The effects of deprivation and relative deprivation on self-reported morbidity in England: an area-level ecological study

Background: Socioeconomic status gradients in health outcomes are well recognised and may operate in part through the psychological effect of observing disparities in affluence. At an area-level, we explored whether the deprivation differential between neighbouring areas influenced self-reported morbidity over and above the known effect of the deprivation of the area itself. Methods: Deprivation differentials between small areas (population size approximately 1,500) and their immediate neighbours were derived (from the Index of Multiple Deprivation (IMD)) for Lower Super Output Area (LSOA) in the whole of England (n=32482). Outcome variables were self-reported from the 2001 UK Census: the proportion of the population suffering Limiting Long-Term Illness (LLTI) and 'not good health'. Linear regression was used to identify the effect of the deprivation differential on morbidity in different segments of the population, controlling for the absolute deprivation. The population was segmented using IMD tertiles and P-2 People and Places geodemographic classification. P-2 is a commercial market segmentation tool, which classifies small areas according to the characteristics of the population. The classifications range in deprivation, with the most affluent type being 'Mature Oaks' and the least being 'Urban Challenge'. Results: Areas that were deprived compared to their immediate neighbours suffered higher rates of 'not good health' (beta=0.312, p<0.001) and LLTI (beta=0.278, p<0.001), after controlling for the deprivation of the area itself ('not good health'-beta=0.655, p<0.001; LLTI-beta=0.548, p<0.001). The effect of the deprivation differential relative to the effect of deprivation was strongest in least deprived segments (e.g., for 'not good health', P-2 segments 'Mature Oaks'-beta=0.638; 'Rooted Households'-beta=0.555). Conclusions: Living in an area that is surrounded by areas of greater affluence has a negative impact on health in England. A possible explanation for this phenomenon is that negative social comparisons between areas cause ill-health. This 'psychosocial effect' is greater still in least deprived segments of the population, supporting the notion that psychosocial effects become more important when material (absolute) deprivation is less relevant.