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Kumagai N, Nishimura S, Jakovljević M. Could high continuity of care (COC) have a negative impact on subjective health of hypertensive patients? A Japanese perspective. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:39. [PMID: 37344814 DOI: 10.1186/s12962-023-00448-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Cardiovascular diseases, such as stroke and ischemic heart disease attributable to hypertension, are major causes of premature death in Japan and worldwide. Nevertheless, a low rate of blood pressure control among hypertensive patients has been observed in most countries. No previous studies have explored the effectiveness of physician visits among hypertensive patients in Japan. METHODS To quantify the effects of persistence in physician visits among hypertensive patients, we evaluated the causal effect of physician visits on the health of hypertensive patients. We used 16 waves of nationally representative longitudinal data drawn from the Longitudinal Survey of Middle-aged and Elderly Persons in Japan (2005-2020). To examine the causal effect of physician visits on patients' health outcomes, we used inverse probability treatment weights and doubly robust estimation and obtained the estimates of the average treatment effects on the treated (ATETs). RESULTS Covariates were well balanced among patients who had physician visits during the past two consecutive years (N = 67,210; 64.9% among hypertensive patients). The estimated ATETs suggest that three consecutive years of physician visits had a negative impact on poor subjective health. Furthermore, patients without habitual exercise tended to not continue physician visits and perceived poor subjective health. CONCLUSIONS Although the impact of frequent physician visits on blood pressure stability remains uncertain, regular appointments every 30 days can be effective for individuals with hypertension, particularly if they receive continuous instruction from their family physician. Because it is important for physicians to strengthen hypertensive patients' blood pressure control, promoting consecutive physician visits to hypertensive patients with diabetes, lower educational attainment, or smoking habits is needed.
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Affiliation(s)
- Narimasa Kumagai
- Faculty of Economics, Seinan Gakuin University, 6-2-92 Nishijin Sawara-Ku, Fukuoka, 814-8511, Japan.
| | - Shuzo Nishimura
- Professor Emeritus of Kyoto University, Kyoto, Japan
- Faculty of Economics and Business Administration, Kyoto University of Advanced Science, Kyoto, Japan
| | - Mihajlo Jakovljević
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University, Chiyoda-Ku, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Lai R, Li R, Wang T, Ju J, Liu Q, Zhang J, Song L, Xu H. Short-term socioeconomic status shift and long-term cardiovascular outcomes in China: a population-based cohort study. J Epidemiol Community Health 2023; 77:152-159. [PMID: 36539279 PMCID: PMC9933156 DOI: 10.1136/jech-2022-219702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Limited studies have discussed the effect of socioeconomic status (SES) shift on cardiovascular outcomes, especially in less developed regions and countries. We; therefore, explored the association between short-term SES shift and long-term cardiovascular outcomes in China. METHODS In participants who had completed China Kadoorie Biobank study resurvey, 18 672 were included in the final analysis after excluding those who had cardiovascular diseases at baseline, and those who had a cardiovascular event before the resurvey. We used education, occupation, household income and healthcare cover as measurement of SES, and generated SES class for each individual at baseline and resurvey using latent class analysis. Outcomes of interest included cardiovascular death, major coronary event (MCE) and stroke. We used accelerated failure time model to obtain survival time ratio for each level of SES shift. RESULTS During a mean time gap of 2.6 years, 10 273 (55%) individuals remained stable in SES, 7763 (41.6%) shifted towards higher SES and 636 (3.4%) shifted towards lower SES. Participants were followed up for a mean of 9.8 years. After adjusting for baseline factors, sharp but not moderate SES downshift was significantly associated with shortened event-free survival time before cardiovascular deaths (p=0.02) and MCEs (p<0.001) occurred. Contrarily, moderate and sharp SES upshift was significantly associated with prolonged event-free survival time before cardiovascular deaths (p=0.0027 and p<0.001) and MCEs (p=0.0079 and p=0.009) occurred. CONCLUSION Short-term SES improvement is associated with better long-term cardiovascular outcome in China. High baseline SES might buffer out some unfavourable impact brought by moderate SES downshift. More comprehensive strategies should be considered in policy-making for socioeconomic development.
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Affiliation(s)
- Runmin Lai
- Department of Cardiology, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Ruiqi Li
- Department of Emergency, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Tong Wang
- Department of Cardiology, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Jianqing Ju
- Department of Cardiology, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
- National Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Qiyu Liu
- Department of Cardiology, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Jie Zhang
- Department of Cardiology, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Luxia Song
- Department of Cardiology, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Hao Xu
- Department of Cardiology, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
- National Research Center for Chinese Medicine Cardiology, Beijing, China
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Nori H, Hajifattahi F, Moezzi ghadim N, Alirezaei S. Evaluation of Patients’ Awareness of Their Blood Pressure and Blood Glucose at the Dental Faculty of Islamic Azad University of Medical Sciences, Tehran, Iran, in 2018. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2020. [DOI: 10.29252/jrdms.5.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Area-Based Socio-Economic Inequalities in Mortality from Lung Cancer and Respiratory Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101791. [PMID: 31117163 PMCID: PMC6571595 DOI: 10.3390/ijerph16101791] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022]
Abstract
Background: After political transformation in 1989/1990, Poland experienced a general improvement in living conditions and quality of life, but the benefits did not extend evenly across all segments of the society. We hypothesized that the regional differences in mortality due to diseases of the respiratory system are related to socioeconomic status (SES) and its changes over time. Materials and methods: An ecological study was carried out in 66 sub-regions of Poland using the data from the period of 2010 to 2014. Age-standardized mortality rates (SMRs) were calculated separately for men and women in three age categories: ≥15, 25–64 years, and ≥65 years. An area-based SES index was derived from the characteristics of the sub-regions using the z-score method. Multiple weighted linear regression models were constructed to estimate a real socioeconomic gradient for mortality resulting from lung cancer and respiratory diseases. Results: In the regions studied, the SMRs for respiratory disease varied from 70/100,000 to 215/100,000 in men and from 18/100,000 to 53/100,000 in women. The SMRs for lung cancer varied from 36/100,000 to 110/100,000 among men and from 26/100,000 to 77/100,000 among women. After adjusting for the prevalence of smoking and environmental pollution, the SES index was found to be inversely associated with the SMR for lung cancer in each category of age among men, and in the age group of 25–64 years among women. An increase of the SES index between 2010 and 2014 was associated with a decrease of SMR for respiratory disease both in men and women, but this change was not significantly associated with the SMR for lung cancer. Conclusion: SES appears to be an important correlate of mortality from respiratory diseases and lung cancer at the population level, particularly in men. A lower SES was associated with greater mortality from lung cancer and respiratory diseases. An increase in SES over time was related to a decrease in mortality from respiratory disease, but not from lung cancer.
