Material deprivation and self-rated health: a multilevel study of adolescents from 22 European and North American countries

This cross-sectional study examined the combined and interactive effects of material deprivation and area deprivation on adolescent self-rated health, using data from the World Health Organization collaborative study ‘Health Behaviour in School-aged Children 1997/1998’. Included in the present study were 94,915 11–15-year-old students from a total of 22 European and North American countries. Multilevel logistic regression analyses revealed significant additive main effects of individual material deprivation and area deprivation, but not interactive effects. The most deprived students had an odds ratio for self-rated poor health almost three times higher than the least deprived students. Area deprivation effects were stronger at the country level than at the school level, and stronger among 11-year-olds than among 13- and 15-year-olds. A combined ‘individual and area deprivation’ model predicted that the most disadvantaged 11-year-old students were eight times more likely to have poor self-rated health compared to the least disadvantaged student (OR (95% CI)=7.96 (3.38, 18.75)). The findings highlight the multilevel effects of deprivation at the individual, local, and national level.