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

Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization

Background

Health systems are increasingly attempting to intervene on social adversity as a strategy to improve health care outcomes. To inform health system efforts to screen for social adversity, we sought to explore the stability of social risk and interest in assistance over time and to evaluate whether the social risk was associated with subsequent healthcare utilization.

Methods

We surveyed Kaiser Permanente members receiving subsidies from the healthcare exchange in Southern California to assess their social risk and desire for assistance using the Accountable Health Communities instrument. A subset of initial respondents was randomized to be re-surveyed at either three or six months later.

Results

A total of 228 participants completed the survey at both time points. Social risks were moderate to strongly stable across three and six months (Kappa range = .59-.89); however, social adversity profiles that included participants’ desire for assistance were more labile (3-month Kappa = .52; 95% CI = .41-.64 & 6-month Kappa = .48; 95% CI = .36-.6). Only housing-related social risks were associated with an increase in acute care (emergency, urgent care) six months after initial screening; no other associations between social risk and utilization were observed.

Conclusions

This study suggests that screening for social risk may be appropriate at intervals of six months, or perhaps longer, but that assessing desire for assistance may need to occur more frequently. Housing risks were associated with increases in acute care. Health systems may need to engage in screening and referral to resources to improve overall care and ultimately patient total health.

Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study

OBJECTIVES

Classifying individuals into multimorbidity patterns can be useful to identify the target population with poorer clinical outcomes. Self-rated health (SRH) is one of the core outcomes in multimorbidity patients. Although studies have reported that multimorbidity is associated with poor SRH, whether certain patterns have stronger associations remains unknown. Therefore, this study aimed to identify the prevalence and patterns of multimorbidity and investigate the association between multimorbidity patterns and SRH in an older Japanese population.

DESIGN

Cross-sectional study.

SETTING

Data were obtained from the 2013 Comprehensive Survey of Living Conditions, a nationally representative survey of the general Japanese population.

PARTICIPANTS

This study mainly examined 23 730 participants aged ≥65 years who were not hospitalised or institutionalised.

PRIMARY OUTCOME MEASURE

Poor SRH was defined as choosing 'not very good' or 'bad' from five options: 'excellent', 'fairly good', 'average', 'not very good' and 'bad'.

RESULTS

The prevalence of multimorbidity was 40.9% and that of poor SRH was 23.8%. Three multimorbidity patterns were identified by exploratory factor analysis: (1) degenerative/mental health, (3) malignant/digestive/urological/haematological and (3) cardiovascular/metabolic. Multivariable modified Poisson regression analysis revealed that high malignant/digestive/urological/haematological, degenerative/mental health and cardiovascular/metabolic pattern scores, corresponding to the number of affected body systems in each pattern, were significantly associated with poor SRH (adjusted risk ratio (aRR)=1.68, 95% CI: 1.60 to 1.76; aRR=1.63, 95% CI: 1.58 to 1.69; and aRR=1.31, 95% CI: 1.26 to 1.36, respectively). When including the Kessler 6 score, a screening scale for psychological distress, in the analysis, the association between each multimorbidity pattern score and poor SRH decreased.

CONCLUSIONS

Malignant/digestive/urological/haematological and degenerative/mental health patterns may be associated with a high risk for poor SRH. Further research should focus on interventions to improve SRH in multimorbidity patients.

Cancer Screening Rate and Related Factors in the Japanese Child-Rearing Generation

In Japan, although the incidence of cancer is increasing, the cancer screening rate is low compared to that in other countries. This study aimed to evaluate the factors associated with cancer screening behavior in Japanese men and women of child-rearing age. The survey was conducted among 2410 child-rearing adults from a countrywide database in August 2018. Among the respondents, there were 1381 (57.3%) who had been screened for cancer and 1029 (42.7%) who had not been screened. When stratified by sex, 503 (40.9%) men and 878 (74.3%) women had been screened for cancer, and education, income, and family history were associated with cancer screening. Among the men, where they lived, age, and family history were associated with cancer screening. In women, annual income was associated with stomach, colon, breast, and uterine cancer screening. In addition, uterine cancer screening was related to the women’s educational level. Our results suggest a need to improve the cancer screening rate among the child-rearing generation, especially for those with limited education and low income.