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The association between personal income and aging: A population-based 13-year longitudinal study. Arch Gerontol Geriatr 2017; 70:76-83. [DOI: 10.1016/j.archger.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/23/2016] [Accepted: 01/02/2017] [Indexed: 11/22/2022]
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Imanishi Y, Fukuma S, Karaboyas A, Robinson BM, Pisoni RL, Nomura T, Akiba T, Akizawa T, Kurokawa K, Saito A, Fukuhara S, Inaba M. Associations of employment status and educational levels with mortality and hospitalization in the dialysis outcomes and practice patterns study in Japan. PLoS One 2017; 12:e0170731. [PMID: 28264035 PMCID: PMC5338767 DOI: 10.1371/journal.pone.0170731] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 01/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) factors such as employment, educational attainment, income, and marital status can affect the health and well-being of the general population and have been associated with the prevalence of chronic kidney disease (CKD). However, no studies to date in Japan have reported on the prognosis of patients with CKD with respect to SES. This study aimed to investigate the influences of employment and education level on mortality and hospitalization among maintenance hemodialysis (HD) patients in Japan. METHODS Data on 7974 HD patients enrolled in Dialysis Outcomes and Practice Patterns Study phases 1-4 (1999-2011) in Japan were analysed. Employment status, education level, demographic data, and comorbidities were abstracted at entry into DOPPS from patient records. Mortality and hospitalization events were collected during follow-up. Patients on dialysis < 120 days at study entry were excluded from the analyses. Cox regression modelled the association between employment and both mortality and hospitalization among patients < 60 years old. The association between education and outcomes was also assessed. The association between patient characteristics and employment among patients < 60 years old was assessed using logistic regression. RESULTS During a median follow-up of 24.9 months (interquartile range, 18.4-32.0), 10% of patients died and 43% of patients had an inpatient hospitalization. Unemployment was associated with mortality (hazard ratio [HR] = 1.57; 95% confidence interval [CI]: 1.05-2.36) and hospitalization (HR = 1.25; 95% CI: 1.08-1.44). Compared to patients who graduated from university, patients with less than a high school (HS) education and patients who graduated HS with some college tended to have elevated mortality (HR = 1.41; 95% CI, 1.04-1.92 and HR = 1.36; 95% CI: 1.02-1.82, respectively) but were not at risk for increased hospitalizations. Factors associated with unemployment included lower level of education, older age, female gender, longer vintage, and several comorbidities. CONCLUSIONS Employment and education status were inversely associated with mortality in patients on maintenance HD in Japan. Employment but not education was also inversely associated with hospitalizations. After adjustment for comorbidities, the associations with clinical outcomes tended to be stronger for employment than education status.
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Affiliation(s)
- Yasuo Imanishi
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
- * E-mail:
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Angelo Karaboyas
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Bruce M. Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
- University of Michigan, Ann Arbor, MI, United States of America
| | - Ronald L. Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | | | - Takashi Akiba
- Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | | - Akira Saito
- Division of Nephrology and Dialysis Center, Shonantobu General Hospital, Kanagawa, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Zimmer Z, Hanson HA, Smith KR. Offspring Socioeconomic Status and Parent Mortality Within a Historical Population. Demography 2016; 53:1583-1603. [PMID: 27664009 PMCID: PMC5086077 DOI: 10.1007/s13524-016-0502-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Considering a network approach to health determinants, we test the hypothesis that benefits of high socioeconomic status (SES) may be transmitted up the generational ladder from offspring to parents. Studies that examine own SES and own health outcomes, or SES of parents and outcomes of young or adolescent children, are common. Those that investigate SES of offspring and their association with parental health are rare. Employing data from a historical population of individuals extracted from a comprehensive population database that links demographic and vital records across generations, this study tests the hypothesis that higher offspring SES associates with lower parental mortality after controlling for parental SES. The sample includes 29,972 individuals born between 1864 and 1883 whose offspring were born between 1886 and 1920. SES is operationalized using Nam-Powers occupational status scores divided into quartiles and a category for farmers. Models assess mortality risk after age 40. Included is a test for whether effects are proportional across parents who died younger and older. Estimated life expectancies across categories of offspring SES conditioned on parental SES are calculated to illustrate specifically how differences in SES relate to differences in years lived. Results indicate a longevity penalty for those whose offspring have low SES and a longevity dividend for those with high-SES offspring. The influence of offspring attributes on well-being of parents points to fluid and myriad linkages between generations.
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Affiliation(s)
- Zachary Zimmer
- Department of Family Studies & Gerontology, and Canada Research Chair in Global Aging and Community, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
| | - Heidi A Hanson
- Department of Family and Preventive Medicine, Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ken R Smith
- Department of Family and Consumer Studies and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Sugisawa H, Harada K, Sugihara Y, Yanagisawa S, Shinmei M. Socioeconomic status and self-rated health of Japanese people, based on age, cohort, and period. Popul Health Metr 2016; 14:27. [PMID: 27489510 PMCID: PMC4971645 DOI: 10.1186/s12963-016-0095-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/25/2016] [Indexed: 12/31/2022] Open
Abstract
Background Differences in health resulting from differences in socioeconomic status (SES) have been identified around the world. Age, period, and cohort (A-P-C) differences in health are vital factors which are associated with disparities in SES. However, few studies have examined these differences simultaneously. Moreover, although self-rated health (SRH) has been frequently used as an indicator of health, biases in reporting SRH that depend on the socioeconomic characteristics of respondents have been scarcely adjusted in the previous studies. To overcome these limitations, we investigated the associations between disparities in SES and adjusted SRH based on A-P-C, by using a repeated, cross-sectional survey of a nationally representative sample of Japanese people. In addition, we further investigated how exogenous (macroeconomic) conditions unique to a period or cohort would explain trends across successive periods and cohorts. Methods Data were obtained from a sample of 653,132 Japanese people that responded to the Comprehensive Survey of Living Conditions (CSLC), which is a cross-sectional survey that had been conducted every three years from 1986 to 2013, on over 10 occasions. In the CSLC, SES has been assessed by household income. We simultaneously controlled for each A-P-C dimension by using the model for cross-classification of random effects, and adjusting SRH data for reporting biases caused by differences in income and A-P-C. Results Differences in adjusted SRH associated with income differences decreased with age and reversed after 76 years of age. Period differences indicated that income differences peaked in 1992 and 2007. Moreover, differences in adjusted SRH associated with income differences decreased in periods with high unemployment across all periods. Furthermore, there were no cohort differences in adjusted SRH that were associated with income differences. Conclusion In Japan, there are age and period variations associated with adjusted differences in SRH as assessed by income. Moreover, exogenous conditions in each period could help explain periodic trends across successive periods.
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Affiliation(s)
- Hidehiro Sugisawa
- Graduate School of Gerontology, J. F. Oberlin University, 3758 Tokiwa-machi, Machida-shi, Tokyo, 194-0294 Japan
| | - Ken Harada
- Jissen Women's University, 1-1-49 Higashi, Shibuya-ku, Tokyo, 150-8538 Japan
| | - Yoko Sugihara
- Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, 192-0397 Japan
| | - Shizuko Yanagisawa
- Tokushima University, 3-18-15 Kuramoto-cho, Tokushima-shi, Tokushima 770-8503 Japan
| | - Masaya Shinmei
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015 Japan
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Sugisawa H, Shimizu Y, Kumagai T, Sugisaki H, Ohira S, Shinoda T. Effects of socioeconomic status on physical and mental health of hemodialysis patients in Japan: differences by age, period, and cohort. Int J Nephrol Renovasc Dis 2016; 9:171-82. [PMID: 27471405 PMCID: PMC4948840 DOI: 10.2147/ijnrd.s107031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Study purpose Whether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients. Methods Data were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients’ association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors. Results Relative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or depressive symptoms. Conclusion The number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period.
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Affiliation(s)
| | - Yumiko Shimizu
- Faculty of Nursing, The Jikei University School of Medicine, Chofu
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Santana P, Costa C, Marí-Dell'Olmo M, Gotsens M, Borrell C. Mortality, material deprivation and urbanization: exploring the social patterns of a metropolitan area. Int J Equity Health 2015; 14:55. [PMID: 26051558 PMCID: PMC4483227 DOI: 10.1186/s12939-015-0182-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/04/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Socioeconomic inequalities affecting health are of major importance in Europe. The literature enhances the role of social determinants of health, such as socioeconomic characteristics and urbanization, to achieve health equity. Yet, there is still much to know, mainly concerning the association between cause-specific mortality and several social determinants, especially in metropolitan areas. This study aims to describe the geographical pattern of cause-specific mortality in the Lisbon Metropolitan Area (LMA), at small area level (parishes), and analyses the statistical association between mortality risk and health determinants (material deprivation and urbanization level). Fourteen causes have been selected, representing almost 60 % of total mortality between 1995 and 2008, particularly those associated with urbanization and material deprivation. Methods A cross-sectional ecological study was carried out. Using a hierarchical Bayesian spatial model, we estimated sex–specific smoothed Standardized Mortality Ratios (sSMR) and measured the relative risks (RR), and 95 % credible intervals, for cause-specific mortality relative to 1. urbanization level, 2. material deprivation and 3. material deprivation adjusted by urbanization. Results The statistical association between mortality and material deprivation and between mortality and urbanization changes by cause of death and sex. Dementia and MN larynx, trachea, bronchus and lung are the causes of death showing higher relative risk associated with urbanization. Infectious and parasitic diseases, Chronic liver disease and Diabetes are the causes of death presenting higher relative risk associated with material deprivation. Ischemic heart disease was the only cause with a statistical association with both determinants, and MN female breast was the only without any statistical association. Urbanization level reduces the impact of material deprivation for most of the causes of death. Men face a higher impact of material deprivation and urbanization level, than women, in most cause-specific mortality, even when considering the adjusted model. Conclusions Our findings explore the specific pattern of fourteen causes of death in LMA and reveals small areas with an excess risk of mortality associated with material deprivation, thereby identifying problematic areas that could potentially benefit from public policies effecting social inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0182-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paula Santana
- Departamento de Geografia, Centro de Estudos de Geografia e Ordenamento do Território, Universidade de Coimbra, Colégio S. Jerónimo, Largo D. Dinis, 3000-043, Coimbra, Portugal.
