Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Eur J Public Health. 2018 Dec 1;28(6):1056-1061. doi: 10.1093/eurpub/cky110.
Three main explanations of the relationship between income and population health have been identified: the absolute, the contextual and the relative income hypotheses. The evidence about their relevance particularly in egalitarian societies is, however, inconsistent. This study aimed to test the three hypotheses in relation to psychological distress in northern Sweden.
Data come from the 2014 cross-sectional survey from the four northern-most counties in Sweden, and included people aged 25-84 years (n = 21 004). Psychological distress was measured by the General Health Questionnaire-12 and income information came from population registers. Absolute income was operationalized by individual disposable income, contextual income as the municipal-level Gini coefficient and relative income by the Yitzhaki index. Prevalence ratios (PR) were calculated from log-binomial regression analyses.
A gradient in poor mental health was observed across quintiles of individual income, with the poorest substantially more likely to report poor health compared with the highest quintile (PR = 1.56; 95% CI = 1.19, 2.04). Second, municipalities in the quintiles 2-3 of the Gini coefficient had a better mental health compared with those in the most equal municipalities. Third, a gradient in poor mental health across quintiles of relative deprivation was also found, with the most deprived quintile the most likely to report poor health (PR = 1.37; 95% CI = 1.06, 1.76).
This study suggests a strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively. Interventions targeting a reduction in the individual income gap may be necessary in order to reduce psychosocial distress differences in northern Sweden.
已经确定了收入与人口健康之间关系的三个主要解释：绝对收入、情境收入和相对收入假设。然而，关于这些假设在平等主义社会中的相关性的证据并不一致。本研究旨在检验这三个假设与瑞典北部的心理困扰之间的关系。
数据来自 2014 年瑞典最北部四个县的横断面调查，包括 25-84 岁的人群（n=21004）。心理困扰用一般健康问卷-12 来衡量，收入信息来自人口登记册。个体可支配收入被定义为绝对收入，市政级别基尼系数被定义为情境收入，伊特扎基指数被定义为相对收入。使用对数二项式回归分析计算患病率比（PR）。
个体收入五分位数之间存在心理健康状况较差的梯度，最贫困的人报告健康状况不佳的可能性明显高于最高五分位数（PR=1.56；95%置信区间=1.19，2.04）。其次，基尼系数五分位数 2-3 的城市的心理健康状况优于最平等的城市。第三，相对剥夺五分位数之间也存在心理健康状况较差的梯度，最贫困的五分位数最有可能报告健康状况不佳（PR=1.37；95%置信区间=1.06，1.76）。
本研究表明，绝对收入、相对收入和情境收入效应假设分别得到了强有力、中等和缺乏支持。为了减少瑞典北部的心理困扰差异，可能需要针对减少个体收入差距的干预措施。
