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Relative deprivation in income and mortality by leading causes among older Japanese men and women: AGES cohort study.

ABSTRACT: Relative deprivation of income is hypothesised to generate frustration and stress through upward social comparison with one's peers. If psychosocial stress is the mechanism, relative deprivation should be more strongly associated with specific health outcomes, such as cardiovascular disease (compared with other health outcomes, eg, non-tobacco-related cancer).We evaluated the association between relative income deprivation and mortality by leading causes, using a cohort of 21?031 community-dwelling adults aged 65?years or older. A baseline mail-in survey was conducted in 2003. Information on cause-specific mortality was obtained from death certificates. Our relative deprivation measure was the Yitzhaki Index, derived from the aggregate income shortfall for each person, relative to individuals with higher incomes in that person's reference group. Reference groups were defined according to gender, age group and same municipality of residence.We identified 1682 deaths during the 4.5?years of follow-up. A Cox regression demonstrated that, after controlling for demographic, health and socioeconomic factors including income, the HR for death from cardiovascular diseases per SD increase in relative deprivation was 1.50 (95% CI 1.09 to 2.08) in men, whereas HRs for mortality by cancer and other diseases were close to the null value. Additional adjustment for depressive symptoms and health behaviours (eg, smoking and preventive care utilisation) attenuated the excess risks for mortality from cardiovascular disease by 9%. Relative deprivation was not associated with mortality for women.The results partially support our hypothesised mechanism: relative deprivation increases health risks via psychosocial stress among men.

SUBMITTER: Kondo N

PROVIDER: S-EPMC4483791 | biostudies-literature | 2015 Jul

REPOSITORIES: biostudies-literature

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Relative deprivation in income and mortality by leading causes among older Japanese men and women: AGES cohort study.

Kondo Naoki N Saito Masashige M Hikichi Hiroyuki H Aida Jun J Ojima Toshiyuki T Kondo Katsunori K Kawachi Ichiro I

Journal of epidemiology and community health 20150219 7

<h4>Background</h4>Relative deprivation of income is hypothesised to generate frustration and stress through upward social comparison with one's peers. If psychosocial stress is the mechanism, relative deprivation should be more strongly associated with specific health outcomes, such as cardiovascular disease (compared with other health outcomes, eg, non-tobacco-related cancer).<h4>Methods</h4>We evaluated the association between relative income deprivation and mortality by leading causes, using ...[more]

PMID: 25700534

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Project description:IntroductionIncome is hypothesized to affect health not just through material pathways (i.e., the ability to purchase health-enhancing goods) but also through psychosocial pathways (e.g., social comparisons with others). Two concepts relevant to the psychosocial effects of income are: relative deprivation (for example expressed by the Yitzhaki Index, measuring the magnitude of difference in income among individuals) and Income Rank. This study examined whether higher relative deprivation and lower income rank are associated with depressive symptoms in an older population independently of absolute income.MethodUsing cross-sectional data of 83,100 participants (40,038 men and 43,062 women) in the Japan Gerontological Evaluation Study (JAGES), this study applied multiple logistic regression models to calculate the odds ratios (OR) of depression associated with relative deprivation/Income Rank. The Japanese Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms, and subjects with a score of ≥5 were categorized as depressed. Reference groups for calculating the Yitzhaki Index and income rank were constructed based on same gender, age-group, and municipality of residence.ResultsThe findings indicated that after controlling for demographic factors, each 100,000 yen increase in relative deprivation and 0.1 unit decrease in relative rank was associated with a 1.07 (95% CI = 1.07, 1.08) and a 1.15 (95% CI = 1.14, 1.16) times higher odds of depression, respectively, in men. The corresponding ORs in women were 1.05 (95% CI = 1.05, 1.06) and 1.12 (95% CI = 1.11, 1.13), respectively. After adjustment for other covariates and stratification by income quartiles, the results remained statistically significant. Women in the highest income quartile appeared to be more susceptible to the adverse mental health effects of low income rank, while among men the associations were reversed. Low income rank appeared to be more toxic for the poor.ConclusionConcepts of relative income appear to be relevant for mental health over and above the effects of absolute income.

Project description:BackgroundThis study aimed to determine long-term variations in mortality trends and identify the leading causes of death among older adults in China from 2009 to 2019 so as to propose interventions to further stabilise the mortality rate among older adults and facilitate healthy ageing.MethodsWe extracted data from the China Death Surveillance database from 2009 to 2019 for all-cause mortality and cause-specific death among individuals aged ≥ 65 years. A joinpoint regression model was used to estimate mortality trends by calculating the annual percentage change (APC). A trend chi-square test was used to estimate sex differences in mortality, and descriptive analysis was used to estimate the leading causes of death. Semi-structured expert interviews were conducted to examine health interventions for older adults.ResultsWe observed an overall declining trend in age-adjusted mortality rates among older adults aged ≥ 65 years in China from 2009 to 2019 (APC, -2.44; P < 0.05). In this population, the male mortality rate was higher than the female mortality rate during this period (P < 0.05). However, the mortality rate among older adults aged ≥ 85 years increased since 2014, particularly among females. Cardiovascular disease (CVD) was the leading cause of death among older adults aged 65-84 years, whereas ischaemic heart disease was the leading cause of death among individuals aged ≥ 85 years, especially among females. The majority of injuries resulting in death were caused by falls, showing an increasing trend.ConclusionsCVD is a major cause of death among older adults aged ≥ 65 years in China, and relevant health intervention strategies should be implemented from the perspectives of physiology, psychology, and living environment. The change in the mortality trend and the distribution of cause of death among older adults aged ≥ 85 years is noteworthy; a diagnostic and management model centred around females aged ≥ 85 years should be implemented. Additionally, a multidimensional fall prevention strategy involving primary medical institutions and care services needs to be implemented to reduce the risk of falls among older adults.

Dataset Information

Relative deprivation in income and mortality by leading causes among older Japanese men and women: AGES cohort study.

Publications

Relative deprivation in income and mortality by leading causes among older Japanese men and women: AGES cohort study.

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