Relative deprivation in income, tobacco chewing and bidi smoking among Indian adults: Findings from a cross-sectional national study

The robust relationship of income with health outcomes is widely documented and there is a rich body of work examining the direct impact of income on health. However, researchers have also extensively studied the relationship of an individuals relative socioeconomic position with their wellbeing, frequently explained by the relative deprivation (RD) hypothesis. Despite the high socioeconomic inequality, research on RD in the Indian context is scarce. Therefore, the primary objective of this study was to assess the relationship of RD in income with the risk of tobacco chewing and bidi smoking in a sample of Indian adults. We drew data from the second round of the nationally representative India Human Development Survey for our analysis. Using data on annual household equivalized income from 26,529 adults, we created the Yitzhaki index to operationalize RD in income. We then fitted survey adjusted logistic regression models accounting for age, gender, absolute household equivalized income, education, place of residence, caste, and religion. Odds ratios from fully adjusted models for the third tertile (greatest relative deprivation) versus the first tertile (lowest relative deprivation) ranged between 1.32 (95% CI=1.15, 1.50) and 1.63 (95% CI=1.40, 1.89) for tobacco chewing and varied between 0.99 (95% CI=0.86, 1.14) and 1.32 (95% CI=1.15, 1.51) for bidi smoking, depending on the reference group used to compute the RD measure. Our findings suggested that with higher RD, the risk of consumption of smokeless tobacco and bidi smoking was higher. These results point to the health hazard of relative deprivation in a society that has enjoyed rapid economic growth coupled with rising income inequality in the last few decades. Our findings call for a comprehensive assessment of the socioeconomic inequality in income and health observed in India and the implementation of efficient programs to narrow the gap. Data availability statementThe data that support the findings of this study are available in IHDS 2 at https://ihds.umd.edu/data/ihds-2.