Measures Of Relative Deprivation Research Articles

Associations of objective and subjective relative deprivation with health, happiness, and life satisfaction

BackgroundRelative deprivation is a critical mechanism for understanding how income inequality affects mental health. However, few studies have compared the effects of objective and subjective relative deprivation on health outcomes. This study compared how objective and subjective relative deprivation and their interaction relate to human flourishing measures, including health, happiness, life satisfaction, social relationships, and financial stability. MethodsThis cross-sectional study analyzed data from 1,592 adults in Taiwan. The objective and subjective relative deprivation were measured using the Yitzhaki Index and the Personal Relative Deprivation Scale-Revised (PRDS-R), respectively. We conducted least-squares regression models to investigate the associations between these relative deprivation measures and human flourishing outcomes. ResultsThe correlation between the Yitzhaki Index and PRDS-R was 0.16 (p < 0.001). After controlling for absolute income and covariates, the regression models showed that objective and subjective relative deprivation was negatively associated with all six human flourishing outcomes. Notably, subjective relative deprivation is strongly associated with outcomes than objective relative deprivation. Also, the Yitzhaki Index remained adversely associated with all human flourishing outcomes after accounting for the PRDS-R. Furthermore, the interaction between the Yitzhaki Index and PRDS-R was associated with additional risks to well-being, particularly affecting health, happiness, life satisfaction, and financial stability. ConclusionBoth objective and subjective relative deprivation were negatively associated with multiple dimensions of human flourishing. Policies aimed at addressing relative deprivation and reducing income inequality could contribute to higher levels of health, happiness, life satisfaction, social relationships, and economic stability.

P046 The influence of deprivation in the outcomes of Psoriatic Arthritis within the UK - utilising Outcomes of Treatment in Psoriatic Arthritis Study Syndicate data

Abstract Background/Aims Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy, which affects approximately 30% of patients with psoriasis and is associated with a high degree of morbidity. The introduction of biological disease-modifying antirheumatic drugs (bDMARDs) revolutionised treatment strategies for patients with PsA, however response is not universal. Deprivation and its associated risk factors may impact the initiation of and response to treatment with bDMARDs. There is limited data exploring the effect of deprivation on disease response to biologics in PsA. Psoriasis patients with a higher socioeconomic status have been shown to be more likely to respond to biologics, to our knowledge this has not been investigated in PsA. This study aimed to assess the impact of deprivation on initiation of and clinical response to biologic DMARDs. Methods Patients commencing a bDMARD were recruited to the UK prospective observational study Outcome of Treatment in Psoriatic Arthritis Studies Syndicate (OUTPASS REC ref:13/NW/0068). Index of Multiple Deprivation (IMD), the official measure of relative deprivation in England, was the exposure of interest. Subjects were ranked based on their IMD and split into the 20% most deprived (deciles 1-2), middle 40% (deciles 3-6) and 40% least deprived (deciles 7-10). This was done to aid analysis as IMD weightings provide greater differentiation among the least advantaged areas with fewer distinctions for less deprived areas. Treatment response was measured using changes in DAS28/PsARC, analysed using multivariate linear regression and multivariate logistic regression, respectively. Response was measured at three months as NICE guidance advises review of biological therapies at this time. Results There was no difference in the distribution of patients between the three groups (most deprived=138, middle deprived=207, least deprived=193). There were no statistically significant differences in the time from diagnosis to starting biologics in the most deprived group compared to the middle (p = 0.62) or least deprived p = 0.42) groups. There was no statistically significant difference in treatment responses between the groups. DAS28 change and PsARC improvement at three months remained similar between the most deprived, the middle deprived (p = 0.71, p = 0.08) and least deprived groups (p = 0.81, p = 0.22). Conclusion There was no difference in the distribution of IMD in patients recruited to OUTPASS, suggesting that the study is inclusive in recruiting across IMD subgroups. There was no difference in time from diagnosis to starting bDMARD therapy or response to treatment across the deprivation spectrum. These findings suggest that the NHS in England is performing its role of providing care according to need and regardless of circumstance. The study assesses deprivation in the context of free healthcare and may not be applicable to fee-paying healthcare systems. Further research is required to determine the relationship between deprivation and other outcomes, including work instability, in PsA. Disclosure M. Lyon: None. S. Zhao: None. A. Barton: Member of speakers’ bureau; speaker fees from Chugai-Roche and Galapagos. Grants/research support; grant funding from BMS, Pfizer, all unrelated to the work presented. H. Chinoy: Corporate appointments; Advisory Board member for Astra Zeneca, Pfizer, Argenx, Galapagos; Data and Science Monitoring Board chair for Horizon Therapeutics.. Consultancies; Consulting for PTC Therapeutics. Member of speakers’ bureau; fees as a speaker for GSK, UCB. M. Jani: None. J. Bluett: Grants/research support; research grant award from Pfizer and travel/conference fees from UCB, Fresenius Kabi, Pfizer and Eli Lilly.

