Deprivation is associated with worse physical and mental health beyond income poverty: a population-based household survey among Chinese adults
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In studying health inequality, poverty as measured by income is frequently used; however, this omits the aspects of non-monetary resources and social barriers to achieving improved living standard. Therefore, our study aimed to examine the associations of individual-level deprivation of material and social necessities with general physical and mental health beyond that of income poverty.
A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed between 2014 and 2015. Income poverty and a Deprivation Index were used as the main independent variables. General health was assessed using the validated 12-item Short-Form Health Survey version 2, from which physical component summary and mental component summary were derived.
Our results in multivariable ordinal logistic regressions consistently showed that, after adjusting for income poverty, socio-demographic and lifestyle factors, being deprived was significantly associated with worse physical (OR 1.66; CI 1.25–2.20) and mental health (OR 1.83; CI 1.43–2.35). Being income poor was also significantly associated with worse mental health (OR 1.63; CI 1.28–2.09) but only marginally with physical health (OR 1.34; CI 1.00–1.80) after adjustments.
Income does not capture all aspects of poverty that are associated with adverse health outcomes. Deprivation of non-monetary resources has an independent effect on general health above and beyond the effect of income poverty. Policies should move beyond endowment and take into account the multidimensionality of poverty, in order to address the problem of health inequality.
KeywordsDeprivation Poverty Physical health Mental health Chinese adults Hong Kong
We acknowledge Prof Peter Saunders and Prof Jonathan Bradshaw for their invaluable inputs to this project. We would also like to thank Ms Suffy Yeung, Ms Stephanie Chan and Mr Philip Yeung for their assistance earlier in the project.
RYC was responsible for literature search, study design, data collection, data analysis, data interpretation and writing. GKC was mainly responsible for literature search, writing, data analysis and data interpretation. DG contributed to literature search, study design, data collection, data interpretation and writing. SYW actively participated in the study design, data collection, data analysis, as well as data interpretation and commented on write-up. DC performed data analysis, data interpretation, generation of tables and writing. ML contributed to literature search, study design, data collection, data interpretation, generation of tables and comments on write-up. VT conducted literature search, data collection, data analysis, as well as data interpretation and commented on write-up. HW was responsible for literature search, study design, data collection, data interpretation and comments on write-up. All authors read and approved the final manuscript.
The work described in this paper was fully supported by a Grant from the Central Policy Unit of the Government of the Hong Kong Special Administrative Region and the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. 4003-SPPR-11).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests.
The study has been approved by the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong in June 2012.
Informed consent was obtained from all individual participants included in the study.
- 4.Kondo, N., Kawachi, I., Hirai, H., Kondo, K., Subramanian, S.V., Hanibuchi, T., & Yamagata, Z. (2009). Relative deprivation and incident functional disability among older Japanese women and men: Prospective cohort study. Journal of Epidemiology and Community Health, 63(6), 461–467. https://doi.org/10.1136/jech.2008.078642.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Kondo, N., Kawachi, I., Subramanian, S.V., Takeda, Y., & Yamagata, Z. (2008). Do social comparisons explain the association between income inequality and health?: Relative deprivation and perceived health among male and female Japanese individuals. Social Science & Medicine, 67(6), 982–987. https://doi.org/10.1016/j.socscimed.2008.06.002.CrossRefGoogle Scholar
- 8.Chen, R., Hu, Z., Chen, R.-L., Zhang, D., Xu, L., Wang, J., & Wei, L. (2015). Socioeconomic deprivation and survival after stroke in China: A systematic literature review and a new population-based cohort study. British Medical Journal Open, 5(1), e005688–e005688. https://doi.org/10.1136/bmjopen-2014-005688.CrossRefGoogle Scholar
