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Chung W. Deconstructing subjective unmet healthcare needs: a South Korean case study with policy implications. Front Public Health 2024; 12:1385951. [PMID: 38799680 PMCID: PMC11122008 DOI: 10.3389/fpubh.2024.1385951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Background Despite widespread efforts by many countries to reduce the prevalence of unmet healthcare needs within their populations, there remains a scarcity of research systematically exploring the components of these needs. Objectives This study aims to deconstruct subjective unmet healthcare needs into two distinct components: the experience of subjective healthcare needs (the "Needs" component) and the experience of unmet needs contingent on those healthcare needs (the "Unmet" component). Methods This analysis utilizes data from 13,359 adults aged 19 or older, collected through the 2018 Korea Health Panel survey, with the aim of minimizing the influence of the coronavirus disease 19 pandemic. The two dependent variables are the experience of subjective healthcare needs and whether these needs have been met. The independent variables include 15 socio-demographic, health, and functional characteristics. The study employs both a population proportion analysis and a multivariable bivariate probit model with sample selection. Results In South Korea, 11.6% (CI [confidence interval] = 11.0-12.3%) of the population experienced subjective unmet healthcare needs. Upon deconstructing these, 96.7% (CI = 96.2-97.1%) of the population exhibited the Needs component, and 12.0% (CI = 11.4-12.7%) displayed the Unmet component. Each independent variable showed different associations between the two components. Furthermore, effective interventions targeting the characteristics associated with each component could reduce the proportion of the population experiencing subjective unmet healthcare needs from 11.6 to 4.0%. Conclusion South Korea faces a significant challenge due to the considerable prevalence of subjective unmet healthcare needs. To address this challenge effectively, the universal healthcare coverage system should adapt its approach based on the characteristics associated with both the Needs and Unmet components of subjective unmet healthcare needs. To achieve this goal, it is highly recommended that the government prioritize strengthening community-based primary healthcare, which currently suffers from insufficient resources.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
- Korea Peace Institute, Seoul, Republic of Korea
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Gao Y, Du L, Cai J, Hu T. Effects of functional limitations and activities of daily living on the mortality of the older people: A cohort study in China. Front Public Health 2023; 10:1098794. [PMID: 36743188 PMCID: PMC9895937 DOI: 10.3389/fpubh.2022.1098794] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Prevalence of functional limitations (FLs) and disabled activities of daily living (ADL) cause heavy burdens to the health of the older people. Stratified by gender, this study aimed to explore the effects of FL and ADL on the mortality of the older people in China, and the mechanism was then discussed. Methods We used survey data of a prospective 10-year cohort (2008-2018), from the China Longitudinal Healthy Longevity Survey (CLHLS). The primary outcome was all-cause mortality, and Independent variables included FL, basic ADL (BADL), and instrumental ADL (IADL). Covariates involved socio-demographic characteristics, health-related behaviors, and health status of the participants in the CLHLS project. Results There were 967 (19.20%) male and 2,235 (32.36%) female older people performed functional limitations, and their survival time was 60.98 (SE = 0.66) and 55.19 (SE = 0.55) months, respectively. Old adults with FL had significantly poorer survival than the ones without (Log-rank test, P < 0.001). Weibull regression suggested that FL (P < 0.001), abnormal BADL (P < 0.001) and IADL (P < 0.001) were negatively associated with the survival of the older people. Further analysis showed that BADL and IADL performed significantly mediating roles in the relation of FL and survival time in old adults; additionally, for female older people, BADL also exhibited a significant moderating role in the effect of FL on survival. Conclusions Prevalence of FL was serious among the older people in China, especially for the women. Disabilities of BADL and IADL and FL were negatively associated with the survival time of the older people in China. Regarding the effect of FL on survival, BADL and IADL performed significantly mediating roles, and the moderating role of BADL existed only for the female. These suggested evidence to implement strategies to maintain health in the older people.
