Socioeconomic status and self-reported health among middle-aged Japanese men: results from a nationwide longitudinal study

Post-injury long-term sickness absence and risk of disability pension: The role of socioeconomic status

INTRODUCTION

Previous research has identified low socioeconomic status (SES) as a risk factor for long-term sickness absence (LTSA) and disability pension (DP) following trauma. However, most studies lack information on medical diagnoses, limiting our understanding of the underlying factors. To address this gap, we retrieved information about diagnostic causes for receipt of welfare benefits to explore the role of SES in the transition from post-injury LTSA to permanent DP among the working population in Norway.

MATERIALS AND METHODS

We conducted a population-based cohort study of all Norwegian residents aged 25-59 years registered with a spell of LTSA due to injury commencing in the period 2000-2003. This cohort was followed through 2014 by linking information on receipt of welfare benefits with sociodemographic data from administrative registers. SES was defined as a composite measure of educational attainment and income level. We used flexible parametric survival models to estimate hazard ratios (HR) with 95 % confidence intervals (CI) for all-cause and diagnosis-specific DP according to SES, adjusting for sex, age, marital status, immigrant status and healthcare region of residence.

RESULTS

Of 53,937 adults with post-injury LTSA, 9,665 (18 %) transferred to DP during follow-up. The crude risk of DP was highest for LTSA spells due to poisoning and head injuries. Overall, individuals in the lowest SES category had twice the risk of DP compared to those in the highest SES category (HR = 2.25, 95 % CI 2.13-2.38). The difference by SES was greatest for LTSA due to poisoning and smallest for LTSA due to head injuries. A majority (75 %) of DP recipients had a non-injury diagnosis as the primary cause of DP. The socioeconomic gradient was more pronounced for non-injury causes of DP (HR = 2.47, 95 % CI 2.31-2.63) than for injury causes (HR = 1.73, 95 % CI 1.56-1.92) and was especially steep for DP due to musculoskeletal diseases and mental and behavioural disorders.

CONCLUSIONS

The relationship between SES and DP varied by both the type of injury that caused LTSA and the diagnosis used to grant DP, highlighting the importance of taking diagnostic information into account when investigating long-term consequences of injuries.

Noncompliance with Hypertension Treatment and Related Factors among Kumamoto Earthquake Victims Who Experienced the COVID-19 Pandemic during Postearthquake Recovery Period

Survivors of the Kumamoto earthquake of 2016 experienced the coronavirus disease (COVID-19) outbreak while carrying additional burdens that might bring inadequate coping. This cross-sectional survey aimed to identify untreated and interrupted consultations among those with hypertension and related factors and to identify the disaster's long-term effects. Of the 19,212 earthquake survivors who had moved to permanent housing, 7367 (4196 women and 3171 men, mean age 61.8 ± 17.3 years) completed a self-administered questionnaire. The prevalence of hypertension was 41.4%. The results of the logistic regression analysis with the significant independent variables in the bivariate analysis were: reduced income due to COVID-19 (AOR = 3.23, 95%CI = 2.27-4.58) and poor self-rated health (AOR = 2.49, 95%CI = 1.72-3.61) were associated with a risk of untreated or discontinued treatment. Moreover, living in rental, public or restoration public housing was also significantly associated with a higher risk of hypertension noncompliance (AOR = 1.92, 95%CI = 1.20-3.07; AOR = 2.47, 95%CI = 1.38-4.42; AOR = 4.12, 95%CI = 1.14-14.90). These results suggest that changes due to COVID-19, the extent of self-rated health and the type of permanent housing influence the hypertension consulting behaviour of earthquake survivors during recovery. It is crucial to implement long-term public support for the mental health, income and housing concerns of the survivors.

Social vulnerability, medical care access and asthma related emergency department visits and hospitalization: An observational study

BACKGROUND

The Social Vulnerability Index (SVI) is a publicly available dataset to identify communities in greatest need of resources.

OBJECTIVE

To examine the utility of using the county-level SVI as predictors of asthma-related outcomes.

METHODS

We used the American Community Survey-derived SVI and the National Environmental Public Health Tracking Network - Query Tool to retrieve data for all counties with available SVI data and at least one matched outcome of interest. Then, we tested SVI as a predictor for emergency department visits (EDV) and hospitalizations, with investigating disparities in primary care physician (PCP) density and emergency department physicians (EDP) density. Linear and logistic regression models were used.