Measuring income inequality in social networks

We present a new index for measuring income inequality in networks. The index is based on income comparisons made by the members of a network who are linked with each other by direct social connections. To model the comparisons, we compose a measure of relative deprivation for networks. We base our new index on this measure. The index takes the form of a ratio: the network’s aggregate level of relative deprivation divided by the aggregate level of the relative deprivation of a hypothetical network in which one member of the network receives all the income, and it is with this member that the other members of the network compare their incomes. We discuss the merits of this representation. We inquire how changes in the composition of a network affect the index. In addition, we show how the index accommodates specific network characteristics.

Relative deprivation and human flourishing: how do upward income comparisons affect health, happiness and life satisfaction?

BackgroundRelative deprivation induced by social comparisons is hypothesised to deleteriously affect health. Previous work has proposed the index as a measure of relative deprivation; however, the performance of this novel...

Reassessing the econometric measurement of inequality and poverty: toward a cost-of-living approach

The econometric measurement of inequality and poverty in advanced capitalist economies has been preoccupied with aggregate measures of relative deprivation, namely, the Gini Index and a relative poverty rate, both of which are based on economic distances from the population median. Using the case of Hong Kong, this article demonstrates the limitations of relative measures: the Gini Index masks social mobility and the relative poverty line understates actual poverty. This article argues instead for a cost-of-living approach to measure poverty, where the poverty line is defined as the cost of essential goods and services. A cost-of-living approach produces a poverty line of HK$28,815 and attendant poverty rate of 44.47% in 2020, nearly double the poverty line of HK$13,450 and poverty rate of 23.6% according to the conventional relative measure of the poverty line set to 50% of median household income—capturing a shortfall of 551,400 poor households that have been overlooked by relative measures.

Association of relative deprivation with loneliness and its underlying mechanisms: Evidence from Chinese migrant children.

Given the increase in the number of internal migrant children, the mental health problems (e.g., loneliness) of this population have received widespread attention. Relative deprivation is considered to be related to migrant children's loneliness. However, the underlying mechanisms of this relationship remain unclear. Therefore, the present study tested the possible mediating role of self-esteem and the moderating role of belief in a just world in the association between relative deprivation and loneliness of migrant children. A total of 1,261 Chinese rural-to-urban migrant children (10-15 years old, M age = 12.34 years, SD = 1.67; 52.0% males, 48.0% females; 23.55% fourth grade students, 16.49% fifth grade students, 19.59% sixth grade students, 15.54% seventh grade students, 13.80% eighth grade students, and 10.86% ninth grade students) were recruited to complete measures of relative deprivation, self-esteem, belief in a just world, loneliness, and demographic variables. Relative deprivation was significantly and positively correlated with migrant children's loneliness, and this connection could be mediated by self-esteem. Moreover, the first part of the indirect effect of self-esteem on this link was moderated by belief in a just world. These effects were stronger for migrant children with higher levels of belief in a just world. This study reveals the potential mechanisms of relative deprivation affecting loneliness, while also providing insights into how to better help migrant children alleviate loneliness and improve their mental health.

P284 Assessing Patient Experience in an Inflammatory Bowel Disease service. Can we measure an effect from socioeconomic deprivation – experience from the AWARE-IBD programme?

