A matter of perception: exploring the role of income satisfaction in the income-mortality relationship in German survey data 1995-2010.

Individual- and community-level income has been shown to be linked to social inequalities in health and mortality. On the individual level, social comparisons and relative deprivation resulting from them have been identified as relevant mechanisms involved in the relationship between income and health, but it is mainly income-based measures of relative deprivation that have been considered in previous studies. Using income satisfaction, this study employs a perception-based indicator of relative deprivation. The study, covering the period between 1995 and 2010, utilized the German Socio-Economic Panel. The follow-up included 11,056 men and 11,512 women at employment age 25-64. Discrete-time survival analysis with Cox regression was performed to estimate the effects of relative income position and income satisfaction on all-cause mortality. The univariate analysis revealed an income gradient on mortality and further showed a strong association between income satisfaction and survival. After education and employment status were adjusted for, the effect of discontent with income on mortality was still present in the female sample, whereas in the male sample only the income gradient prevailed. When self-rated health was controlled for, the hazard ratios of income satisfaction attenuated and turned non-significant for both men and women while the effects of income position remained stable. In conclusion, the findings suggest that income satisfaction and income position measure different aspects of income inequality and complement one another. Income satisfaction appeared to be a possible contributing component to the causal pathway between income and mortality.