en [6-8,13]. Eibner and Evans restricted their study to include only men, arguing that the measure of relative deprivation is not of equal importance to women due to their lower degree of labour market participation . This could not be an argument in the Swedish context, although there may be other reasons why the measure lacks importance to women. In a study on pay reference standards and pay satisfaction, men were more affected by the national pay reference level and women more by the occupational level . Comparing different measures of relative deprivation also showed that measures more closely related to everyday life and consumption affected women’s health more than measures of objective social status did. In a previous study a measure of self-rated deprivation, measuring a number of consumption items that the individual finds necessary but cannot afford, was found closely related to women’s health . Among men, this is supported by the findings of Wolff and colleagues, showing that comparisons with distal reference groups impact health outcomes .
We also tried to isolate the effect of relative deprivation, over and above the effect of absolute income. The Yitzhaki index calculates the accumulated shortfall between one person’s income compared to all other with a higher income in his or her reference group. Considering this effect within different income strata give us an idea of the importance of social comparisons depending on income level. Among men, we did not find any significant effect of relative deprivation within the lowest income quartile (Table (Table3).3). A similar pattern was found in Japan by analysing relative deprivation and incident disability among the elderly , as well as in Sweden for the relation between relative deprivation and self-rated health . It could be argued that psychosocial mechanisms, such as social comparisons, play a larger role when basic material needs are fulfilled. For individuals who are having problems making ends meet, relative deprivation may be of less importance.
The following limitations of the study should be considered. First, the way in which we formed our reference groups could be argued to be objective, thus not reflecting the groups people actually use for making social comparisons. Our data do not include any questions on people’s actual reference groups, rather we have based them on the assumption that people compare themselves to similar others – an argument that has also been used in other studies [5-8,13]. Based on previous studies, we would argue that our combinations of reference groups are sufficient for the present analyses.
Occupation was classified in accordance with the Swedish Socioeconomic Classification (SEI) and divided into the categories higher non-manual employees, lower non-manual employees, qualified manual workers, unqualified manual workers, self-employed and farmers. The total proportion of individuals who had an unclassifiable profession or had a missing value was 19%, somewhat higher among women than men. These individuals were excluded from the analyses. This is likely to have impacted the results when using occupation as a reference group and could be one reason why the analysis of top vs. bottom within the lowest quartile showed a lower HR in the crude model when using occupation as a reference group. In the excluded group of people, those with an unclassifiable profession or a missing value, the proportion of individuals with a low income is likely to be higher. However, we performed analyses using different reference groups and all showed a similar pattern, namely that relative income deprivation is significantly associated with mortality.
There are reasons to believe that income inequality has an impact on individual health outcomes, and different mechanisms and explanations within this relation have been discussed [2,23]. Social comparisons’, generating relative deprivation, has been put forward as one possible mechanism. There are different hypotheses as to the breeding ground for relative deprivation. It has been argued that a con