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Relative deprivation and incident functional disability among older Japanese women and men: Prospective cohort study
  1. Naoki Kondo1,
  2. Ichiro Kawachi1,
  3. Hiroshi Hirai2,
  4. Katsunori Kondo2,
  5. S V Subramanian1,
  6. Tomoya Hanibuchi3,
  7. Zentaro Yamagata4
  1. 1 Harvard School of Public Health, United States;
  2. 2 Nihon Fukushi University, United States;
  3. 3 Osaka University of Commerce, Japan;
  4. 4 University of Yamanashi, Japan
  1. E-mail: nkondo{at}


Background: We conducted a prospective observational study to test the hypothesis that relative deprivation was associated with incident physical or cognitive disability, independent of absolute income.

Methods: Study subjects consist of 9463 non-disabled persons aged 65+ years in the Aichi Gerontological Evaluation Study (AGES), Aichi prefecture, Japan. Baseline mail-in survey in 2003 gathered information on income, educational attainment, lifestyle factors (smoking, alcohol consumption, and health check-up), and healthcare utilization. Three-year incidence of disability was assessed through public long-term care insurance data bases and resident registry.

Results: We analyzed 7673 subjects (81%) with complete information. Our measure of relative deprivation was the Yitzhaki Index across eight reference groups, which calculates the deprivation suffered by each individual as a function of the aggregate income shortfall for each person relative to everyone else with higher incomes in that person's reference group. Cox regression demonstrated that after controlling for sociodemographic factors (including absolute income) the hazard ratio (and 95% confidence intervals) of incident physical/cognitive disability per one standard deviation increase in relative deprivation ranged from 1.13 (0.99, 1.29) to 1.15 (1.01, 1.31) in men, and from 1.11 (0.94, 1.31) to 1.18 (1.00, 1.39) in women, depending on the definition of the reference group. Additional adjustment for lifestyle factors attenuated the hazard ratios to statistical non-significance.

Conclusion: Relative deprivation may be a mechanism underlying the link between income inequality and disability in older age, at least among males. Lifestyle factors in part explain the association between relative deprivation and incident disability.

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