- 11.Chung, R. Y., Mercer, S., Lai, F. T. T., Yip, B. H. K., Wong, M. C. S., & Wong, S. Y. S. (2015). Socioeconomic determinants of multimorbidity: A population-based household survey of Hong Kong Chinese. PLoS ONE, 10(10), e0140040. https://doi.org/10.1371/journal.pone.0140040.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Chung, R. Y., & Wong, S. Y. (2015). Health inequality in Hong Kong. China Review, 15(2), 91–118.Google Scholar
- 14.Townsend, P. (1979). Poverty in the United Kingdom: A survey of household resources and standards of living. London: Allen Lane and Penguin Books.Google Scholar
- 16.Chow, N. W. (1982). Poverty in an affluent city: A report of a survey on low income families in Hong Kong.Google Scholar
- 19.International Labour Office. (2012). International standard classification of occupations: ISCO-08. Geneva: International Labour Office.Google Scholar
- 20.Bush, K., Kivlahan, D., McDonell, M., Fihn, S., & Bradley, K. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789–1795. https://doi.org/10.1001/archinte.158.16.1789.CrossRefPubMedGoogle Scholar
- 21.Yip, B. H. K., Chung, R. Y., Chung, V. C. H., Kim, J., Chan, I. W. T., Wong, M. C. S., … Griffiths, S. M. (2015). Is alcohol use disorder identification test (AUDIT) or its shorter versions more useful to identify risky drinkers in a Chinese population? A diagnostic study. PLoS ONE, 10(3), e0117721. https://doi.org/10.1371/journal.pone.0117721.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Craig, C., Marshall, A., Sjöström, M., Bauman, A., Booth, M., Ainsworth, B., … Oja, P. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35(8), 1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB.CrossRefPubMedGoogle Scholar
- 23.Wong, H., Saunders, P., Wong, W. P., Chan, M., & Chua, H. W. (2012). Report of research study on deprivation and social exclusion in Hong Kong. Hong Kong: The Hong Kong Council of Social ServiceGoogle Scholar
- 24.Gordon, D., & Spicker, P. (1999). The International Glossary on Poverty. London: CROP Publications.Google Scholar
- 25.OECD. (2012). Quality review of the OECD database on household incomes and poverty and the OECD earnings database part I.Google Scholar
- 26.Lau, M., Pantazis, C., Gordon, D., Lai, L., & Sutton, E. (2015). Poverty in Hong Kong. China Review, 15(2), 23–58.Google Scholar
- 27.Fahmy, E., Pemberton, S., & Sutton, E. (2012). Public perceptions of poverty and social exclusion: Final report on focus group findings. Poverty and Social Exclusion in the UK, Working Paper Analysis Series No. 3. University of Bristol: Townsend Centre for International Poverty Research.Google Scholar
- 28.Mack, J., & Lansley, S. (1985). Poor Britain. London: Allen and Unwin.Google Scholar
- 29.Lam, E., Lam, C., Fong, D., & Huang, W. (2013). Is the SF-12 version 2 health survey a valid and equivalent substitute for the SF-36 version 2 health survey for the Chinese? Journal of Evaluation in Clinical Practice, 19(1), 200–208. https://doi.org/10.1111/j.1365-2753.2011.01800.x.CrossRefPubMedGoogle Scholar
- 35.Groffen, D. A., Bosma, H., van den Akker, M., Kempen, G. I., & van Eijk, J. T. (2008). Material deprivation and health-related dysfunction in older Dutch people: Findings from the SMILE study. The European Journal of Public Health, 18(3), 258–263. https://doi.org/10.1093/eurpub/ckm119.CrossRefPubMedGoogle Scholar
- 36.Baumann, M., Spitz, E., Guillemin, F., Ravaud, J.-F., Choquet, M., Falissard, B., & Chau, N. (2007). Associations of social and material deprivation with tobacco, alcohol, and psychotropic drug use, and gender: A population-based study. International Journal of Health Geographics, 6, 50. https://doi.org/10.1186/1476-072X-6-50.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Townsend, P., Phillimore, P., & Beattie, A. (1988). Health and deprivation: Inequality and the north. London: Croom Helm.Google Scholar
- 41.Carstairs, V., & Morris, R. (1989). Deprivation and mortality: An alternative to social class? Community Medicine, 11(3), 210–219. https://doi.org/10.1093/oxfordjournals.pubmed.a042469.PubMedCrossRefGoogle Scholar
- 43.Townsend, P., & Davidson, N. (1988). Inequalities in health: The Black report. Harmondsworth: Penguin.Google Scholar
- 44.Sen, A. (2006). Conceptualizing and measuring poverty. In D. D. Grusky & R. Kanbur (Eds.), Poverty and inequality. Stanford, CA: Stanford University Press.Google Scholar
- 46.McEwen, B. S., & Seeman, T. (1999). Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load. Annals of the New York Academy of Sciences, 896(1), 30–47. https://doi.org/10.1111/j.1749-6632.1999.tb08103.x.CrossRefPubMedGoogle Scholar