| | - Claudia Costa
- Departamento de Geografia, Centro de Estudos de Geografia e Ordenamento do Território, Universidade de Coimbra, Colégio S. Jerónimo, Largo D. Dinis, 3000-043, Coimbra, Portugal.
| | - Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain. .,Universitat Pompeu Fabra, Doctor Aiguader, 80, 08003, Barcelona, Spain.
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Honjo K, Iso H, Nakaya T, Hanibuchi T, Ikeda A, Inoue M, Sawada N, Tsugane S. Impact of neighborhood socioeconomic conditions on the risk of stroke in Japan. J Epidemiol 2015; 25:254-60. [PMID: 25757802 PMCID: PMC4341003 DOI: 10.2188/jea.je20140117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Neighborhood deprivation has been shown in many studies to be an influential factor in cardiovascular disease risk. However, no previous studies have examined the effect of neighborhood socioeconomic conditions on the risk of stroke in Asian countries. Methods This study investigated whether neighborhood deprivation was associated with the risk of stroke and stroke death using data from the Japan Public Health Center-based Prospective Study. We calculated the adjusted hazard ratios of stroke mortality (mean follow-up, 16.4 years) and stroke incidence (mean follow-up, 15.4 years) according to the area deprivation index (ADI) among 90 843 Japanese men and women aged 40–69 years. A Cox proportional-hazard regression model using a shared frailty model was applied. Results The adjusted hazard ratios of stroke incidence, in order of increasing deprivation with reference to the least deprived area, were 1.16 (95% CI, 1.04–1.29), 1.12 (95% CI, 1.00–1.26), 1.18 (95% CI, 1.02–1.35), and 1.19 (95% CI, 1.01–1.41), after adjustment for individual socioeconomic conditions. Behavioral and psychosocial factors attenuated the association, but the association remained significant. The associations were explained by adjusting for biological cardiovascular risk factors. No significant association with stroke mortality was identified. Conclusions Our results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke.
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Affiliation(s)
- Kaori Honjo
- Global Collaboration Center, Osaka University
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Gillespie DOS, Trotter MV, Tuljapurkar SD. Divergence in age patterns of mortality change drives international divergence in lifespan inequality. Demography 2014; 51:1003-17. [PMID: 24756909 DOI: 10.1007/s13524-014-0287-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the past six decades, lifespan inequality has varied greatly within and among countries even while life expectancy has continued to increase. How and why does mortality change generate this diversity? We derive a precise link between changes in age-specific mortality and lifespan inequality, measured as the variance of age at death. Key to this relationship is a young-old threshold age, below and above which mortality decline respectively decreases and increases lifespan inequality. First, we show for Sweden that shifts in the threshold's location have modified the correlation between changes in life expectancy and lifespan inequality over the last two centuries. Second, we analyze the post-World War II (WWII) trajectories of lifespan inequality in a set of developed countries-Japan, Canada, and the United States-where thresholds centered on retirement age. Our method reveals how divergence in the age pattern of mortality change drives international divergence in lifespan inequality. Most strikingly, early in the 1980s, mortality increases in young U.S. males led to a continuation of high lifespan inequality in the United States; in Canada, however, the decline of inequality continued. In general, our wider international comparisons show that mortality change varied most at young working ages after WWII, particularly for males. We conclude that if mortality continues to stagnate at young ages yet declines steadily at old ages, increases in lifespan inequality will become a common feature of future demographic change.
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Kano M, Hotta M, Prasad A. Inequalities in noncommunicable disease mortality in the ten largest Japanese cities. J Urban Health 2013; 90:1041-52. [PMID: 23722269 PMCID: PMC3853170 DOI: 10.1007/s11524-013-9808-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The burden of noncommunicable diseases and social inequalities in health among urban populations is becoming a common problem around the world. This phenomenon is further compounded by population aging. Japan faces the task of maintaining its high level of population health while dealing with these challenges. This study focused on the ten largest cities in Japan and, using publicly available administrative data, analyzed standardized mortality ratios to examine inequalities in relative mortality levels due to major noncommunicable disease at both city and subcity levels. On average, the ten major cities had excess mortality due to cancer and lower mortality due to heart disease and cerebrovascular disease compared to the country as a whole. Substantial inequalities in relative mortality were observed both between and within cities, especially for heart disease and cerebrovascular disease among men. Inequalities in relative mortality levels within cities appear to be increasing over time even while relative mortality levels are decreasing overall. The widely observed health inequalities signal the need for actions to ensure health equity while addressing the burden of noncommunicable diseases. Increasingly, more countries will have to deal with these challenges of inequity, urbanization, aging, and noncommunicable diseases. Local health governance informed by locally specific data on health determinants and outcomes is essential for developing contextualized interventions to improve health and health equity in major urban areas.
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Affiliation(s)
- Megumi Kano
- Centre for Health Development, World Health Organization, I.H.D. Centre Building 9F, 1-5-1 Wakinohama-Kaigandori, Chuo-ku, Kobe, 651-0073, Japan,
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Influence of Municipal- and Individual-level Socioeconomic Conditions on Mortality in Japan. Int J Behav Med 2013; 21:737-49. [DOI: 10.1007/s12529-013-9337-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rohani-Rasaf M, Moradi-Lakeh M, Ramezani R, Asadi-Lari M. Measuring socioeconomic disparities in cancer incidence in Tehran, 2008. Asian Pac J Cancer Prev 2013; 13:2955-60. [PMID: 22938489 DOI: 10.7314/apjcp.2012.13.6.2955] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health disparities exist among and within countries, while developing and low income countries suffer more. The aim of this study was to quantify cancer disparities with regard to socioeconomic position (SEP) in 22 districts of Tehran, Iran. METHOD According to the national cancer registry, 7599 new cancer cases were recorded within 22 districts of Tehran in 2008. Based on combined data from census and a population-based health equity study (Urban HEART), socioeconomic position (SEP) was calculated for each district. Index of disparity, absolute and relative concentration indices (ACI and RCI) were used for measuring disparities in cancer incidence. RESULTS The overall cancer age standardised rate (ASR) was 117.2 per 100,000 individuals (120.4 for men and 113.5 for women). Maximum ASR in both genders was seen in districts 6, 3, 1 and 2. Breast, colorectal, stomach, skin and prostate were the most common cancers. Districts with higher SEP had higher ASR (r=0.9, p<0.001). Positive ACI and RCI indicated that cancer cases accumulated in districts with high SEP. Female disparity was greater than for men in all measures. Breast, colorectal, prostate and bladder ASR ascended across SEP groups. Negative ACI and RCI in cervical and skin cancers in women indicate their aggregation in lower SEP groups. Breast cancer had the highest absolute disparities measure. CONCLUSION This report provides an appropriate guide and new evidence on disparities across geographical, demographic and particular SEP groups. Higher ASR in specific districts warrants further research to investigate the background predisposing factors.