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Affiliation(s)
- Yumeng Gao
- Department of Medical Insurance, Jinshan Hospital of Fudan University, Shanghai, China,*Correspondence: Yumeng Gao ✉
| | - Liang Du
- School of Public Health, Fudan University, Shanghai, China
| | - Jianping Cai
- Department of Medical Insurance, Jinshan Hospital of Fudan University, Shanghai, China
| | - Tingfa Hu
- Department of Medical Insurance, Jinshan Hospital of Fudan University, Shanghai, China
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Li Y, Hu C. Marital status and its correlation with age, race, and gender in prognosis of tonsil squamous cell carcinomas. Open Med (Wars) 2022; 17:1773-1779. [DOI: 10.1515/med-2022-0568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The objective of this study was to assess the impact of marital status on tonsil squamous cell carcinomas (TSCCs) prognosis and to analyze whether the impact is correlated with gender, age, and race. We examined the clinicopathological variables using Chi-squared tests and evaluated the association between survival and different variables using the methods of Kaplan–Meier. Univariate and multivariate analyses were performed to determine the effects of each variable on survival. A total of 10,720 patients were analyzed. The rate of being married was higher among Asian or Caucasian, and this rate decreased with higher tumor stage. While both married male and female survivors benefit from their marital status, we found a differential in cancer-specific survival based on gender, with males benefitting more than females (p < 0.05). The same results were found in overall survival. Subgroup analysis shows that the protective effect of marriage was consistent in all patients except for N3 groups (all, p < 0.05). While there are survival benefits for married patients with TSCCs, married/partnered males may benefit more than females. Age, race, and gender could affect the correlation between marital status and survival.
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Affiliation(s)
- Yujiao Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai 200032 , China
- Department of Oncology, Shanghai Medical College , Shanghai , China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center , 270 Dong An Road , Shanghai 200032 , China
- Department of Oncology, Shanghai Medical College , Shanghai , China
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Chung W. Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data. Healthcare (Basel) 2022; 10:2243. [PMID: 36360584 PMCID: PMC9691171 DOI: 10.3390/healthcare10112243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 01/31/2024] Open
Abstract
Using 68,930 observations selected from 16,535 adults in the Korea Health Panel Survey (2014-2018), this study explored healthcare barriers that prevent people from meeting their healthcare needs most severely during adulthood, and the characteristics that are highly associated with the barrier. This study derived two outcome variables: a dichotomous outcome variable on whether an individual has experienced healthcare needs, and a quadchotomous outcome variable on how an individual's healthcare needs ended. An analysis was conducted using a multivariable panel multinomial probit model with sample selection. The results showed that the main cause of unmet healthcare needs was not financial difficulties but non-financial barriers, which were time constraints up to a certain age and the lack of caring and support after that age. People with functional limitations were at a high risk of experiencing unmet healthcare needs due to a lack of caring and support. To reduce unmet healthcare needs in South Korea, the government should focus on lowering non-financial barriers to healthcare, including time constraints and lack of caring and support. It seems urgent to strengthen the foundation of "primary care", which is exceptionally scarce now, and to expand it to "community-based integrated care" and "people-centered care".
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
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Amiri P, Mohammadi A, Bahaadinbeigy K, Kalantari Khandani B, Maazed V. Identifying unmet information needs of advanced cancer patients in Iran: An in-depth qualitative study. Health Sci Rep 2022; 5:e914. [PMID: 36320651 PMCID: PMC9617646 DOI: 10.1002/hsr2.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/18/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND AIMS One of the main vital needs for self-care in patients with advanced cancer is information need. Meeting this need has significant positive effects on improving their treatment and care. This study was conducted to identify the unmet information needs of patients with advanced cancer in Iran. METHODS This exploratory study was performed from July to February 2021 in the Kerman University of Medical Sciences cancer treatment centers. Oncologists selected eligible patients by purposeful sampling method. Semistructured and in-depth interviews were conducted with selected patients to collect data. Interviews continued until data saturation. Each interview was audio-recorded and transcribed verbatim. RESULTS In the interviews, 15 patients with advanced cancer ranging in age from 43 to 65 years participated. The most common type of cancer in women was breast (71.4%) and prostate (50%) in men. The two main categories of "types of unmet information needs" and "reasons for not meeting information needs" were extracted from the analysis of patient interviews, with six and four subcategories, respectively. CONCLUSION Cancer patients had a large number of unmet information needs. At the time of identifying the unmet information needs of cancer patients, the basic reasons for not meeting these needs should also be considered because cultural differences and social gaps in societies are inevitable.
