Compared with whom? Reference groups in socio-economic comparisons and self-reported health in 34 countries

Background: The association between socio-economic position and health is believed to be mediated, in part, by psycho-social comparison of one's situation with that of others. But with whom? Possibilities include family, friends, elites, or even those in other countries or in previous times. So far, there has been almost no research on whether the reference point matters. Methods: We take advantage of a comparative data set that, uniquely, allows us to ask this question. The Life in Transition Survey was conducted in four Southern European and 30 Central and Eastern European and Eurasian countries. We sought differences in the probability of good self-reported health among those using different reference groups, including own family, friends and neighbours, domestic elites, people living in other countries and those living prior to a major politico-economic transition. We used multivariable and multilevel mixed-effects Poisson regressions and estimated treatment effects via the regression adjustment of Poisson models. Results: In most cases the choice of reference group did not matter but in some it did. Among men in Eastern European and Eurasian societies, those who compared themselves with their parents and their own families before the start of transition were less likely to report good health compared with those who did not compare their own economic situation with any specific reference group. Conclusions: For some individuals, the choice of who to compare one's situation with does seem to matter, pointing to an area for future investigation in research on psycho-social determinants of health.