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Affiliation(s)
- Marzieh Rohani-Rasaf
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Fujino Y, Tanaka R, Kubo T, Matsuda S. Taxation categories for long-term care insurance premiums and mortality among elderly Japanese: a cohort study. J Epidemiol 2012; 23:41-6. [PMID: 23258217 PMCID: PMC3700237 DOI: 10.2188/jea.je20120011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background This cohort study examined the association between taxation categories of long-term care insurance premiums and survival among elderly Japanese. Methods A total of 3000 participants aged 60 years or older were randomly recruited in Y City, Japan in 2002, of whom 2964 provided complete information for analysis. Information on income level, mobility status, medical status, and vital status of each participant was collected annually from 2002 to 2006. Follow-up surveys on survival were conducted until August 2007. Hazard ratios (HRs) were estimated by a Cox model, using taxation categories at baseline. In these analyses, age-adjusted and age- and mobility-adjusted models were used. Results A significantly higher mortality risk was seen only in the lowest taxation category among men: as compared with men in the second highest taxation category, the HR in the lowest category was 2.53 (95% CI, 1.26–5.08, P = 0.009). This significant association between taxation category and mortality was lost after adjustment for mobility. There was no other difference in mortality among taxation categories in men or women. Conclusions The present findings only partly supported our hypothesis that taxation category is a good indicator of socioeconomic status in examining health inequalities among elderly Japanese.
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Affiliation(s)
- Yoshihisa Fujino
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
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Social Determinants of Active Aging: Differences in Mortality and the Loss of Healthy Life between Different Income Levels among Older Japanese in the AGES Cohort Study. Curr Gerontol Geriatr Res 2012; 2012:701583. [PMID: 23028385 PMCID: PMC3458408 DOI: 10.1155/2012/701583] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/12/2012] [Indexed: 11/17/2022] Open
Abstract
We examined the relationship between income, mortality, and loss of years of healthy life in a sample of older persons in Japan. We analyzed 22,829 persons aged 65 or older who were functionally independent at baseline as a part of the Aichi Gerontological Evaluation Study (AGES). Two outcome measures were adopted, mortality and loss of healthy life. Independent variables were income level and age. The occurrence of mortality and need for care during these 1,461 days were tracked. Cox regressions were used to calculate the hazard ratio for mortality and loss of healthy life by income level. We found that people with lower incomes were more likely than those with higher incomes to report worse health. For the overall sample, using the governmental administrative data, the hazard ratios of mortality and loss of healthy life-years comparing the lowest to the highest income level were 3.50 for men and 2.48 for women for mortality and 3.71 for men and 2.27 for women for loss of healthy life. When only those who responded to questions about income on the mail survey were included in the analysis, the relationships became weaker and lost statistical significance.
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Geographic inequalities in all-cause mortality in Japan: compositional or contextual? PLoS One 2012; 7:e39876. [PMID: 22761918 PMCID: PMC3384616 DOI: 10.1371/journal.pone.0039876] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/28/2012] [Indexed: 11/19/2022] Open
Abstract
Background A recent study from Japan suggested that geographic inequalities in all-cause premature adult mortality have increased since 1995 in both sexes even after adjusting for individual age and occupation in 47 prefectures. Such variations can arise from compositional effects as well as contextual effects. In this study, we sought to further examine the emerging geographic inequalities in all-cause mortality, by exploring the relative contribution of composition and context in each prefecture. Methods We used the 2005 vital statistics and census data among those aged 25 or older. The total number of decedents was 524,785 men and 455,863 women. We estimated gender-specific two-level logistic regression to model mortality risk as a function of age, occupation, and residence in 47 prefectures. Prefecture-level variance was used as an estimate of geographic inequalities in mortality, and prefectures were ranked by odds ratios (ORs), with the reference being the grand mean of all prefectures (value = 1). Results Overall, the degree of geographic inequalities was more pronounced when we did not account for the composition (i.e., age and occupation) in each prefecture. Even after adjusting for the composition, however, substantial differences remained in mortality risk across prefectures with ORs ranging from 0.870 (Okinawa) to 1.190 (Aomori) for men and from 0.864 (Shimane) to 1.132 (Aichi) for women. In some prefectures (e.g., Aomori), adjustment for composition showed little change in ORs, while we observed substantial attenuation in ORs in other prefectures (e.g., Akita). We also observed qualitative changes in some prefectures (e.g., Tokyo). No clear associations were observed between prefecture-level socioeconomic status variables and the risk of mortality in either sex. Conclusions Geographic disparities in mortality across prefectures are quite substantial and cannot be fully explained by differences in population composition. The relative contribution of composition and context to health inequalities considerably vary across prefectures.
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Fukuda Y, Hiyoshi A. Association of income with symptoms, morbidities and healthcare usage among Japanese adults. Environ Health Prev Med 2011; 17:299-306. [PMID: 22180347 DOI: 10.1007/s12199-011-0254-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 11/23/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Socioeconomic inequalities in healthcare services are major public health and healthcare concerns. We have examined the association of income with symptoms, morbidities and healthcare usage in a national sample of the Japanese population. METHODS For this study, data compiled on 21,929 men and 24,620 women from the Comprehensive Survey of the Living Conditions of People on Health and Welfare in 2007 were assessed. Among the survey respondents with symptoms, we compared the prevalences of symptoms and treatments and the number of respondents who received treatments for 16 groups of symptoms and disorders according to household income, from the highest to the lowest, using the relative index of inequalities (RII). The RIIs were computed by age groups [25-59 years (young group) and 60+ years (senior group)]. RESULTS People with lower incomes had higher prevalences of symptoms and treatments for most of the disorders examined. The RIIs of symptoms and treatments were 1.19 [95% confidence interval (CI) 1.09-1.31] and 1.04 (95% CI 0.93-1.16) for the young group and 1.69 (1.53-1.87) and 1.51 (1.36-1.67) for the senior group, respectively. In terms of treatment prevalence among those with symptoms, the RII was not significantly lower than 1.0 except for a few disorders in the young group. CONCLUSIONS Our results indicate that income inequalities can be related to the prevalences of various symptoms and morbidities in our Japanese sample population and that these inequalities were greater in the senior group than in the young group. Our results also suggest that lower income is not a substantial barrier to the use of healthcare services by older Japanese individuals, while it is related to lower healthcare usage by individuals of working age.
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Affiliation(s)
- Yoshiharu Fukuda
- Department of Community Health and Medicine, Yamaguchi University School of Medicine, 1-1-1 Minami Kogushi, Ube, Yamaguchi 755-8505, Japan.
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Murayama H, Taguchi A, Murashima S. Does Similarity in Educational Level Between Health Promotion Volunteers and Local Residents Affect Activity Involvement of the Volunteers? Public Health Nurs 2011; 29:36-43. [DOI: 10.1111/j.1525-1446.2011.00965.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brownell MD, Derksen SA, Jutte DP, Roos NP, Ekuma O, Yallop L. Socio-economic inequities in children's injury rates: has the gradient changed over time? CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2010; 101 Suppl 3:S28-S31. [PMID: 21416816 PMCID: PMC6973951 DOI: 10.1007/bf03405575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Changing socio-economic gradients in adult health over time have been documented, but little research has investigated temporal changes in child health gradients. Childhood hospitalizations for injury have fallen over the last two decades; whether the socio-economic gradient in childhood injury has changed is unknown. METHODS Population-based hospital discharge data were used to calculate rates of hospitalization for injury from 1986/87 through 2005/06 for all children under 20 years of age in Manitoba (average yearly number of hospitalizations = 326,357). Information on socio-economic status (SES) came from area-level census data and was assigned by residential postal codes. Generalized linear models with generalized estimating equations were employed to describe the relation between SES and injury rates and whether this relation changed over time. All-cause injuries were examined as well as injuries for motor vehicle collisions (MVCs), other vehicle injuries, self-inflicted injuries, assault, poisoning, injuries caused by machinery, sports injuries and falls. RESULTS Injury hospitalizations for children decreased steadily over the study period, from 1.07% to 0.51%. SES significantly predicted injury hospitalizations (p < 0.0001), children with lower SES showing higher rates. A significant SES by year interaction (p < 0.0001) indicated that the SES gradient for injury hospitalizations increased over time. Analysis by type of injury found a significant SES by year interaction for MVCs, self-inflicted injuries and falls; for MVCs and self-inflicted injuries the pattern (increasing SES gradient) was similar to that of hospitalization for all-cause injury. The pattern for falls was inconsistent. CONCLUSION Despite the overall drop in injury hospitalizations over time, the SES gradient in hospitalized injury rates has increased.