Abstract Background There is increasing international attention on delivery of services for people with Inflammatory bowel diseases (IBD). Experience of care is defined and measured as ‘what’ happened, ‘how’ and ‘how often’ and is an important facet of service provision. Socioeconomic deprivation may be associated with poor disease-related outcomes and sub-optimal utilisation of services but its effect on experience of care in people with inflammatory bowel disease has not been reported. Methods An invitation to participate in a research study nested within the AWARE-IBD quality improvement programme was sent to 4082 patients attending the IBD service at a single UK teaching centre in October 2021. A second invitation was sent in May 2022 followed by telephone recruitment targeted to those from the most deprived deciles based on the index of multiple deprivation (IMD), a measure of relative deprivation for small areas in England (‘lower-layer super areas’, approximately 1500 residents). Participants returned an IBD specific patient reported experience measure (PREM) via a web application comprising 38 items across 3 domains: ‘My Care Team’, “What matters to me’, ‘Living with Crohn’s or Colitis’. Each item was scored 1 (poorest experience) to 5 (best experience). Median scores for individual items and by domain was compared in the following demographic groups: IMD decile IMD (1 = most deprived; 10 = least deprived), age, gender, disease type (ulcerative colitis or Crohn’s disease). Results PREM responses were received from 249/4,082 (6%) patients. Patients from the most deprived decile were underrepresented in respondents compared to the invited cohort (Decile 1 22/249 (9%) vs 667/4,063(16%) p=0.002) and patients from the least deprived decile were over-represented; Decile 10: 38/249 (15%) vs 379/4063(9%) p=0.002). Respondents were otherwise broadly comparable to the invited cohort in terms of age, gender and disease type. Experience of care for respondents for individual PREM items or by domain did not differ according between IMD deciles (Figure 1), age, gender or disease type. Conclusion Measuring experience of care is an important part of IBD service quality improvement. No effect from socioeconomic deprivation was demonstrated. This finding conflicts with the literature on links between socioeconomic factors and quality of care and results across a service should be interpreted with caution. Experience of those at greatest risk is difficult to elicit with survey based experience measurement. Instead, tailored engagement exercises are required including qualitative and ethnographic approaches to better understand the impact of deprivation on experience.

Relative deprivation patterns in social and geographical references for health trajectories in China: Investigations of gender and urban-rural disparities

ObjectiveA pervasive link between relative deprivation and health has been well-documented. However, prior studies suffered from inadequate relative deprivation measures that fail to define appropriate reference groups to which individuals compare themselves, and few provided longitudinal evidence. This study explores latent relative deprivation patterns based on multiple social and geographic reference groups, examining their impacts on health trajectories and variations by gender and urban-rural areas. MethodsUsing three waves (2013, 2015, & 2018) of the China Health and Retirement Longitudinal Study (n = 6035), we conducted latent class analysis (LCA) to identify the baseline latent relative deprivation patterns among five social and geographic reference groups (relatives, schoolmates, colleagues, neighbors, and other people in the city or county). The LCA results were linked to the latent growth curve parallel process modeling (PPM) to investigate the impacts of deprivation patterns on dual health trajectories (depressive symptoms and self-rated health), and the results were stratified to explore gender and urban-rural differences. ResultsThe LCA revealed a relatively deprived group (36.39%) and a non-deprived group (63.61%). The PPM results indicated that the relatively deprived group showed a higher initial level of depressive symptoms and a lower initial level of self-rated health than the non-deprived group. However, the relatively deprived group showed a slower growth rate in depressive symptoms than the non-deprived group. These findings were particularly evident among women and rural residents. ConclusionsFindings emphasize the negative impact of relative deprivation on health. Furthermore, there is a complex interplay in these effects intertwined with gender and locality. Policies aimed at promoting mental health should not only consider relatively deprived groups, but also non-deprived women and rural residents who are at higher risk for later-life depression.