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Affiliation(s)
- Parasto Amiri
- Medical Informatics Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Ali Mohammadi
- Department of Health Information Technology, Paramedical SchoolKermanshah University of Medical SciencesKermanshahIran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Behjat Kalantari Khandani
- Department of Oncology, Shahid Bahonar Hospital, School of MedicineKerman University of Medical SciencesKermanIran
| | - Vahid Maazed
- Hematology and Oncology, Faculty of MedicineKerman University of Medical SciencesKermanIran
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Ghaznavi C, Kawashima T, Tanoue Y, Yoneoka D, Makiyama K, Sakamoto H, Ueda P, Eguchi A, Nomura S. Changes in marriage, divorce and births during the COVID-19 pandemic in Japan. BMJ Glob Health 2022; 7:bmjgh-2021-007866. [PMID: 35569835 PMCID: PMC9108437 DOI: 10.1136/bmjgh-2021-007866] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/23/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Marriage, divorce and fertility are declining in Japan. There is concern that the COVID-19 pandemic may have accelerated the decrease in marriages and births while increasing the number of divorces. Changes in partnership behaviours and fertility have significant implications for mental health, well-being and population demographics. Methods Japanese vital statistical data were collected for December 2011–May 2021. We used the Farrington algorithm on the daily numbers of marriages, divorces and births (per month) in order to determine whether any given month between January 2017 and May 2021 had a significant excess or deficit. Analyses were conducted at the national and regional levels. Results During the pandemic, significant deficits in the national number of marriages were noted in January 2020, April 2020, May 2020, July 2020, September 2020 and April 2021. Regional marriage patterns reflected national trends. Divorces were noted to be in deficit during April 2020, May 2020 and May 2021 at the country level. Regional analyses mirrored national divorce trends with the exception of Shikoku, which showed no deficits during the pandemic. Significant deficits in the number of total births were noted in December 2020, January 2021 and February 2021. Regionally, birth deficits were concentrated in Chubu, Kansai and Kanto. After the start of the pandemic, no significant excesses in marriages, divorces or births were noted at the national or regional level. Conclusions Marriages and divorces declined during the pandemic in Japan, especially during state of emergency declarations. There were decreased births between December 2020 and February 2021, approximately 8–10 months after the first state of emergency, suggesting that couples altered their pregnancy intention in response to the pandemic. Metropolitan regions were more affected by the pandemic than their less metropolitan counterparts.
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Affiliation(s)
- Cyrus Ghaznavi
- Department of Health Policy and Management, Keio University, Tokyo, Japan .,Medical Education Program, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Takayuki Kawashima
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Department of Mathematical and Computing Science, Tokyo Institute of Technology, Tokyo, Japan
| | - Yuta Tanoue
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Institute for Business and Finance, Waseda University, Tokyo, Japan
| | - Daisuke Yoneoka
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Haruka Sakamoto
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.,Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Peter Ueda
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Akifumi Eguchi
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
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Muramatsu Y, Takagi K, Suzuki T, Dhungel B, Tsuchiya A, Wada K. Does poor spousal health negatively affect own health among elderly retired Japanese couples? A 1-year follow-up study. SSM Popul Health 2021; 16:100970. [PMID: 34841039 PMCID: PMC8606512 DOI: 10.1016/j.ssmph.2021.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Yoko Muramatsu
- NLI Research Institute (A Member of the Nippon Life Insurance Company Group), 4-1-7 Kudankita, Chiyoda-ku, Tokyo, 102-0073, Japan
| | - Kuniyasu Takagi
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, 4-1-26 Akasaka, Minato City, Tokyo, 107-8402, Japan
| | - Tomoko Suzuki
- Department of Public Health, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Bibha Dhungel