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Affiliation(s)
- Marni D Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
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Koh HK, Oppenheimer SC, Massin-Short SB, Emmons KM, Geller AC, Viswanath K. Translating research evidence into practice to reduce health disparities: a social determinants approach. Am J Public Health 2010; 100 Suppl 1:S72-80. [PMID: 20147686 PMCID: PMC2837437 DOI: 10.2105/ajph.2009.167353] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2009] [Indexed: 11/04/2022]
Abstract
Translating research evidence to reduce health disparities has emerged as a global priority. The 2008 World Health Organization Commission on Social Determinants of Health recently urged that gaps in health attributable to political, social, and economic factors should be closed in a generation. Achieving this goal requires a social determinants approach to create public health systems that translate efficacy documented by research into effectiveness in the community. We review the scope, definitions, and framing of health disparities and explore local, national, and global programs that address specific health disparities. Such efforts translate research evidence into real-world settings and harness collaborative social action for broad-scale, sustainable change.
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Affiliation(s)
- Howard K Koh
- Division of Public Health Practice, Harvard School of Public Health, Boston, MA 02115, USA
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Chen F, Yang Y, Liu G. Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis. AMERICAN SOCIOLOGICAL REVIEW 2010; 75:126-150. [PMID: 20379373 PMCID: PMC2850448 DOI: 10.1177/0003122409359165] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This article examines social stratification in individual health trajectories for multiple cohorts in the context of China's dramatically changing macro-social environment. Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities in the mean levels of health and health trajectories. The effect of education on health slightly decreases across successive cohorts. By contrast, the income gap in health trajectories diverges for earlier cohorts but converges for most recent cohorts. Both effects are more pronounced in rural areas. Given that these cohort effects are opposite those reported in recent U.S. studies, we discuss China's unique social, economic, and political settings. We highlight the association between SES and health behaviors, China's stage of epidemiologic transition, and the changing power of the state government and its implications for health care.
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Murakami K, Sasaki S, Takahashi Y, Uenishi K. Neighborhood socioeconomic status in relation to dietary intake and insulin resistance syndrome in female Japanese dietetic students. Nutrition 2010; 26:508-14. [PMID: 20060264 DOI: 10.1016/j.nut.2009.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/13/2009] [Accepted: 08/17/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An increasing number of studies in Western countries have shown that living in a socioeconomically disadvantaged neighborhood is associated with unfavorable dietary intake patterns and health status. However, information on such neighborhood socioeconomic differences in diet and health among different cultural settings, including Japan, is limited. This cross-sectional study examined the association of neighborhood socioeconomic status (SES) with dietary intake and a summary score of the insulin resistance syndrome (IRS) in a group of young Japanese women. METHODS Subjects were 1081 female Japanese dietetic students aged 18 to 22 y residing in 295 municipalities in Japan. Neighborhood SES index was defined by seven municipal-level variables, namely unemployment, household overcrowding, poverty, education, income, home ownership, and vulnerable group, with an increasing index signifying increasing neighborhood socioeconomic disadvantage. Dietary intake was estimated using a validated, comprehensive self-administered diet-history questionnaire. Measurements of body mass index, systolic blood pressure, fasting high-density lipoprotein cholesterol, triacylglycerol, glucose, and insulin were combined into an IRS score, with an increasing score signifying increasing levels of components of the IRS. RESULTS Neighborhood SES index was not associated with most of the dietary variables, body mass index, high-density lipoprotein cholesterol, triacylglycerol, or glucose. However, neighborhood SES index was significantly positively associated with systolic blood pressure, insulin, and IRS score, after adjustment for potential confounding or mediating factors, including household SES, dietary, and lifestyle factors. CONCLUSION Neighborhood socioeconomic disadvantage was associated with unfavorable profiles of the IRS score, but not dietary intake, in a group of young Japanese women.
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Affiliation(s)
- Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, the University of Tokyo, Tokyo, Japan
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Neighborhood Socioeconomic Disadvantage Is Associated with Higher Ratio of 24-Hour Urinary Sodium to Potassium in Young Japanese Women. ACTA ACUST UNITED AC 2009; 109:1606-11. [DOI: 10.1016/j.jada.2009.06.391] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/10/2009] [Indexed: 01/03/2023]
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Murakami K, Sasaki S, Okubo H, Takahashi Y. Neighborhood socioeconomic status in relation to dietary intake and body mass index in female Japanese dietetic students. Nutrition 2009; 25:745-52. [DOI: 10.1016/j.nut.2009.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 01/19/2009] [Accepted: 01/21/2009] [Indexed: 01/02/2023]
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Kagamimori S, Gaina A, Nasermoaddeli A. Socioeconomic status and health in the Japanese population. Soc Sci Med 2009; 68:2152-60. [DOI: 10.1016/j.socscimed.2009.03.030] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Indexed: 10/20/2022]
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Rey G, Jougla E, Fouillet A, Hémon D. Ecological association between a deprivation index and mortality in France over the period 1997 - 2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death. BMC Public Health 2009; 9:33. [PMID: 19161613 PMCID: PMC2637240 DOI: 10.1186/1471-2458-9-33] [Citation(s) in RCA: 318] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 01/22/2009] [Indexed: 11/29/2022] Open
Abstract
Background Spatial health inequalities have often been analysed in terms of deprivation. The aim of this study was to create an ecological deprivation index and evaluate its association with mortality over the entire mainland France territory. More specifically, the variations with the degree of urbanicity, spatial scale, age, gender and cause of death, which influence the association between mortality and deprivation, have been described. Methods The deprivation index, 'FDep99', was developed at the 'commune'(smallest administrative unit in France) level as the first component of a principal component analysis of four socioeconomic variables. Proxies of the Carstairs and Townsend indices were calculated for comparison. The spatial association between FDep99 and mortality was studied using five different spatial scales, and by degree of urbanicity (five urban unit categories), age, gender and cause of death, over the period 1997–2001. 'Avoidable' causes of death were also considered for subjects aged less than 65 years. They were defined as causes related to risk behaviour and primary prevention (alcohol, smoking, accidents). Results The association between the FDep99 index and mortality was positive and quasi-log-linear, for all geographic scales. The standardized mortality ratio (SMR) was 24% higher for the communes of the most deprived quintile than for those of the least deprived quintile. The between-urban unit category and between-région heterogeneities of the log-linear associations were not statistically significant. The association was positive for all the categories studied and was significantly greater for subjects aged less than 65 years, for men, and for 'avoidable' mortality. The amplitude and regularity of the associations between mortality and the Townsend and Carstairs indices were lower. Conclusion The deprivation index proposed reflects a major part of spatial socioeconomic heterogeneity, in a homogeneous manner over the whole country. The index may be routinely used by healthcare authorities to observe, analyse, and manage spatial health inequalities.
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Reynolds SL, Hagedorn A, Yeom J, Saito Y, Yokoyama E, Crimmins EM. A tale of two countries--the United States and Japan: are differences in health due to differences in overweight? J Epidemiol 2008; 18:280-90. [PMID: 19057112 PMCID: PMC3013295 DOI: 10.2188/jea.je2008012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Despite similar standards of living and health care systems for older persons, there are marked differences in the relative health of the elderly populations in the United States (US) and Japan. We explore the association of overweight and obesity with these health disparities. Methods Data on older adults from the US National Health Interview Survey (1994) and the Longitudinal Study of Aging II (1994) were compared to similar data from the 1999-2001 Nihon University Japanese Longitudinal Study of Aging. Regression analyses for the 2 countries were conducted to examine the correlates of being overweight and obese, and the relationships of overweight and obesity with activities of daily living functioning, heart disease, arthritis, and diabetes. Results The prevalence of overweight and obesity is higher in the US than in Japan, as is the prevalence of heart disease, diabetes, arthritis, and functioning problems. Education level and marital status are predictors of overweight for older Americans but not for older Japanese people. Health behaviors affect weight in all groups. The prevalence of functioning problems and disease are more likely to be associated with being overweight in US men and women than in Japanese women, and are not associated with being overweight in Japanese men. Conclusion Despite similar standards of living and health care systems for older persons, the conditions associated with poor health differ in the US and Japan. Being overweight or obese appears to be related to more functioning problems and arthritis in the US than in Japan.