Relative deprivation, depression and quality of life among adults in Shandong Province, China: A conditional process analysis based on social support

BackgroundRelative deprivation has been confirmed as one of the pathways underlying the link between income inequality and health. However, the mechanism between relative deprivation and health was still unclear. This study aimed to test the mediating role of depression and the moderating role of social support in the association between relative deprivation and quality of life. MethodsData were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. In total, 8496 adults were included to complete the measures of relative deprivation, depressive symptoms, perceived social support, and quality of life. ResultsRelative deprivation was negatively associated with quality of life, and depressive symptoms could mediate this association. Furthermore, the direct effect of relative deprivation on quality of life and the indirect effect of depressive symptoms in this relationship were moderated by perceived social support. Both these two effects were stronger for individuals with a low level of perceived social support. LimitationsData are cross-sectional, and causal conclusions cannot be drawn. All measures were based on participant self-report. ConclusionsPersonal relative deprivation has negative effects on quality of life. Social support moderated the direct effect of relative deprivation and the mediating effect of depressive symptoms on quality of life. For individuals with a high level of relative deprivation, particularly those with a low level of social support, interventions tailoring psychological services and community-based activities could be designed to reduce relative deprivation and promote social support for disadvantaged individuals.

The 2021 Joseph St Geme, Jr, Leadership Award Address: The Role of Structural Racism in Injuries to Children and Adolescents.

The 2021 Joseph St Geme, Jr, Leadership Award Address: The Role of Structural Racism in Injuries to Children and Adolescents.

Bottom-up populism: How relative deprivation and populist attitudes mobilize leaderless anti-government protest

The present research focuses on populism as a bottom-up phenomenon that emerges from shared perceptions of relative deprivation. We predict that by serving as a shared ideological basis, populist attitudes can mobilize leaderless anti-government protest across ideological boundaries. We test this prediction in the context of the French Yellow Vests movement. Using a sample of French citizens (N = 562), we compare the effects of different indicators of relative deprivation on Yellow Vest protest participation and the extent to which populist attitudes account for these relationships. Results indicate that protests were fuelled by indicators of relative deprivation at the individual and group levels. Populist attitudes were best predicted by vertical comparisons between “the people” and “the elite” and fully accounted for the relationship between this type of group relative deprivation and protesting. Conversely, populist attitudes only partially accounted for the relationships between protesting and traditional measures of relative deprivation that either contrast natives with immigrants or individuals with fellow citizens. The findings strengthen the understanding of populism as a “thin centred” belief set that can unite and mobilize those who feel unfairly disadvantaged compared to a socio-political elite.

Income, Relative Deprivation and the Self-Rated Health of Older People in Urban and Rural China

Background: Substantial evidence indicated that absolute income is directly associated with health. Few studies have, however, examined if relative income may be equally associated with health. This study aimed to investigate the association between absolute income/relative deprivation (RD) and self-rated health (SRH). We also investigated whether the urban-rural difference was existing in these associations.Methods: Using cross-sectional data of 7,070 participants in the Shandong Family Health Service Survey of older people, this study applied binary logistic model and semi-parametric model to estimate the effect of absolute income and relative deprivation on SRH of older people. The Kakwani Index was used as a measure of relative deprivation at the individual level.Results: Absolute income has a significant positive effect on the SRH among both urban and rural older people. When considered RD as a variable, both absolute income and RD have negative significant effects on SRH among all older people. In addition, the negative effect of RD on rural elderly is more pronounced than that of urban older populations. Semi-parametric regression results show that there was a complex non-linear relationship between income and SRH. Psychological distress substantially attenuated the association between relative deprivation and SRH.Conclusions: Relative deprivation is negatively associated with self-rated health in both urban and rural older people after controlling the absolute income. RD may partly explain the association between income inequality and worse health status. Compared with the urban elderly, the effect of income-based relative deprivation on SRH was more pronounced among the rural elderly, and more care should be given to the lower income and rural older populations.

Relative Deprivation and Hope: Predictors of Risk Behavior

The belief that one is in a worse situation than similar others (Relative Deprivation) has been associated with involvement in a range of maladaptive escape behaviors, including excessive risk taking. Yet not everyone scoring high on measures of relative deprivation makes maladaptive choices. We hypothesized that hope may ameliorate the negative effects of relative deprivation. In two laboratory-based experiments using a novel risk-taking task (N = 101) we show that hope reduces risk-taking behavior in relatively deprived participants. A third study (N = 122) extended the moderating effect of hope on relative deprivation to real-world risk behavior; increased hope was associated with decreased likelihood of loss of control of one’s gambling behavior in relatively deprived individuals. Nurturing hope in relatively deprived populations may protect them against maladaptive behaviors with potential applications for harm reduction.