RESULTS

Compared to counties of the lowest SVI quartile, counties of mid-low, mid-high, and highest SVI quartiles had 1%, 4%, and 5% higher odds of asthma-related EDV per 10,000 population, respectively, and 4%, 21%, and 24% higher odds of asthma-related hospitalization per 10,000 population, respectively. Moreover, the data showed an apparent resources mismatch between the EDP densities per 10,000 populations and the SVI quartiles, and the effect of the county level SVI on the asthma-related EDV and hospitalization is not strongly affected by PCP or EDP densities.

CONCLUSION

The counties with the highest SVI -and the most vulnerable to asthma hazards- have a lower coverage of PCP and EDP. Interventions directed to address persistent social vulnerability would offer the opportunity of primary prevention with less exhaustion for the medical resources.

Injury severity and increased socioeconomic differences: A population-based cohort study

BACKGROUND

Several studies have documented an inverse gradient between socioeconomic status (SES) and injury mortality, but the evidence is less consistent for injury morbidity. The aim of this study was to investigate the association between SES and injury severity for acute hospitalizations in a nationwide population-based cohort.

METHODS

We conducted a registry-based cohort study of all individuals aged 25-64 years residing in Norway by 1st of January 2008. This cohort was followed from 2008 through 2014 using inpatient registrations for acute hospitalizations due to all-cause injuries. We derived two measures of severity: threat-to-life using the International Classification of Disease-based Injury Severity Score (ICISS), and threat of disability using long-term disability weights from the Injury-VIBES project. Robust Poisson regression models, with adjustment for age, sex, marital status, immigrant status, municipality population size and healthcare region of residence, were used to calculate incidence rate ratios (IRRs) by SES measured as an index of education, income, and occupation.

RESULTS

We identified 177,663 individuals (7% of the population) hospitalized with at least one acute injury in the observation period. Two percent (n = 4,186) had injuries categorized with high threat-to-life, while one quarter (n = 43,530) had injuries with high threat of disability. The overall adjusted IRR of hospitalization among people with low compared to high SES was 1.57 (95% CI 1.55, 1.60). Comparing low to high SES, injuries with low threat-to-life were associated with an IRR of 1.56 (95% CI 1.54, 1.59), while injuries with high threat-to-life had an IRR of 2.25 (95% CI 2.03, 2.51). Comparing low to high SES, injuries with low, medium, and high threat of disability were associated with IRRs of respectively, 1.15 (95% CI 1.11, 1.19), 1.70 (95% CI 1.66, 1.73) and 1.99 (95% CI 1.92, 2.07).

DISCUSSION

We observed an inverse gradient between SES and injury morbidity, with the steepest gradient for the most severe injuries. This suggests a need for targeted preventive measures to reduce the magnitude and burden of severe injuries for patients with low socioeconomic status.

Does poor spousal health negatively affect own health among elderly retired Japanese couples? A 1-year follow-up study

Background

We aimed to determine whether poor spousal health affected respondents’ own self-rated health after 1 year among older retired Japanese couples.

Methods

Data were extracted from the nationwide population-based survey, the “Longitudinal Survey of Middle-aged and Elderly Persons”, which has been conducted annually since 2005 by the Japanese Ministry of Health, Labour and Welfare. We used 2016 survey data as a baseline and 2017 data for 1-year follow-up. Baseline respondents comprised 21,916 individuals; of these, we focused on 4397 respondents who were retired, married, aged 65–70 years, and had good self-rated health. The survey included questions about respondents' own health and lifestyle, and their spouses' health status. Multivariate logistic regression analysis was used to explore the association between spousal health at baseline and respondents' own self-rated health after 1 year.

Results

We found that poor spousal health is associated with respondents' own self-rated poor health after 1 year. The odds ratio (OR) for worsening health was 1.67 (95% confidence interval (CI): 1.11–2.52) for men and 1.72 (95% CI: 1.25–2.37) for women when their spouse's health was “somewhat bad”. The OR was 2.25 (95% CI: 1.40–3.62) for women when spousal health was “bad/very bad”, compared with “somewhat good”. Conversely, good spousal health was associated with a low risk of declining health for respondents after 1 year. The association for men was apparent when their spouse's health was “good” [OR: 0.69; 95% CI: 0.49–0.98], and the association for women was apparent when their spouse's health was “very good” [OR: 0.46; 95% CI: 0.24–0.90].