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Affiliation(s)
- Sandra L Reynolds
- School of Aging Studies, University of South Florida, Tampa, FL 33620, USA.
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Abstract
Inequality in health has long been a topic of discussion. The purpose of this research was to provide estimates of the proportions of elderly who had difficulties in activities of daily living in each of the 23 administrative areas of Taiwan, and to assess if there was geographical disparity in disability across areas. A nationally representative sample of 303,545 subjects was selected for interview. Among the subjects selected for interview, 239,861 completed the survey, a completion rate of about 80%. For the purpose of this research, only those aged 65 years or older were included (N = 114,873) in the analyses. Non-standardized and standardized prevalences of disability were presented for each of the 23 administrative areas in Taiwan, and geographical distribution of elderly disability was plotted. Results show that significant difference in disability prevalence exists among administrative districts, even after adjusting for age and sex structure of the population. Moreover, the extent of gender disparity also varied from one area to another. The western region, in general, had lower disability prevalence than the eastern region. Findings imply that since disability prevalence varied significantly across administrative areas, funding for long-term care should not be allocated based on the number of elderly population in an administrative area. Areas with high prevalence should identify reasons for their high prevalence rates and implement proper interventions.
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Tobiasz-Adamczyk B, Brzyski P, Kopacz MS. Health Attitudes and Behaviour as Predictors of Self-rated Health in Relation to Mortality Patterns (17-year Follow-up in a Polish Elderly Population - Cracow Study). Cent Eur J Public Health 2008; 16:47-53. [DOI: 10.21101/cejph.a3458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Felícitas Domínguez-Berjón M, Borrell C, Cano-Serral G, Esnaola S, Nolasco A, Isabel Pasarín M, Ramis R, Saurina C, Escolar-Pujolar A. Construcción de un índice de privación a partir de datos censales en grandes ciudades españolas (Proyecto MEDEA). GACETA SANITARIA 2008; 22:179-87. [DOI: 10.1157/13123961] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tang KK, Petrie D, Rao DSP. Measuring health inequalities between genders and age groups with realization of potential life years (RePLY). Bull World Health Organ 2008; 85:681-7. [PMID: 18026624 DOI: 10.2471/blt.06.037382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Accepted: 03/14/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We propose a new method to measure health inequalities caused by conditions amenable to policy intervention and use this to identify health differences between sexes and age groups. METHODS The lowest observed mortality rates are used as a proxy of unavoidable mortality risks to develop a new measure of health outcome - realization of potential life years (RePLY). The RePLY distribution is used to measure avoidable health inequalities between sex and age groups respectively. FINDINGS Using RePLY we find that even those countries with very high life expectancy at birth can have substantial health inequalities across different age groups. Also, gender inequality is more pronounced among those aged < 30. Among countries with a life expectancy < 60 years, there is a much larger prevalence of gender inequality against females; countries with life expectancy > 60 years have comparable numbers of cases of inequality among females and males. Finally, high avoidable health inequality is associated with low average income, high income inequality and high population fractionalization. CONCLUSION It is important to distinguish between unavoidable and avoidable mortality when measuring health outcomes and their distribution in society. The proposed new measure (RePLY) enables policy-makers to focus on age-sex groups with low realization of potential life years and thus high avoidable mortality risks.
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Affiliation(s)
- Kam Ki Tang
- School of Economics, University of Queensland, Brisbane, Queensland 4072, Australia.
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Karpati AM, Bassett MT, McCord C. Neighbourhood mortality inequalities in New York City, 1989-1991 and 1999-2001. J Epidemiol Community Health 2007; 60:1060-4. [PMID: 17108302 PMCID: PMC2465510 DOI: 10.1136/jech.2006.047100] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine whether inequalities in mortality across socioeconomically diverse neighbourhoods changed alongside the decline in mortality observed in New York City between 1990 and 2000. DESIGN Cross-sectional analysis of neighbourhood-level vital statistics. SETTING New York City, 1989-1991 and 1999-2001. MAIN RESULTS In both poor and wealthy neighbourhoods, age-adjusted mortality for most causes declined between the time periods, although mortality from diabetes increased. Relative inequalities decreased slightly-largely in the under 65 years population-although all-cause rates in 1999-2001 were still 50% higher, and rates of years of potential life lost before age 65 years were 150% higher, in the poorest communities than in the wealthiest ones (relative index of inequality 1.7 and 3.3, respectively). The relative index of inequality for mortality from AIDS increased from 4.7 to 13.9. Over 50% of the excess mortality in the poorest neighbourhoods in 1999-2001 was due to cardiovascular disease, AIDS and cancer. CONCLUSIONS In New York City, despite substantial declines in absolute mortality and rate differences between poor and wealthy neighbourhoods, great relative socioeconomic inequalities in mortality persist.
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Affiliation(s)
- Adam M Karpati
- New York City Department of Health and Mental Hygiene, Brooklyn District Public Health Office, 485 Throop Avenue, Brooklyn, NY 11221, USA.
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Kim MH, Subramanian SV, Kawachi I, Kim CY. Association between childhood fatal injuries and socioeconomic position at individual and area levels: a multilevel study. J Epidemiol Community Health 2007; 61:135-40. [PMID: 17234872 PMCID: PMC2465637 DOI: 10.1136/jech.2006.047738] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To simultaneously examine the effects of area-level and individual-level socioeconomic position on fatal injuries in children <5 years of age. METHODS A retrospective cohort study based on the national birth and death registers of Korea. 2 667 060 children born during 1995-8 were followed up from birth to the 5th birthday. Cumulative incidences of fatal injuries were calculated, and through multilevel Poisson regression models, relative risks (RRs) of incidence rate were estimated according to children's sex, father's occupation and mother's education at individual level, and deprivation and degree of urbanity at area level. RESULTS Girls had lower risk for fatal injuries than boys (RR 0.81; 95% confidence interval (CI) 0.75 to 0.87). Compared with children with fathers in non-manual occupations, those with fathers in manual (RR 1.45; 95% CI 1.34 to 1.58) or other occupations (RR 1.35; 95% CI 1.13 to 1.62) had higher risk. Children with mothers who were high school graduates (RR 1.23; 95% CI 1.12 to 1.36) or junior school graduates (RR 1.91; 95% CI 1.66 to 2.19) had higher risk than those whose mothers were college graduates. After controlling for individual-level variables, residence in more deprived districts (RR 1.13; 95% CI 1.05 to 1.21) or non-metropolitan regions (urban RR 1.34; 95% CI 1.22 to 1.47 and rural RR 1.61; 95% CI 1.40 to 1.86) was significantly associated with increased risk. CONCLUSIONS Both individual-level and area-level socioeconomic position influenced the risk for childhood fatal injuries. To reduce the socioeconomic inequalities and the absolute burden in Korea, universal strategies should receive priority, and special efforts in implementation should be directed towards both disadvantaged households and areas.