Relative food insecurity, mental health and wellbeing in 160 countries.

Food insecurity contributes to various stress-related health problems and previous research found that its association with mental illness is stronger in more affluent countries. We hypothesised that this pattern is a function of relative deprivation whereby the severity of individual food insecurity relative to others in a reference group determines its associations with mental health and wellbeing after differences in absolute food insecurity are controlled for. Using survey data from the Gallup World Poll collected in 160 countries and a measure of relative deprivation (Yitzhaki index), we found that relative food insecurity-based on national or regional reference groups-related to more mental health symptoms, lower positive wellbeing and lower life satisfaction after controlling for absolute food insecurity, household income, and country differences. Our analysis also found that relative food insecurity was more strongly related to mental health and wellbeing where the prevalence of food insecurity was lower. The findings underscore the negative health consequences of material deprivation and unfavourable social comparisons. Consistent with relative deprivation theory, individuals who live with constant worries about not getting enough food, have to skip meals, or face chronic hunger are deprived of material and social resources that support mental health and wellbeing, especially in settings where food insecurity is less common and potentially more stigmatised. The implications of these findings for global food policy and surveillance efforts are discussed.

Comparing indices of relative deprivation using behavioural evidence.

What measure of relative deprivation best predicts health? While numerous indices of relative deprivation exist, few studies have compared how well different measures account for empirical data. Hounkpatin et al. (2016) demonstrated that the relative ranked position of an individual i's income within a comparison group (their relative rank) was a better predictor of i's health than i's relative deprivation as assessed by the widely-used Yitzhaki index. In their commentary, Stark and Jakubek (2020) argue that both relative rank and relative deprivation may matter, and they develop a composite index. Here we identify some issues with their composite index, develop an alternative based on behavioural evidence, and test the various indices against data. Although almost all existing indices assume that the significance of an income yj to an individual with income yi (yj>yi) will be some increasing function of the difference between yj and yi, we find that the influence of j's income on i's health is actually a reducing function of (yj-yi). This finding - that less significance is assigned to distant higher incomes than to near higher incomes - is consistent with the well-established idea that we compare ourselves primarily to similar others.

A methodological rejoinder to “Does income relate to health due to psychosocial or material factors?”

There is a presumption that when an individual's comparison of his income with the incomes of others in his comparison group yields an unfavorable outcome, the individual is dismayed and experiences stress that impinges negatively on his health. In a recent study, Hounkpatin et al. (2016) conduct an inquiry aimed at deciphering which measure of low relative income reflects better the adverse psychosocial effect of low relative income on health. Hounkpatin et al. pit against each other two indices that they characterize as "competing:" the "relative deprivation (Yitzhaki Index)" of individual i, RDi; and the "income rank position" of individual i, Ri. In this Rejoinder we show that because a measure of rank is embodied in the RDi index and the Ri index can be elicited from the RDi index, these two indices need not be viewed as competing. Furthermore, we formulate a composite measure of relative deprivation, CRDi, which can be used to assess more fully the psychosocial effect of individual i's low relative income on his health.

A Methodological Rejoinder to 'Does Income Relate to Health Due to Psychosocial or Material Factors?'

There is a presumption that when an individual's comparison of his income with the incomes of others in his comparison group yields an unfavorable outcome, the individual is dismayed and experiences stress that impinges negatively on his health. In a recent study, Hounkpatin et al. (2016) conduct an inquiry aimed at deciphering which measure of low relative income reflects better the adverse psychosocial effect of low relative income on health. Hounkpatin et al. pit against each other two indices that they characterize as 'competing:' the 'relative deprivation (Yitzhaki Index)' of individual i, RD i; and the 'income rank position' of individual i, R i. In this Rejoinder we show that because a measure of rank is embodied in the RD i index and the R i index can be elicited from the RD i index, these two indices need not be viewed as competing. Furthermore, we formulate a composite measure of relative deprivation, CRD i, which can be used to assess more fully the psychosocial effect of individual i's low relative income on his health.

