were significantly associated with a higher risk for death, respectively (Table 1 & Table S1)
A significantly greater HR for higher mortality was seen for these subjects, compared with non-deprived people: 1.53 (95% confidence interval (CI): 1.24–1.90), 2.10 (95%CI: 1.46–3.02), and 2.36 (95%CI: 1.41–3.95), respectively
Summary
Several studies have shown that relative poverty based on low income is significantly associated with poor health [1]. A relative income approach has limitations when attempting to capture the diverse and complex aspects of poverty. In order to assess poverty line, researchers of poverty have proposed the concept of relative deprivation to measure the lack of a living standard that most people in society enjoy. Townsend reported that people experience relative deprivation when they lack the resources to follow a proper diet, cannot participate in activities, and do not have living conditions and amenities that are customary, or are at least widely encouraged, in the societies in which they. Res. Public Health 2019, 16, 182; doi:10.3390/ijerph16020182 www.mdpi.com/journal/ijerph
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