- Department of Public Health, Graduate School of Public Health, St. Luke's International University, 10-1 Akashicho, Chuo City, Tokyo, 104-0044, Japan.,Department of Health Policy, National Centre for Child Health and Development, 2-10-1 Okura, Setagaya City, Tokyo, 157-0074, Japan
| | - Akihiro Tsuchiya
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, 4-1-26 Akasaka, Minato City, Tokyo, 107-8402, Japan
| | - Koji Wada
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, 4-1-26 Akasaka, Minato City, Tokyo, 107-8402, Japan.,Department of Public Health, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan
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Maharlouei N, Cobb S, Bazargan M, Assari S. Subjective Health and Happiness in the United States: Gender Differences in the Effects of Socioeconomic Status Indicators. ACTA ACUST UNITED AC 2020; 4:8-17. [PMID: 32568256 DOI: 10.29245/2578-2959/2020/2.1196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Education, employment, and marital status are among the main socioeconomic status (SES) indicators that are associated with subjective health and happiness. The effects of these SES indicators may, however, be different for various demographic groups. Aims To understand if SES indicators differently impact men and women, we tested gender differences in the effects of education, employment, and marital status on the subjective health and happiness of American adults. Methods This cross-sectional study used data of the General Social Survey (GSS), a series of nationally representative surveys between 1972 and 2018 in the US. Our analytical sample included 65,814 adults. The main independent variables were education attainment, marital status, and employment. Outcomes were self-rated health (SRH) and happiness measured using single items. Age and year of the study were covariates. Gender was the moderator. Results Overall, high education, being employed, and being married were associated with better SRH and happiness. We, however, found significant interactions between gender and educational attainment, marital status, and employment on the outcomes, which suggested that the effect of high education and marital status were stronger for women. In comparison, the effect of employment was stronger for men. Some inconsistencies in the results were observed for SRH compared to happiness. Conclusions In the United States, while education, employment, and marital status are critical social determinants of subjective health and happiness, these effects vary between women and men. Men's outcomes seem to be more strongly shaped by employment, while women's outcomes are more strongly shaped by education and marital status.
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Affiliation(s)
- Najmeh Maharlouei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA.,Department of Family Medicine, UCLA, Los Angeles, CA
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
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Subjective Happiness, Health and Quality of Life and Their Sociocultural Correlates among Younger Population in Malawi. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8020055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Public health research and policy in sub-Saharan Africa are generally disease-oriented, with the focus being largely confined within the biological determinants of health. So far, little attention has been given to developing a more health-oriented approach by emphasising the psychosocial dimensions of health, especially among the younger population. To this regard, we conducted the present study to assess the prevalence and sociocultural correlates of perceived happiness, health, and life satisfaction among the adolescent and young (15–24 years) population in Malawi. We analysed cross-sectional data on 12,610 men and women based on a Malawi multiple indicator cluster survey conducted in 2013–2014. Data were analysed using descriptive and multivariable regression methods. According to the findings, more than 80% of the men and women reported being satisfied about happiness, health, and life. Multivariate analysis showed an inverse relationship between being currently or formerly married and perceived happiness. Ethnic disparities in perceived health and happiness were more pronounced in men, whereas that of life satisfaction was more pronounced in women. Living in households of the highest wealth quintile was positively associated with health and life satisfaction, but not with happiness. These findings highlight the need for prioritising the psychosocial needs of the adolescent and youth populations in designing health and social policy in Malawi. The findings need to be interpreted in light of the factors specific to the sociocultural environment in Malawi.