Losing ground in the income hierarchy: relative deprivation revisited

The paper discusses a one-parameter generalization of individual relative deprivation measures to a two-period setting that differs from earlier approaches. The parameter is, by definition, independent of the income distributions under consideration—it is to be chosen by a social planner. Its value has an intuitive interpretation: it represents the additional weight assigned to the income shortfalls associated with agents who passed the individual in question when moving from yesterday’s income distribution to today’s. Therefore, the choice of this parameter represents an important value judgment on the part of a social planner regarding the relative impact of being left behind. As a special case, it is illustrated how the well-known Yitzhaki index can be extended to this environment. Journal of Economic Literature Classification No.: D63.

Effects of area-based deprivation on dental caries, perceived dental treatment need and oral health related quality of life of UK adults

Aims and Objectives: To measure the influence of Index of Multiple Deprivation England (IMDE) on dental caries prevalence, perceived dental need, and oral health related quality of life (OHRQoL). Materials and Methods: Secondary analysis of the 2009 Adult Dental Health Survey (ADHS) was carried out to report the influence of IMDE on the number of carious teeth, perceived need toward dental treatment OHRQoL of UK adults using Oral Health Impact Profile (OHIP-14). Results: As the range of IMDE from the least to the most deprived area is 10 to 1, IMDE score was negatively correlated with the number of carious teeth (r = −0.147, P = 0.01). Similarly, IMDE score was negatively correlated with total OHIP-14 score (higher score indicating higher impact on OHRQoL) with r = −0.135 (P = 0.01). Logistic regression showed statistically significant results of IMDE score in increasing the likelihood of respondent in having higher number of caries (odds ratio [OR] = 0.93, P = 0.000), perception of needing dental treatment (OR = 1.111, P = 0.000), and higher OHIP-14 score (OR = 0.94, P = 0.000). Conclusion: Measures of relative deprivation are important in research related to oral health inequality. Area-based deprivation index proved to be one of the tools that can visibly disclose the inequalities of burden of disease in oral health. Policymakers should consider concentrating resources toward those with low household income in highly deprived areas rather than those with similar income but in less-deprived area.

Could socioeconomic inequity in bronchiolitis admissions be reduced through intervening on gestational age? A principled analysis of cohort data

BackgroundAbout 4% of infants in England are admitted to hospital for bronchiolitis, an acute lung infection, and the rates are unequal among socioeconomic groups. However, the causal pathways of this inequity are yet to be determined. We aimed to establish the extent to which socioeconomic inequity in hospital admissions for bronchiolitis would be reduced if disparities in gestational age were eliminated. MethodsHospital episode statistics were used to create a cohort of all singleton children born in English National Health Service hospitals between 2011 and 2016. Infants were followed up until their first birthday, and all emergency admissions to hospital for bronchiolitis (identified in hospital records by ICD-10 code J21) were linked to birth records. The index of multiple deprivation 2010, a neighbourhood measure of relative deprivation, was used to represent socioeconomic deprivation (high or low). We focused on estimating the randomised interventional analogue indirect effect of gestational age as the counterfactual difference in bronchiolitis admissions rates if children born into the high deprivation group had the same distribution of gestational age of children from the low deprivation group. Unlike traditional mediational analysis methods this recent generalisation does not require a continuous outcome or linearity between variables. Estimation was by g-computation, controlling for a-priori confounders of the mediator and outcome association—presence of congenital anomalies (yes or no) and infant sex. Ethics approval was not required since all data were de-identifiable. FindingsThe cohort consisted of 3 948 819 children (51·7% male). Between 2012 and 2016, 155 607 (60·6% male) were admitted to hospital for bronchiolitis (45·0 admissions per 1000 person-years, 95% CI 45·0–45·0). With the assumption of no unmeasured confounding, if socioeconomic disparities could be removed the rate of admissions would decrease by 9·4 per 1000 person-years (95% CI 9·0–9·8); if instead disparities remained but the distribution of gestational age could be equalised across deprivation groups, 12·0% (11·3–12·7) of this effect could be removed. InterpretationThere is some evidence that, in England, interventions aimed at ensuring infants are born at term might help reduce a small proportion of inequity in bronchiolitis morbidity. Future research should explore the contribution of other likely mediators, including birthweight, tobacco smoke exposure, and housing conditions. FundingMedical Research Council (grant number MR/N013867/1) (for KML).