Conclusions

Poor spousal health is an independent factor that negatively affects own self-rated health after 1 year among retired couples in Japan aged 65–70 years.

•

Of married post-retirees aged 65–70 years with good baseline health, 14% had worsening health 1 year later.

•

Poor spousal health negatively affects own self-rated health after 1 year controlling for lifestyle and social factors.

•

Health worsened more among female respondents whose spouses had poor health at baseline.

•

Health did not worsen for both male and female respondents whose spouses had good health at baseline.

Increased income over time predicts better self-perceived mental health only at a population level but not for individual changes: An analysis of a longitudinal cohort using cross-lagged models

BACKGROUND

The literature identifies a strong relationship between mental health and income, but there is little research that clarifies the directional association between household income and self-perceived mental health (SPMH) overtime either at between-perso+n or within-person levels. This study investigates whether higher income predicts better SPMH overtime and poor SPMH predicts lower income overtime both at between-person or within-person levels.

METHODS

Data analyzed was from the Montreal Southwest Social and Psychiatric Epidemiology Catchment Area study (ZEPSOM), a longitudinal community-based cohort. The baseline survey was conducted in 2007/8 with follow-up every two years. We traced a total of 3464 participants over a period of 8 years. To examine the associations between income and SPMH at both between-person or within-person levels, cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs) were used. Gender and age effects were examined using multiple group analyses. Complete case analyses evaluated the findings' robustness.

RESULTS

At between-person levels, higher household income predicted higher SPMH, but not vice versa. These associations were stronger among men and older adults. At within-person levels, higher income did not predict higher SPMH. No significant gender- or age- group differences were observed. Complete case analyses supported the findings.

LIMITATIONS

Loss to follow-up may affect the generalizability of the research findings.

CONCLUSIONS

This study suggests that higher household income predicts higher SPMH at between-person levels. Policy and programs aiming at promoting mental health should focus on low-income individuals, especially men and older adults.

Intimate Partners Violence against Women during a COVID-19 Lockdown Period: Results of an Online Survey in 7 Provinces of the Democratic Republic of Congo

Intimate Partners’ Violence (IPV) is a public health problem with long-lasting mental and physical health consequences for victims and their families. As evidence has been increasing that COVID-19 lockdown measures may exacerbate IPV, our study sought to describe the magnitude of IPV in women and identify associated determinants. An online survey was conducted in the Democratic Republic of Congo (DRC) from 24 August to 8 September 2020. Of the 4160 respondents, 2002 eligible women were included in the data analysis. Their mean age was 36.3 (SD: 8.2). Most women (65.8%) were younger than 40 years old. Prevalence of any form of IPV was 11.7%. Being in the 30–39 and >50 years’ age groups (OR = 0.66, CI: 0.46–0.95; p = 0.026 and OR = 0.23, CI: 0.11–048; p < 0.001, respectively), living in urban setting (OR = 0.63, CI: 0.41–0.99; p = 0.047), and belonging to the middle socioeconomic class (OR = 0.48, CI: 0.29–0.79; p = 0.003) significantly decreased the odds for experiencing IPV. Lower socioeconomic status (OR = 1.84, CI: 1.04–3.24; p = 0.035) and being pregnant (OR = 1.63, CI: 1.16–2.29; p = 0.005) or uncertain of pregnancy status (OR = 2.01, CI: 1.17–3.44; p = 0.011) significantly increased the odds for reporting IPV. Additional qualitative research is needed to identify the underlying reasons and mechanisms of IPV in order to develop and implement prevention interventions.

Adherence to COVID-19 Prevention Measures in the Democratic Republic of the Congo, Results of Two Consecutive Online Surveys

