Skip to main content

Deprivation is associated with worse physical and mental health beyond income poverty: a population-based household survey among Chinese adults

Quality of Life Research volume 27, pages 2127–2135 (2018)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to agreement with the subjects to safeguard confidentiality, but are available from the corresponding author on reasonable request.

References

  1. Kawachi, I., Subramanian, S., & Almeida-Filho, N. (2002). A glossary for health inequalities. Journal of Epidemiology and Community Health, 56(9), 647–652. https://doi.org/10.1136/jech.56.9.647.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Marmot, M., Allen, J., Bell, R., Bloomer, E., & Goldblatt, P. (2012). WHO European review of social determinants of health and the health divide. The Lancet, 380(9846), 1011–1029. https://doi.org/10.1016/S0140-6736(12)61228-8.

    Article  Google Scholar 

  3. Wagstaff, A. (2002). Poverty and health sector inequalities. Bulletin of the World Health Organization, 80(2), 97–105.

    PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  CAS  Google 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.

    Article  Google Scholar 

  6. Hanandita, W., & Tampubolon, G. (2014). Does poverty reduce mental health? An instrumental variable analysis. Social Science & Medicine, 113, 59–67. https://doi.org/10.1016/j.socscimed.2014.05.005.

    Article  Google Scholar 

  7. Tampubolon, G., & Hanandita, W. (2014). Poverty and mental health in Indonesia. Social Science & Medicine, 106, 20–27. https://doi.org/10.1016/j.socscimed.2014.01.012.

    Article  Google 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.

    Article  Google Scholar 

  9. Zhang, Y., Ou, F., Gao, S., Gao, Q., Hu, L., & Liu, Y. (2015). Effect of low income on health-related quality of life. Asia Pacific Journal of Public Health, 27(2), NP1013–NP1025. https://doi.org/10.1177/1010539513496839.

    Article  PubMed  Google Scholar 

  10. Li, N., Pang, L., Du, W., Chen, G., & Zheng, X. (2012). Association between poverty and psychiatric disability among Chinese population aged 15–64 years. Psychiatry Research, 200(2–3), 917–920. https://doi.org/10.1016/j.psychres.2012.05.026.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Chung, R. Y., & Wong, S. Y. (2015). Health inequality in Hong Kong. China Review, 15(2), 91–118.

    Google Scholar 

  13. Townsend, P. (1954). Measuring poverty. The British Journal of Sociology, 5(2), 130. https://doi.org/10.2307/587651.

    Article  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 

  15. Townsend, P. (1987). Deprivation. Journal of Social Policy, 16(2), 125–146.

    Article  Google Scholar 

  16. Chow, N. W. (1982). Poverty in an affluent city: A report of a survey on low income families in Hong Kong.

  17. Saunders, P., Wong, H., & Wong, W. P. (2014). Deprivation and poverty in Hong Kong. Social Policy and Administration, 48(5), 556–575. https://doi.org/10.1111/spol.12042.

    Article  Google Scholar 

  18. Lau, M., & Gordon, D. (2017). Poverty in a rich society: The case of Hong Kong. Hong Kong: The Chinese University Press.

    Book  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.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  PubMed Central  CAS  Google 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.

    Article  PubMed  Google 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 Service

    Google 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.

  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.

  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.

    Article  PubMed  Google Scholar 

  30. Lam, C. L. K., Tse, E. Y. Y., & Gandek, B. (2005). Is the standard SF-12 health survey valid and equivalent for a Chinese population? Quality of Life Research, 14(2), 539–547. https://doi.org/10.1007/s11136-004-0704-3.

    Article  PubMed  Google Scholar 

  31. White, I. R., Royston, P., & Wood, A. M. (2011). Multiple imputation using chained equations: Issues and guidance for practice. Statistics in Medicine, 30(4), 377–399. https://doi.org/10.1002/sim.4067.

    Article  PubMed  Google Scholar 

  32. Woo, J., Lynn, H., Leung, J., & Wong, S. Y. (2008). Self-perceived social status and health in older Hong Kong Chinese women compared with men. Women & health, 48(2), 209–234. https://doi.org/10.1080/03630240802313563.

    Article  CAS  Google Scholar 

  33. Cheng, Y. H., Chi, I., Boey, K. W., Ko, L. S. F., & Chou, K. L. (2002). Self-rated economic condition and the health of elderly persons in Hong Kong. Social Science & Medicine, 55(8), 1415–1424. https://doi.org/10.1016/S0277-9536(01)00271-4.

    Article  CAS  Google Scholar 

  34. van Jaarsveld, C. H. M., Miles, A., & Wardle, J. (2007). Pathways from deprivation to health differed between individual and neighborhood-based indices. Journal of Clinical Epidemiology, 60(7), 712–719. https://doi.org/10.1016/j.jclinepi.2006.10.005.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Yilmaz, E., & Raynaud, D. (2013). The influence of social deprivation on length of hospitalisation. European Journal of Health Economics, 14(2), 243–252. https://doi.org/10.1007/s10198-011-0365-4.

    Article  PubMed  Google Scholar 

  38. Saito, M., Kondo, K., Kondo, N., Abe, A., Ojima, T., & Suzuki, K. (2014). Relative deprivation, poverty, and subjective health: JAGES cross-sectional study. PLoS ONE, 9(10), e111169. https://doi.org/10.1371/journal.pone.0111169.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Townsend, P., Phillimore, P., & Beattie, A. (1988). Health and deprivation: Inequality and the north. London: Croom Helm.

    Google Scholar 

  40. Jarman, B. (1983). Identification of underprivileged areas. British Medical Journal, 286(6379), 1705–1709. https://doi.org/10.1136/bmj.286.6379.1705.

    Article  PubMed  CAS  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.

    PubMed  CAS  Article  Google Scholar 

  42. Townsend, P. (1962). The meaning of poverty. The British Journal of Sociology, 13(3), 210. https://doi.org/10.2307/587266.

    Article  Google 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 

  45. Mishra, S., & Carleton, R. N. (2015). Subjective relative deprivation is associated with poorer physical and mental health. Social Science & Medicine, 147, 144–149. https://doi.org/10.1016/j.socscimed.2015.10.030.

    Article  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.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

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.

Funding

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).

Author information

Affiliations

  1. JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China

    Roger Yat-Nork Chung, Gary Ka-Ki Chung, Samuel Yeung-Shan Wong & Dicken Chan

  2. School for Policy Studies, University of Bristol, Bristol, UK

    David Gordon

  3. Asia-Pacific Institute of Ageing Studies, Lingnan University, Hong Kong, China

    Maggie Ka-Wai Lau & Vera Mun-Yu Tang

  4. Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China

    Hung Wong

Authors
  1. Roger Yat-Nork Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gary Ka-Ki Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Gordon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samuel Yeung-Shan Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dicken Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maggie Ka-Wai Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vera Mun-Yu Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hung Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Roger Yat-Nork Chung.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 49 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chung, R.YN., Chung, G.KK., Gordon, D. et al. Deprivation is associated with worse physical and mental health beyond income poverty: a population-based household survey among Chinese adults. Qual Life Res 27, 2127–2135 (2018). https://doi.org/10.1007/s11136-018-1863-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-018-1863-y

Keywords

  • Deprivation
  • Poverty
  • Physical health
  • Mental health
  • Chinese adults
  • Hong Kong