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Affiliation(s)
- Myoung-Hee Kim
- Department of Preventive Medicine, Eulji University School of Medicine, South Korea
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Fukuda Y, Nakamura K, Takano T. Higher mortality in areas of lower socioeconomic position measured by a single index of deprivation in Japan. Public Health 2007; 121:163-73. [PMID: 17222876 DOI: 10.1016/j.puhe.2006.10.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 09/04/2006] [Accepted: 10/02/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To formulate an index representing area deprivation and elucidate the relation between the index and mortality in Japan. STUDY DESIGN Ecological study for prefectures (N=47) and municipalities (N=3366) across Japan. METHODS Based on socioeconomic indicators of seven domains of deprivation (i.e. unemployment, overcrowding, low social class and poverty, low education, no home ownership, low income and vulnerable group), an index was formulated using the z-scoring method. The relation between the index and mortality was examined by correlation analysis, hierarchical Poisson regression and comparison of standardized mortality ratio according to the index. RESULTS The deprivation index ranged from -7.48 to 10.98 for prefectures and from -16.97 to 13.82 for municipalities. The index was significantly positively correlated with prefectural mortality, especially in the population aged under 74 years: r=0.65 for men and r=0.41 for women. At the municipal level, hierarchical Poisson regression showed a significant positive coefficient of the index to mortality for both men and women, and excess mortality in the most deprived fifth compared to the least deprived fifth was 26.4% in men and 11.8% in women. CONCLUSIONS We formulated a deprivation index, which was substantially related to mortality at the prefectural and municipal levels. This study highlights the higher risk of dying among populations in socially disadvantaged areas and encourages the use of indices representing area socioeconomic conditions for further studies of area effects on health.
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Affiliation(s)
- Yoshiharu Fukuda
- Health Promotion/International Health and Medicine, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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Choi YJ, Jeong BG, Cho SI, Jung-Choi K, Jang SN, Kang M, Khang YH. A Review on Socioeconomic Position Indicators in Health Inequality Research. J Prev Med Public Health 2007; 40:475-86. [DOI: 10.3961/jpmph.2007.40.6.475] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yong-Jun Choi
- Department of Social and Preventive Medicine, College of Medicine, Health Services Research Center, Hallym University, Korea
| | - Baek-Geun Jeong
- Department of Preventive Medicine, Institute of Health Science, Gyeongsang National University, Korea
| | - Sung-Il Cho
- School of Public Health, Seoul National University, Korea
| | - Kyunghee Jung-Choi
- Division of Occupational and Environmental Medicine, KyungHee University Medical Center, Korea
| | - Soong-Nang Jang
- Institute of Health and Environment, Seoul National University, Korea
| | - Minah Kang
- Department of Public Administration, College of Social Sciences, Ewha Womans University, Korea
| | - Young-Ho Khang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Korea
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Kim Y, Joh S. A vulnerability study of the low-income elderly in the context of high temperature and mortality in Seoul, Korea. THE SCIENCE OF THE TOTAL ENVIRONMENT 2006; 371:82-8. [PMID: 17007909 DOI: 10.1016/j.scitotenv.2006.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 07/21/2006] [Accepted: 08/09/2006] [Indexed: 05/12/2023]
Abstract
INTRODUCTION We investigated the impact of environmental high temperature on mortality in Seoul, Korea, and the consequences of high temperature-induced mortality with a focus on the low-income elderly. METHODS Changes in the risk of death by age and income were estimated by a 1 degrees C increase in temperature using a generalized additive model adjusting for non-temperature related factors: time trends, seasonality, and air pollution. The study covered the years of 2000, 2001, and 2002. RESULTS We found that income and age were potential factors in high-temperature-induced excess mortality. Evidences to support these results are as follows: first, regarding the effect of an economic factor in the association between mortality and high temperature, the study shows that the mortality rate of the low-income group is higher, by as much as 1.3- to 1.7-fold, than that of the general population. Second, taking age into consideration, the mortality of low-income elderly people is 1.5-fold higher than that of the whole low-income group. The combined effect of income and age on mortality is estimated as 2.3-fold higher than that of the general population. But the results of the low-income and elderly group were not statistically significant due to wide standard deviation. CONCLUSIONS The relationship between high-temperature-induced excess mortality, income, and age suggests the need for a public health message, yet many results were not statistically significant: preventive and health care interventions need to be administered to the elderly and low-income group during periods of high temperature.
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Affiliation(s)
- Youngmin Kim
- Graduate School of Environmental Studies Seoul National University, San 56-1, Shillim-dong, Kwanak-Ku, Seoul 151-742, South Korea.
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Cesaroni G, Agabiti N, Forastiere F, Ancona C, Perucci CA. Socioeconomic differentials in premature mortality in Rome: changes from 1990 to 2001. BMC Public Health 2006; 6:270. [PMID: 17081291 PMCID: PMC1647282 DOI: 10.1186/1471-2458-6-270] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 11/02/2006] [Indexed: 11/28/2022] Open
Abstract
Background While socioeconomic inequalities in mortality have widened in many countries, evidence of social differentials is scarce in Southern Europe. We studied temporal changes in premature mortality across socioeconomic groups in Rome between 1990 and 2001. Methods We analysed all 126,511 death certificates of residents of Rome aged 0–74 years registered between 1990–2001. A 4-level census block index based on the 1991 census was used as an indicator of socioeconomic position (SEP). Using routine mortality data, standardised mortality rates (per 100,000 inhabitants) were calculated by SEP and gender for four time periods. Rate ratios were used to compare mortality by gender and age. Results Overall premature mortality decreased in both genders and in all socioeconomic groups; the change was greater in the highest socio-economic group. In both men and women, inequalities in mortality strengthened during the 1990s and appeared to stabilise at the end of the 20th century. However, for 60–74 year old women the gap continued to widen. Conclusion Socioeconomic inequalities in health in Rome are still present at the beginning of the 21st century. Strategies to monitor the impact of SEP on mortality over time in different populations should be implemented to direct health policies.
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Affiliation(s)
- Giulia Cesaroni
- Department of Epidemiology, Rome E Health Authority, Via Santa Costanza 53, Rome 00198, Italy
| | - Nera Agabiti
- Department of Epidemiology, Rome E Health Authority, Via Santa Costanza 53, Rome 00198, Italy
| | - Francesco Forastiere
- Department of Epidemiology, Rome E Health Authority, Via Santa Costanza 53, Rome 00198, Italy
| | - Carla Ancona
- Department of Epidemiology, Rome E Health Authority, Via Santa Costanza 53, Rome 00198, Italy
| | - Carlo A Perucci
- Department of Epidemiology, Rome E Health Authority, Via Santa Costanza 53, Rome 00198, Italy
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Murata C, Kondo T, Tamakoshi K, Yatsuya H, Toyoshima H. Determinants of self-rated health: Could health status explain the association between self-rated health and mortality? Arch Gerontol Geriatr 2006; 43:369-80. [PMID: 16530864 DOI: 10.1016/j.archger.2006.01.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 01/23/2006] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate factors related to self-rated health and to mortality among 2490 community-living elderly. Respondents were followed for 7.3 years for all-cause mortality. To compare the relative impact of each variable, we employed logistic regression analysis for self-rated health and Cox hazard analysis for mortality. Cox analysis stratified by gender, follow-up periods, age group, and functional status was also employed. Series of analysis found that factors associated with self-rated health and with mortality were not identical. Psychological factors such as perceived isolation at home or 'ikigai (one aspect of psychological well-being)' were associated with self-rated health only. Age, functional status, and social relations were associated both with self-rated health and mortality after controlling for possible confounders. Illnesses and functional status accounted for 35-40% of variances in the fair/poor self-rated health. Differences by gender and functional status were observed in the factors related to self-rated health. Overall, self-rated health effect on mortality was stronger for people with no functional impairment, for shorter follow-up period, and for young-old age group. Although, illnesses and functional status were major determinants of self-rated health, economical, psychological, and social factors were also related to self-rated health.
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Affiliation(s)
- Chiyoe Murata
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan.