Adherence to preventive measures is essential to reduce the risk of COVID-19 transmission. Two online surveys were conducted in the Democratic Republic of the Congo (DRC) from 23 April to 8 June 2020, and from August 24th to September 8th, respectively. A total of 3268 (round 1) and 4160 (round 2) participants were included. In both surveys, there was a moderate level of adherence to regular handwashing (85% and 77%, respectively), wearing of facemasks (41.4% and 69%, respectively), and respecting physical distancing (58% and 43.4%, respectively). The second survey found that, working in private (OR = 2.31, CI: 1.66-3.22; p < 0.001) and public organizations (OR = 1.61, CI: 1.04-2.49; p = 0.032) and being a healthcare worker (OR = 2.19, CI: 1.57-3.05; p < 0.001) significantly increased the odds for better adherence. However, a unit increase in age (OR = 0.99, CI: 0.98-0.99; p < 0.026), having attained lower education levels (OR = 0.60, CI: 0.46-0.78; p < 0.001), living in a room (OR = 0.36, CI: 0.15-0.89; p = 0.027), living in a studio (OR = 0.26, CI: 0.11-0.61; p = 0.002) and apartment (OR = 0.29, CI: 0.10-0.82; p = 0.019) significantly decreased the odds for better adherence. We recommend a multi-sectorial approach to monitor and respond to the pandemic threat. While physical distancing may be difficult in Africa, it should be possible to increase the use of facemasks.

Analysis of Predictors of Breast Cancer Screening among Japanese Women using Nationally Representative Survey Data, 2001-2013

Objective:

Predictors of participation in breast cancer screening in recent years or the trend of participation rate by predictors over the years has not been investigated in Japan. In this study, we investigated predictors for participation in breast cancer screening and analyzed the trend of participation rate depending on the predictors using nationally representative survey data in Japan.

Methods:

The data of “Comprehensive Survey of Living Conditions” in Japan from 2001 to 2013 were used. Participation in breast cancer screening was used as an outcome. Next, as explanatory variables, we used age group, marital status, living arrangements, educational level, household income, employment status, smoking status, regular outpatient visit status, and self-rated health status. Then, the participation rate for breast cancer screening was calculated for each of the factors over the years. In addition, multivariate logistic regression analysis was conducted to analyze the association between each factor and the participation rate using data from 2010 and 2013.

Results:

We found that non-married women, women with lower educational level, women with low household income, self-employed or unemployed women, smokers, and women with low self-rated health status were significantly less likely to participate in breast cancer screening. Conversely, the participation rate increased for all predictor groups from 2001 to 2013, and the increase in the participation rate for never-married women was particularly evident compared with the other marital statuses. However, significant differences in the participation rate for breast cancer screening existed depending on marital status, household income, employment status, and smoking status throughout the analyzed years.

Conclusion:

Our findings suggest that further recommendations for breast cancer screening are particularly needed among women of low socioeconomic status and those who are self-employed or unemployed to increase the participation rate in Japan.

Factors influencing health care use by health insurance subscribers and medical aid beneficiaries: a study based on data from the Korea welfare panel study database

BACKGROUND

The use of health care services is influenced by various factors, including demographic, social, economic, and health status factors. This study aimed to identify the factors that influence health care use in health insurance subscribers and medical aid beneficiaries in Korea.

METHODS

A total of 11,793 subjects were identified, including 10,838 health insurance subscribers and 955 medical aid beneficiaries, using the Korea Welfare Panel Study database. The data were analysed by percentage, t-test, and multiple regression using SPSS 20.0.

RESULTS

Medical aid beneficiaries had 13.51 more days of outpatient visits and 8.38 more days of hospitalization compared with health insurance subscribers. Factors affecting the frequency of outpatient visits for health insurance subscribers were gender, age, household type, education level, income level, administrative district, perceived health status, chronic disease, and disability. These factors accounted for 19.8% of explanation (p < .001). Whereas, gender, household type, administrative district, perceived health status, and chronic disease were identified as factors influencing outpatient frequency for medical aid beneficiaries. These factors accounted for 11.2% of explanation (p < .001). For health insurance subscribers, factors affecting the length of hospitalization were gender, public pension status, place of residence, administrative district, economic activity, income level, perceived health status, and disability status. These factors accounted for 7.2% of explanation (p < .001). While, factors affecting the length of hospitalization for medical aid beneficiaries were accounted for by 3.4% (p < .001). Gender and perceived health status were identified as factors influencing the length of hospitalization of medical aid beneficiaries.

CONCLUSIONS

There were differences between medical aid beneficiaries and health insurance subscribers in health care use and influencing factors. Future management programs should take into consideration the specific factors that influence the use of health care services in health insurance subscribers and medical aid beneficiaries.

Prevalence of lifestyle-related chronic diseases among agricultural and non-agricultural workers in ruralareas of Japan: the Shimane CoHRE study

Objective: Engaging in agriculture greatly affects workers’ lifestyles, particularly related to physical activity. This study aimed to clarify the prevalence of lifestyle-related chronic diseases among workers engaging and not engaging in agriculture in rural areas of Japan.

