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.
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