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Ota A, Yatsuya H, Nishi N, Okuda N, Ohkubo T, Hayakawa T, Kadota A, Okayama A, Miura K. Relationships among Socioeconomic Factors and Self-rated Health in Japanese Adults: NIPPON DATA2010. J Epidemiol 2018; 28 Suppl 3:S66-S72. [PMID: 29503389 PMCID: PMC5825690 DOI: 10.2188/jea.je20170246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan
| | - Nobuo Nishi
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takehito Hayakawa
- Research Center for Social Studies of Health and Community, Ritsumeikan University, Kyoto, Japan
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
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11
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Shi X, Zhang TT, Hu WP, Ji QH. Marital status and survival of patients with oral cavity squamous cell carcinoma: a population-based study. Oncotarget 2017; 8:28526-28543. [PMID: 28415710 PMCID: PMC5438670 DOI: 10.18632/oncotarget.16095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/28/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The relationship between marital status and oral cavity squamous cell carcinoma (OCSCC) survival has not been explored. The objective of our study was to evaluate the impact of marital status on OCSCC survival and investigate the potential mechanisms. RESULTS Married patients had better 5-year cancer-specific survival (CSS) (66.7% vs 54.9%) and 5-year overall survival (OS) (56.0% vs 41.1%). In multivariate Cox regression models, unmarried patients also showed higher mortality risk for both CSS (Hazard Ratio [HR]: 1.260, 95% confidence interval (CI): 1.187-1.339, P < 0.001) and OS (HR: 1.328, 95% CI: 1.266-1.392, P < 0.001). Multivariate logistic regression showed married patients were more likely to be diagnosed at earlier stage (P < 0.001) and receive surgery (P < 0.001). Married patients still demonstrated better prognosis in the 1:1 matched group analysis (CSS: 62.9% vs 60.8%, OS: 52.3% vs 46.5%). MATERIALS AND METHODS 11022 eligible OCSCC patients were identified from Surveillance, Epidemiology, and End Results (SEER) database, including 5902 married and 5120 unmarried individuals. Kaplan-Meier analysis, Log-rank test and Cox proportional hazards regression model were used to analyze survival and mortality risk. Influence of marital status on stage, age at diagnosis and selection of treatment was determined by binomial and multinomial logistic regression. Propensity score matching method was adopted to perform a 1:1 matched cohort. CONCLUSIONS Marriage has an independently protective effect on OCSCC survival. Earlier diagnosis and more sufficient treatment are possible explanations. Besides, even after 1:1 matching, survival advantage of married group still exists, indicating that spousal support from other aspects may also play an important role.
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Affiliation(s)
- Xiao Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ting-ting Zhang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei-ping Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing-hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Hasegawa T, Goto N, Matsumoto N, Sasaki Y, Ishiguro T, Kuzuya N, Sugiyama Y. Prevalence of unmet needs and correlated factors in advanced-stage cancer patients receiving rehabilitation. Support Care Cancer 2016; 24:4761-7. [PMID: 27344328 DOI: 10.1007/s00520-016-3327-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Although rehabilitation for patients with cancer is currently being provided throughout all phases of the disease, including the advanced stage, much remains unknown about the needs of such patients. The aims of this study were to identify the supportive care and unmet needs of cancer patients receiving rehabilitation interventions and to investigate the factors associated with those unmet needs. METHODS A total of 45 patients with cancer receiving rehabilitation interventions participated in this study between June 2013 and December 2015. Measures included the Japanese version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34), the Functional Independence Measure (FIM), the Hospital Anxiety and Depression Scale (HADS), and various other medico-social factors. RESULTS The mean age of the cancer patients was 66.6 years, the mean (±standard deviation) FIM score was 111.8 (±16.1), and the mean HADS score was 13.9 (±8.2). The patients had a mean of 17.4 (±10.3) unmet needs. The top ten unmet needs related to rehabilitation intervention included seven psychological needs, two health system and information needs, and one physical and daily living need. Multiple regression analysis revealed that psychological distress (HADS ≥11), marital status, and sex were significantly associated with physical and daily living needs. CONCLUSIONS These results suggest that psychosocial factors are important in understanding the supportive care and unmet needs of cancer patients receiving rehabilitation interventions.