Methods: A total of 4,666 consecutive participants aged ≥40 years (1,929 men and 2,737 women) were recruited during health examinations conducted from 2006 to 2014. For analysis, the participants were divided by sex and age into those engaging in agriculture and those not engaging in agriculture.

Results: Engaging in agriculture may be contributing with a low prevalence of dyslipidemia, a constitutive factor of metabolic syndrome, in both sexes between the ages of 40 and 64 years. In the elderly aged ≥65 years, engaging in agriculture may influence the low prevalence of hypertension in men. Hypertension, a strong risk factor for stroke and cardiovascular disease, is very frequent among the Japanese elderly and, therefore, engaging in agriculture may have a significant impact on its prevention and control.

Conclusion: In rural areas of Japan, engaging in agriculture may contribute to the control of lipid metabolism in middle-aged individuals and blood pressure in the elderly.

Precarious working conditions and health of metropolitan bus drivers and conductors in Minas Gerais, Brazil

BACKGROUND

To investigate the relationship between precarious working conditions and the health of bus drivers and conductors.

METHODS

Data were gathered by means of a survey and interviews conducted in 2012 with 1607 employees of the public transport system of the metropolitan region of Belo Horizonte, Brazil. Nine proxy variables were used to create a precariousness score, ranging from 0 to 9, on a comparative scale: score 0 "less precarious" and 9 "more precarious." Negative self-evaluations of health, medical diagnoses of depression and sleep disorders, common mental disorders, musculoskeletal pain and medical leave were assessed. Poisson regression was used to assess associations between precariousness and health adjusted for age, sex, education, vibration, and noise.

RESULTS

The sample was composed of 853 drivers and 754 conductors. Most were men (87%), with age below 40 years (67.4%) and medium educational level (64.5%). The maximum precariousness score observed was 7. Most individuals were in the groups of scores 3 (26.7%) and 4 (26.1%). The prevalences of the health situations were: common mental disorders, 26.3%; medical diagnosis of depression, 9.7%; medical diagnosis of sleep disorder, 14.6%; musculoskeletal pain, 43.0%; medical leave (absenteeism), 34.8%; and negative self-evaluation of health, 20.2%. The prevalences of health conditions, with the exception of negative self-evaluations of health, were significantly higher among workers with higher levels of precarious working conditions.

CONCLUSIONS

Worse health, particularly common mental disorders, was associated with self-assessed work precariousness.

Factors associated with possession of accurate knowledge regarding occupational health management among operations leaders of radiation decontamination workers in Fukushima, Japan: a cross-sectional study

OBJECTIVES

An operations leader (OL) takes an important role in occupational health management for radiation decontamination workers in Japan, and candidates for the position must participate in a training session to acquire the necessary knowledge as required by law. However, it has not been clarified whether the candidates for the OL position actually possess accurate knowledge regarding occupational health management for such work after the training session. We, therefore, aimed at examining the current occupational health management knowledge among the candidates and investigating factors related to the knowledge, with hypothesis that possession of accurate knowledge is associated with prior experience of having worked in radiation decontamination.

DESIGN

A cross-sectional study.

SETTING

The training sessions held by Fukushima Prefecture Labor Standard Associations in Fukushima, Japan, in 2017.

PARTICIPANTS

Eighty male candidates participated in the training sessions.

OUTCOME

The number/proportion of correct answers to the questions regarding occupational health management, such as those on working environment management, control of operations and health management.

RESULTS

The proportion of those who possessed accurate knowledge regarding working environment management, control of operations and health management was 68.8%, 55.0% and 51.2%, respectively. Experience of radiation decontamination work was associated with the possession of inaccurate knowledge regarding working environment management (OR 0.140 (95% CI 0.042 to 0.464)), and the uncertainty of future radiation decontamination work schedules in difficult-to-return zones was associated with the possession of accurate knowledge regarding health management (OR 4.344 (95% CI 1.509 to 12.50)).

CONCLUSIONS

Previous experience in radiation decontamination work may hinder the ability to acquire accurate information regarding working environment management among candidates for an OL position. To promote adequate occupational health management for radiation decontamination workers, it is required to establish an effective instructional method for the OL candidate training sessions with consideration of previous relevant experience.

Relationships among Socioeconomic Factors and Self-rated Health in Japanese Adults: NIPPON DATA2010

BACKGROUND

The distributions of socioeconomic status (SES) factors have been changing in Japan. We examined the relationships among SES and self-rated health (SRH) in Japanese adults.