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Hirokawa K, Tsutusmi A, Kayaba K. Impacts of educational level and employment status on mortality for Japanese women and men: the Jichi Medical School cohort study. Eur J Epidemiol 2006; 21:641-51. [PMID: 17048083 DOI: 10.1007/s10654-006-9049-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 08/08/2006] [Indexed: 10/24/2022]
Abstract
The objective of this study was to examine educational levels and employment status as independent determinants of overall and cause-specific mortality in a Japanese population. Participants were 4,301 men and 6,780 women in a multi-center community-based prospective study, and data of the baseline survey was collected between 1992 and 1995. The participants were followed up until December 31, 2002 (the average follow-up period was 9.17 years). Early termination of education was associated with an increased risk of mortality from all causes for both men and women. This tendency was more prominent in women aged 59 and younger (hazard ratio (HR) = 3.82, 95% confidence interval (CI): 1.18-12.34), after adjusting for confounding factors using the Cox proportional hazard models. Similar trends were shown for men; specifically, cardiovascular disease mortality for all men was increased by early termination of education (HR = 2.97, 95% CI: 1.17-7.52) compared to later termination. For employment status, unemployed men showed increased mortality from all causes compared to white-collar workers (HR = 1.51, 95% CI: 1.00-2.28). Female farmers and forestry workers showed reduced mortality from all causes compared to white-collar workers (HR = 0.55, 95% CI: 0.33-0.93). Male farmers and forestry workers also showed reduced mortality from cardiovascular diseases compared to white-collar workers (HR = 0.34, 95% CI: 0.14-0.82). Educational level and employment status may affect mortality for Japanese women and men.
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Affiliation(s)
- Kumi Hirokawa
- Hygiene and Preventive Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, 700-8558, Japan.
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Kurimori S, Fukuda Y, Nakamura K, Watanabe M, Takano T. Calculation of prefectural disability-adjusted life expectancy (DALE) using long-term care prevalence and its socioeconomic correlates in Japan. Health Policy 2006; 76:346-58. [PMID: 16061303 DOI: 10.1016/j.healthpol.2005.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Accepted: 06/26/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were: (1) to determine the disability weight, "utility", for calculation of disability-adjusted life expectancy (DALE) using the prevalence of long-term care; (2) to calculate prefectural DALE; and (3) to clarify the relation between DALE and area socioeconomic conditions in Japan. METHODS Disability utility by care level (support and levels I-V) of long-term care insurance was determined by a survey of 236 professionals with four standard utility measures: EuroQol-5D, time trade-off, standard gamble, and visual analogue scale. DALE at age 65 (DALE65) and age-adjusted weighted disability prevalence (WDP) of 47 prefectures were calculated using the determined utilities, prevalence of long-term care, and life tables. The relationships of DALE and WDP to mortality from major causes and socioeconomic indicators were examined by correlation analysis. RESULTS The determined utilities were: support, 0.78; level I, 0.68; level II, 0.64; level III, 0.44; level IV, 0.34; and level V, 0.21. The prefectural DALE65 ranged from 17.11 to 15.29 years for men and from 20.21 to 18.42 years for women. Strong correlations were found between DALE65 and mortality for both sexes. Male DALE65 was correlated with no socioeconomic indicators, while female DALE65 was correlated with some indicators. WDP was positively associated with indicators representing socioeconomic disadvantage, such as unemployment rate and percentage of elderly single households. CONCLUSIONS The socioeconomic correlates of DALE and WDP suggested that favorable socioeconomic policies, in addition to a decrease in mortality from major causes, will contribute to significant extension of the independence period in the elderly. The method proposed here encourages the practical use of health expectancy in health policy, especially at local and regional levels.
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Affiliation(s)
- Sugako Kurimori
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Fukuda Y, Nakamura K, Takano T. Municipal health expectancy in Japan: decreased healthy longevity of older people in socioeconomically disadvantaged areas. BMC Public Health 2005; 5:65. [PMID: 15955249 PMCID: PMC1177965 DOI: 10.1186/1471-2458-5-65] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 06/14/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about small-area variation in healthy longevity of older people and its socioeconomic correlates. This study aimed to estimate health expectancy at 65 years (HE65) at the municipal level in Japan, and to examine its relation to area socio-demographic conditions. METHODS HE65 of municipalities (N = 3361) across Japan was estimated by a linear regression formula with life expectancy at 65 years and the prevalence of those certificated as needing nursing care. The relation between HE65 and area socio-demographic indicators was examined using correlation coefficients. RESULTS The estimated HE65 (years) ranged from 13.13 to 17.39 for men and from 14.84 to 20.53 for women. HE65 was significantly positively correlated with the proportion of elderly and per capita income, and negatively correlated with the percentage of households of a single elderly person, divorce rate, and unemployment rate. These relations were stronger in large municipalities (with a population of more than 100,000) than in small and medium-size municipalities. CONCLUSION A decrease in healthy longevity of older people was associated with a higher percentage of households of a single elderly person and divorce rate, and lower socioeconomic conditions. This study suggests that older people in urban areas are susceptible to socio-demographic factors, and a social support network for older people living in socioeconomically disadvantaged conditions should be encouraged.
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Affiliation(s)
- Yoshiharu Fukuda
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Keiko Nakamura
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takehito Takano
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Fukuda Y, Umezaki M, Nakamura K, Takano T. Variations in societal characteristics of spatial disease clusters: examples of colon, lung and breast cancer in Japan. Int J Health Geogr 2005; 4:16. [PMID: 15953394 PMCID: PMC1177982 DOI: 10.1186/1476-072x-4-16] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 06/14/2005] [Indexed: 11/21/2022] Open
Abstract
Background Spatial analyses and ecological studies are essential for epidemiology and public health. The present study combining these two methods was performed to identify spatial clusters of selected types of cancer in Japan and to determine their societal characteristics focusing on homogeneity among clusters. Results Spatial clusters of high mortality rates of male colon and lung cancer and of female breast cancer were identified by the spatial scan statistic using Japanese municipal data (N = 3360) from 1993 to 1998 and also municipalities were divided into four societal clusters based on socioeconomic indicators and population density (urban-rich, suburban, rural-poor, and clutter). Five, seven, and four mortality clusters were identified for lung, colon and breast cancer, respectively. For colon and breast cancer, most municipalities of all except one cluster were included in a single societal cluster (urban-rich). The municipalities associated with mortality clusters for lung cancer belonged to various societal clusters. Conclusion Increased mortality rates of colon and breast cancer can be explained by homogenous societal characteristics related to urbanisation, although there were exceptional areas with higher mortality rates. The regional variation in lung cancer mortality rate appeared to be due to heterogeneous factors. These findings and the analysis performed in the present study will contribute to both nationwide and region-specific cancer prevention strategies.
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Affiliation(s)
- Yoshiharu Fukuda
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan
| | - Masahiro Umezaki
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan
| | - Keiko Nakamura
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan
| | - Takehito Takano
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan
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Fukuda Y, Nakamura K, Takano T. Accumulation of health risk behaviours is associated with lower socioeconomic status and women's urban residence: a multilevel analysis in Japan. BMC Public Health 2005; 5:53. [PMID: 15921512 PMCID: PMC1174875 DOI: 10.1186/1471-2458-5-53] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 05/27/2005] [Indexed: 01/17/2023] Open
Abstract
Background Little is known about the socioeconomic differences in health-related behaviours in Japan. The present study was performed to elucidate the effects of individual and regional socioeconomic factors on selected health risk behaviours among Japanese adults, with a particular focus on regional variations. Methods In a nationally representative sample aged 25 to 59 years old (20,030 men and 21,076 women), the relationships between six risk behaviours (i.e., current smoking, excessive alcohol consumption, poor dietary habits, physical inactivity, stress and non-attendance of health check-ups), individual characteristics (i.e., age, marital status, occupation and household income) and regional (N = 60) indicators (per capita income and unemployment rate) were examined by multilevel analysis. Results Divorce, employment in women, lower occupational class and lower household income were generally associated with a higher likelihood of risk behaviour. The degrees of regional variation in risk behaviour and the influence of regional indicators were greater in women than in men: higher per capita income was significantly associated with current smoking, excessive alcohol consumption, stress and non-attendance of health check-ups in women. Conclusion Individual lower socioeconomic status was a substantial predictor of risk behaviour in both sexes, while a marked regional influence was observed only in women. The accumulation of risk behaviours in individuals with lower socioeconomic status and in women in areas with higher income, reflecting an urban context, may contribute to their higher mortality rates.
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Affiliation(s)
- Yoshiharu Fukuda
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Keiko Nakamura
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takehito Takano
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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