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Affiliation(s)
- Takaaki Hasegawa
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan. .,Palliative Care Center, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan.
| | - Naoya Goto
- Department of Rehabilitation, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Naoto Matsumoto
- Department of Rehabilitation, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Yusuke Sasaki
- Department of Rehabilitation, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan.,Palliative Care Center, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Nanori Kuzuya
- Palliative Care Center, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
| | - Yasuyuki Sugiyama
- Palliative Care Center, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu, 500-8513, Japan
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Motamed N, Maadi M, Sohrabi M, Keyvani H, Poustchi H, Zamani F. Rural Residency has a Protective Effect and Marriage is a Risk Factor for NAFLD. HEPATITIS MONTHLY 2016; 16:e38357. [PMID: 27642349 PMCID: PMC5018359 DOI: 10.5812/hepatmon.38357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/07/2016] [Accepted: 05/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is considered the leading cause of liver disease worldwide. Although many previous studies have evaluated the potential risk factors of NAFLD, few studies have determined the effect of residency or marriage status on NAFLD. OBJECTIVES We aim to evaluate whether residency and marriage status increased the risk factors for NAFLD. MATERIALS AND METHODS We utilized data from 5,052 participants, 18 years and older, from a cohort study conducted using 6,140 participants in northern Iran. The population was divided into 16 subgroups according to sex and age; the age groups had an interval of 10 years. We randomly selected the subjects from each subgroup in proportion to the size of each subpopulation group. Logistic regression analyses were conducted on NAFLD as an outcome of marriage status, residency (rural vs. urban), and other potential risk factors. RESULTS We found that NAFLD had an inverse association with rural living in men (OR = 0.513, 0.422 - 0.622, P value < 0.001) and women (OR = 0.431, 0.345 - 0.539, P value < 0.001). Furthermore, we determined that NAFLD had a direct association with marriage status for men (OR = 2.770, 2.004 - 3.831, P value < 0.001) and women (OR = 1.241, 1.033 - 1.490, P value = 0.0209). CONCLUSIONS While rural living has a protective effect on NAFLD, marriage may be a potential risk factor for this condition.
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Affiliation(s)
- Nima Motamed
- Gastrointestinal and Liver Disease Research Centre, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mansooreh Maadi
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Masoudreza Sohrabi
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Hossein Keyvani
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Farhad Zamani
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, IR Iran
- Corresponding Author: Farhad Zamani, Gastrointestinal and Liver Disease Research Centre, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2182141303, E-mail:
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Ahmadipour H, Kiarash G. Promoting Healthy Lifestyles for Women in Kerman, Iran: A Population-Based Study. WOMEN’S HEALTH BULLETIN 2016. [DOI: 10.17795/whb-33612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Fu R, Noguchi H. Does Marriage Make Us Healthier? Inter-Country Comparative Evidence from China, Japan, and Korea. PLoS One 2016; 11:e0148990. [PMID: 26862896 PMCID: PMC4749249 DOI: 10.1371/journal.pone.0148990] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/26/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study focuses on East Asian countries and investigates the difference in the marriage premium on the health-marriage protection effect (MPE) between younger and older generations and the intra-couple education concordance effect (ECE) on the health of married individuals. This study used inter-country comparative data from China, Japan, and Korea. METHODS This study focused on individuals (n = 7,938) in China, Japan, and Korea who were sampled from the 2010 East Asian Social Survey. To investigate MPE and ECE, four health indicators were utilized: a physical and mental components summary (PCS and MCS), self-rated health status (Dself), and happiness level (Dhappy). Ordinary least squares regression was conducted by country- and gender-specific subsamples. RESULTS We found that the MPE on PCS, MCS, and Dself was more significant for the older generation than for the younger generation in both China and Japan, whereas the results were inconclusive in Korea. With regard to the ECE on happiness (Dhappy), for both men and women, couples tend to be happier when both the husband and the wife are well educated ("higher balanced marriage") compared to couples with a lower level of educational achievement ("lower balanced marriage"). Significant benefits from a "higher balanced marriage" on MCS and Dself were observed for women only. In contrast, no statistically significant differences in health status were observed between "higher balanced marriage" couples and couples with different levels of educational achievements ("upward marriage" or "downward marriage"). CONCLUSIONS This study found that (1) the MPE was more significant for the older generation, and (2) the health gap, particularly the happiness gap, between higher- and lower-balanced married couples was significant. The inter-country comparative findings are useful to explain how the role of marriage (and therefore of family) on health has been diluted due to the progress of industrialization and modernization.
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Affiliation(s)
- Rong Fu
- Graduate School of Economics, Waseda University, Tokyo, Japan
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, Tokyo, Japan
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