Preplanned Studies: Driving Factors for Subjective Relative Deprivation Alleviating Among Middle-Aged and Older Adults with Disabilities — China, 2023

Subjective relative deprivation (SRD) represents an individual’s perceptions and feelings of inequality and disadvantage in comparison to a referential group (1). Since its conceptualization (2), SRD has surged as a pivotal research field across various disciplines — ranging from psychology and sociology to political science and economics — covering all stages of the human life cycle (3). With the progression of aging, the enhancement of subjective well-being for the elderly and the reduction of SRD have become critical areas of concern for researchers, service providers, and policymakers. However, the digital divide’s emergence, particularly among older adults, has led to a discrepancy between those with and without disabilities. Past research indicates that older adults with disabilities are less frequent internet users and benefit from it less than their non-disabled counterparts.

Individuals with disabilities, including those in their later years, have demonstrated lower self-rated health and subjective well-being. This is contrary to the traditional definition of successful aging outlined by the MacArthur model, which includes a decreased risk of disability, heightened physical and cognitive capacity, and engaging in social activities (4). Therefore, this study aims to examine the correlation between objective and subjective relative deprivation, identifying key factors that may mitigate subjective relative deprivation in middle-aged and older adults suffering from disabilities in China. The study proposes two hypotheses: first, that economic objective relative deprivation has a direct influence on subjective relative deprivation within this demographic; and second, that internet usage among these adults acts as a mediating factor, impacting the extent and course of this direct influence.

Data for this study was extracted from the National Sample Survey on Subjective Perceptions and Evaluation of Persons with Disabilities’ Protection and Development. To identify potential subjects, we used a proportional stratification and a multi-stage random sampling method, targeting those listed in the National Basic Database of People with Disabilities (NBDPD) who were in possession of an identification card provided by the China Disabled Persons’ Federation (CDPF). From March to June 2023, trained interviewers from CDPF conducted surveys on selected individuals. In instances where the person with a disability was unable to participate, a cohabitating family member filled out the questionnaire on their behalf.

The survey included objective and subjective questions related to economic status, employment, social security, education, usage of rehabilitation services, accessibility, and internet usage. The construction of the Personal Relative Deprivation Scale of People with Disabilities (PRDS-PwDs) was based on existing research and incorporated into the survey (Supplementary Table S1)(1,5). Through this process, we were able to interview 9,104 individuals with disabilities and gather 5,073 relevant responses, with 3,876 of the respondents aged 45 and above. The NBDPD, a continually updated database, was utilized due to its accuracy in determining eligibility and types of social security and benefits for people with disabilities.

The analysis conducted after addressing missing responses included 3,870 participants, who had an average age of 63.87 years [standard deviation (SD)=10.93], and a median age of 64 years. Male participants comprised 56.3% of the sample, with 30.5% residing in urban areas, and the majority identified as individuals with physical disabilities (58.1%). More details can be found in Supplementary Table S2.

This study used several indices to assess deprivation: the SRD index for subjective relative deprivation, per capita annual household income for absolute economic deprivation, and the Yitzhaki index for relative economic deprivation (6). Based on relevant literature and theoretical studies, a 10-item scale was adapted, designed to identify the cognitive-emotional dual-dimensional structure of relative deprivation among individuals with disabilities (5). The scale included variables such as family economic income status, medical rehabilitation, public education, vocational training, and accessibility. A 5-point Likert scoring method was used, allowing scores from 10 to 50. A higher total score indicated a greater level of subjective relative deprivation. Additionally, a higher score on the Yitzhaki index suggested a higher level of relative economic deprivation.

Within the confines of internet utilization, the current study employed two indices — the frequency of internet use and the dimensions of internet use — to delineate the patterns of internet usage. The frequency of internet use was gauged via two questions, namely: “How frequently do you utilize the internet on your computer?” and “How frequently do you engage with the internet via your mobile device?” Response options provided were “never,” “rarely,” “sometimes,” “often,” and “very frequently”, with each corresponding to a value between 1 and 5. By adding the scores of both questions, we derived an Internet Frequency Index which ranged from 2 (minimal internet usage) to 10 (extensive internet usage).

The dimensions of internet use were determined by enquiring if the participants deployed the internet for specific activities such as accessing news, online shopping, mobile payments, telemedicine, social interaction, relaxation and entertainment, seeking employment information or engaging in work-related activities, among others. Participants were to respond with either a “yes” (equivalent to 1 point) or a “no” (equivalent to 0 points) for each activity. The aggregate of these points from all the activities gave rise to the internet use dimension index, which ranges from 0 to 8 points.

This study employed the ordinary least squares (OLS) linear regression model to examine the correlations between economic deprivation, subjective relative deprivation, and internet use. Following this, the Sobel mediation effect detection method (7) was utilized to investigate the potential intermediary role of internet usage in the relationship between economic deprivation and subjective relative deprivation. All statistical analyses were conducted using STATA software (version 16; StataCorp. LLC, USA), with P<0.05 considered statistically significant.

The study results revealed significant relationships between both absolute and relative economic deprivation and subjective relative deprivation, after controlling for additional variables (Table 1). An increase in the annual per capita household income was associated with a decrease in the subjective relative deprivation index (Coefficient=0.163, P=0.009), and a high Yitzhaki index corresponded to a lower subjective relative deprivation index (Coefficient=0.687, P=0.003). The Yitzhaki index assessed relative economic deprivation through a horizontal comparison within the reference group which comprised family members, friends, neighbors, work colleagues, and others comparable to the interviewees with disabilities (8). Yet, this type of horizontal relative economic deprivation did not have a noticeable mitigating impact on the subjective relative deprivation experienced by individuals with disabilities. Additional details are provided in Table 1.

Further investigation, as outlined in Table 2, examined the complex relationship between both absolute and relative economic deprivation and internet usage patterns among middle-aged and older adults with disabilities. Controlling for other variables, an increase in per capita annual household income was positively correlated with both the frequency (Coefficient=0.243, P<0.001) and scope (Coefficient=0.164, P<0.001) of internet usage. Conversely, a rise in the Yitzhaki index indicated a negative relationship with both the frequency (Coefficient=–0.593, –0.309, P<0.001) and scope (Coefficient=–0.309, P <0.001) of internet usage. Detailed findings can be found in Table 2.

Using the Sobel mediation effect measure for analysis, Table 3 presents the mediating role of internet usage in middle-aged and older adults with disabilities. The findings highlighted that both absolute and relative economic deprivation directly and indirectly impacted the subjective relative deprivation experienced by this group. An increase in absolute income mitigated subjective relative deprivation by promoting more frequent and broader use of the internet. With respect to relative economic deprivation, the mediation mechanism showed complexity. The Yitzhaki index served as a direct reducing factor for subjective relative deprivation. However, significant relative economic deprivation reduced both the frequency and breadth of internet use, indirectly exacerbating the issue of subjective relative deprivation. For a detailed examination, please refer to Table 3.