Pathways from deprivation to health differed between individual and neighborhood-based indices.

OBJECTIVE To explore the role of behavioral and psychosocial factors in explaining the social gradient in self-rated health as defined either by an individual or a neighborhood deprivation index. STUDY DESIGN AND SETTING Data were from the baseline survey of the UK Flexible Sigmoidoscopy trial. Recruitment through general practices was stratified to generate a socioeconomically diverse sample (N=5,253, aged 55-64). Assessments included an individual and neighborhood deprivation index, each of which were categorized in four levels; three behavioral and three psychosocial factors; and self-rated health. RESULTS Neighborhood deprivation was more strongly related to behavioral than to psychosocial factors, whereas individual deprivation was strongly related to both. The social gradient in poor self-rated health (odds in most compared to least deprived group) was 6.5 for individual and 4.2 for the neighborhood deprivation index. Behavioral and psychosocial variables explained, respectively, 7% and 11% of the individual deprivation gradient and 11% and 4% of the neighborhood gradient. The psychosocial pathway did not significantly mediate the neighborhood deprivation effect on self-rated health. CONCLUSION Intermediary pathways of the social gradient in self-rated health differed between individual and neighborhood-based deprivation indices, suggesting at least partly independent influences on poor health of individual and neighborhood-level deprivation.