METHODS

We analyzed 1,178 men and 1,555 women. We showed the distribution of SRH by sex and age and examined cross-sectional relationships among educational attainment, marital/living statuses, working status, household income and expenditure, and fine SRH (defined as excellent, very good, or good). We adjusted for age, subjective symptoms, visiting doctors, monthly equivalent household expenditure (EHE), and living in their own house.

RESULTS

The age-standardized prevalence of fine SRH was 79% and 73% among men and women, respectively. Among men, graduating from high school (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI], 1.07-2.19, relative to graduating from elementary or junior high school) and university or junior college (aOR 1.74; 95% CI, 1.15-2.62) was associated with fine SRH. Among women, graduating from university or junior college was associated with fine SRH (aOR 1.65; 95% CI, 1.12-2.46). Neither marital/living status nor working status was associated with SRH after adjustments for age in either sex. Among women, high EHE and income were associated with fine SRH (the highest expenditure group: aOR 1.80; 95% CI, 1.22-2.65; the highest income group: aOR 2.15; 95% CI, 1.34-3.46, relative to the corresponding lowest group). These simple relationships were not observed for men.

CONCLUSIONS

High educational attainment was associated with fine SRH. Relationships among household income, EHE, and fine SRH differed by sex.

Temporal change to self-rated health in the Swiss population from 1997 to 2012: the roles of age, gender, and education

OBJECTIVES

Our study aimed to describe the temporal changes in self-rated health status (SRH) from 1997 to 2012 in adults aged 25 to 84 residing in Switzerland, with a view to identifying groups at risk for declining health.

STUDY DESIGN

Secondary analysis of population-based cross-sectional health surveys.

METHODS

Data were collected from the cross-sectional, population-based, five-year Swiss Health Survey, from 1997, 2002, 2007 and 2012. A total of 63,861 individuals' data were included. Multilevel mixed-effect logistic regression analysis was employed to estimate the probability of very good and good health within the framework of a hierarchical cross-classified age-period-cohort model (HAPC), adjusting for education level, gender, civil status, smoking status and body mass index.

RESULTS

Individuals with higher education were substantially more likely than those with primary education to report good SRH (OR = 2.12; 95% CI = 1.93-2.33 for secondary education and OR = 3.79; 95% CI = 3.39-4.23 for tertiary education). The education effect depended on birth cohort and age: higher proportions of good SRH were reported by secondary (8%-17%) and tertiary (10%-22%) compared with primary educated individuals from the 1940 birth cohort onward; the proportion of secondary/tertiary (compared to primary) educated people reporting good SRH increased with age (by 10/11% at 45-50 years and 25/36% at 80-84 years). Gender health equality was achieved by the 1955 (primary educated) and 1960 (secondary educated) birth cohorts, while these women overtook men in reporting good SRH from the 1975 birth cohort onward. Tertiary educated younger women were significantly less likely to report good SRH than men but parity was achieved at around pension age. Similarly, gender inequality in those with primary and secondary education reduced in the younger ages to not be significant at around age 55, with women overtaking men from age 65.

CONCLUSIONS

Younger birth cohorts with lower education levels appear most vulnerable in terms of their SRH. The education effect cumulatively increases when attaining incrementally higher education levels. While women report lower health than men, gender inequality in SRH has declined and even reversed over time and is substantially linked to differences in educational status. Swiss public health strategies should particularly target the younger adults with only primary school education of both genders; for women, to combat health burdens in their early life, and men, to mitigate issues in their later life.

How Socioeconomic Status Affects Patient Perceptions of Health Care: A Qualitative Study

Introduction: Clinician perceptions of patients with low socioeconomic status (SES) have been shown to affect clinical decision making and health care delivery in this group. However, it is unknown how and if low SES patients perceive clinician bias might affect their health care. Methods: In-depth interviews with 80 enrollees in a state Medicaid program were analyzed to identify recurrent themes in their perceptions of care. Results: Most subjects perceived that their SES affected their health care. Common themes included treatment provided, access to care, and patient-provider interaction. Discussion: This study highlights complex perceptions patients have around how SES affects their health care. These results offer opportunities to reduce health care disparities through better understanding of their impact on the individual patient-provider relationship. This work may inform interventions that promote health equity via a multifaceted approach, which targets both providers and the health care system as a whole.

