Pathways from deprivation to health differed between individual and neighborhood-based indices

J Clin Epidemiol. 2007 Jul;60(7):712-9. doi: 10.1016/j.jclinepi.2006.10.005. Epub 2007 Jan 22.


Objective: To explore the role of behavioral and psychosocial factors in explaining the social gradient in self-rated health as defined either by an individual or a neighborhood deprivation index.

Study design and setting: Data were from the baseline survey of the UK Flexible Sigmoidoscopy trial. Recruitment through general practices was stratified to generate a socioeconomically diverse sample (N=5,253, aged 55-64). Assessments included an individual and neighborhood deprivation index, each of which were categorized in four levels; three behavioral and three psychosocial factors; and self-rated health.

Results: Neighborhood deprivation was more strongly related to behavioral than to psychosocial factors, whereas individual deprivation was strongly related to both. The social gradient in poor self-rated health (odds in most compared to least deprived group) was 6.5 for individual and 4.2 for the neighborhood deprivation index. Behavioral and psychosocial variables explained, respectively, 7% and 11% of the individual deprivation gradient and 11% and 4% of the neighborhood gradient. The psychosocial pathway did not significantly mediate the neighborhood deprivation effect on self-rated health.

Conclusion: Intermediary pathways of the social gradient in self-rated health differed between individual and neighborhood-based deprivation indices, suggesting at least partly independent influences on poor health of individual and neighborhood-level deprivation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Health
  • Exercise / psychology
  • Female
  • Health Behavior
  • Health Status*
  • Humans
  • Life Style
  • Logistic Models
  • Male
  • Middle Aged
  • Poverty Areas
  • Psychological Tests
  • Psychosocial Deprivation*
  • Residence Characteristics
  • Self Concept
  • Smoking / psychology
  • Social Class
  • Social Support
  • Socioeconomic Factors
  • Stress, Psychological / psychology