Current status of health among workers in Japan: Results from the Japan Epidemiology Collaboration on Occupational Health Study

Data are limited on the sex-specific prevalence of diseases and their risk factors in middle-aged and older workers in Japan. In this cross-sectional study, we investigated the age- and sex-specific prevalence of hypertension, diabetes, dyslipidemia, metabolic syndrome (defined using joint statement criteria), obesity, underweight, abdominal obesity, and smoking among approximately 70,000 to 90,000 Japanese workers (predominantly men) aged 20-69 years in 2014. We also investigated the prevalence of low cardiorespiratory fitness in 2012 and no leisure-time exercise in 2014. In both sexes, the prevalence of lifestyle-related risk factors, including hypertension, diabetes, dyslipidemia, metabolic syndrome, obesity, and abdominal obesity, was increased with aging. In contrast, the prevalence of underweight was decreased with aging. Smoking prevalence exceeded 30% in men regardless of age, whereas the prevalence was around 10% in women of all age groups. Prevalence of no leisure-time exercise exceeded 50% among middle-aged and older workers in both sexes. Among workers aged 50-64 years, less than half of men had low fitness, whereas more than half of women had low fitness. Given the high prevalence of lifestyle-related risk factors among middle-aged and older workers, effective strategies to prevent cardiovascular disease in this age group are needed in Japan.

Inequality in mortality by occupation related to economic crisis from 1980 to 2010 among working-age Japanese males

The mortality rate for Japanese males aged 30–59 years in managerial and professional spiked in 2000 and remains worse than that of other occupations possibly associated with the economic downturn of the 1990s and the global economic stagnation after 2008. The present study aimed to assess temporal occupation-specific mortality trends from 1980 to 2010 for Japanese males aged 30–59 years for major causes of death. We obtained data from the Occupation-specific Vital Statistics. We calculated age-standardized mortality rates for the four leading causes of death (all cancers, suicide, ischaemic heart disease, and cerebrovascular disease). We used a generalized estimating equation model to determine specific effects of the economic downturn after 2000. The age-standardized mortality rate for the total working-age population steadily declined up to 2010 in all major causes of death except suicide. Managers had a higher risk of mortality in all leading causes of death compared with before 1995. Mortality rates among unemployed people steadily decreased for all cancers and ischaemic heart disease. Economic downturn may have caused the prolonged increase in suicide mortality. Unemployed people did not experience any change in mortality due to suicide and cerebrovascular disease and saw a decline in cancer and ischemic heart disease mortality, perhaps because the basic properties of Japan’s social welfare system were maintained even during economic recession.

Occupational differences in suicide mortality among Japanese men of working age

BACKGROUND

Although suicide rates among Japanese men of working-age have steadily increased over the past two decades, the distribution by occupation and industry is not uniform. Little is known regarding occupation and industry differences in relation to suicide risk. This study examined differences in suicide risk among Japanese men of working age (25-59 years) during 2010.

METHODS

We analysed the Japanese government's 2010 national survey data regarding occupation and industry-specific death rates. Poisson regression models were formulated for each occupation and industry to estimate the relative risk of death by suicide. Potential interactions between age and occupation/industry were also examined.

RESULTS

Suicide incidence was highest among workers in the fields of agriculture and mining. When compared with referent groups (sales for occupation and wholesale and retail for industry), the age-adjusted relative risk of suicide was highest for administrative and managerial workers (Incident Relative Risk [IRR]: 3.91, 95% Confidence Interval [95%CI]: 3.16-4.85), service industries (IRR: 3.63, 95%CI: 2.93-4.51) and agriculture (IRR: 3.53, 95%CI: 2.84-4.38) occupations, and for mining (IRR: 23.9, 95%CI: 19.4-29.4), fisheries (IRR: 6.26, 95%CI: 5.03-7.80), electricity and gas (IRR: 5.86, 95%CI: 4.71-7.30) and agricultural industries (IRR: 4.73, 95%CI: 3.78-5.91).

LIMITATIONS

Bias resulting from misclassification of deceased individuals' occupation or industry was a potential limitation of this study. Furthermore, detailed information regarding occupation-related factors, such as employment status, had not been recorded in the initial survey.

CONCLUSIONS

These findings help elucidate Japanese occupations and industries with a higher suicide risk, most likely due to economic changes or workplace factors relating to stress and depression.