Association of Financial Worry and Material Financial Risk with Short-Term Ambulatory Healthcare Utilization in a Sample of Subsidized Exchange Patients

BACKGROUND

Financial burden can affect healthcare utilization. Few studies have assessed the short-term associations between material (debt, trouble paying rent) and psychological (worry or distress about affording future healthcare) financial risks, and subsequent outpatient and emergency healthcare use. Worry was defined as concerns about affording future healthcare.

OBJECTIVE

Examine whether worry about affording healthcare is associated with healthcare utilization when controlling for material risk and general anxiety DESIGN: Longitudinal observational study PARTICIPANTS: Kaiser Permanente members with exchange-based federally subsidized health insurance (n = 450, 45% response rate) MAIN MEASURES: Survey measures of financial risks (material difficulty paying for medical care and worry about affording healthcare) and general anxiety. Healthcare use (primary care, urgent care, emergency department, and outpatient specialty visits) in the 6 months following survey completion.

KEY RESULTS

Emergency department and primary care visits were not associated with material risk, worry about affording care, or general anxiety in individual and pooled analyses (all 95% confidence intervals (CI) for relative risk (RR) included 1). Although no individual predictor was associated with urgent care use (all 95% CIs for RR included 1), worry about affording prescriptions (relative risk (RR) = 2.01; 95% CI 1.14, 3.55) and general anxiety (RR = 0.38; 95% CI 0.15, 0.95) were significant when included in the same model, suggesting the two confounded each other. Worry about affording healthcare services was associated with fewer specialty care visits (RR = 0.40; 95% CI 0.25, 0.64) even when controlling for material risk and general anxiety, although general anxiety was also associated with more specialty care visits (RR = 1.98; 95% CI, 1.23, 3.18).

CONCLUSIONS

Screening for both general anxiety and financial worry may assist with specialty care utilization. Identifying these concerns may provide more opportunities to assist patients. Future research should examine interventions to reduce worry about cost of care.

Assessing Health Needs in African American Churches: A Mixed-Methods Study

Among major racial and ethnic groups in the USA, African Americans are the most religious, and faith-based organizations play an important role in health promotion for African Americans. This study aimed to assess health needs in African American churches using a mixed-methods approach. Based on quantitative and qualitative data collected from eight African American churches in Nebraska in 2017, the most prevalent chronic conditions among participating African American church members (n = 388) included hypertension (60.8%), allergies (41.0%), arthritis (36.4%), high cholesterol (35.8%), and diabetes (28.1%). Significant predictors of fair or poor health were identified as male sex, unemployment, delayed utilization of health care in the past 12 months due to cost, lower frequency of church attendance, and feeling down, depressed, or hopeless in the past 2 weeks. Pastors from participating churches identified cost as one of the primary barriers to providing church-based health services. There were substantial unmet health needs in African American faith communities, especially in the areas of chronic disease prevention and management, and churches would need more support to realize their full potential in faith-based health promotion.

Working cancer survivors' physical and mental characteristics compared to cancer-free workers in Japan: a nationwide general population-based study

PURPOSE

This study compared working cancer survivors' self-rated health status (SRHS), physical functional capacity, depressive symptoms, and happiness to those of cancer-free workers.

METHODS

A nationwide general population-based cross-sectional study on a sample of Japanese was conducted. Prevalence of deteriorated SRHS, restricted physical functional capacity, depressive symptoms, and perceived happiness were compared between working cancer survivors and cancer-free workers with multivariable logistic regression analysis adjusted for age and sociodemographic and health-related backgrounds.

RESULTS

Of the 28,311 male and 26,068 female workers, 977 (3.5%) and 1267 (4.9%) were cancer survivors, respectively. Working cancer survivors reported deteriorated SRHS more frequently than cancer-free workers: 21.3% vs. 13.8%, multivariable-adjusted odds ratio (95% confidence interval), 1.64 (1.39-1.95) for men, 23.8% vs. 17.5%, 1.34 (1.16-1.54) for women. Restricted physical functional capacity was reported more frequently in working cancer survivors than cancer-free workers: 6.8% vs. 2.6%, 1.76 (1.34-2.32) for men, 4.9% vs. 2.0%, 2.06 (1.56-2.71) for women. No significant difference was found for depressive symptoms: 21.6% vs. 22.9% in men, 30.0% vs. 28.5% in women. Working cancer survivors felt happiness more frequently than cancer-free survivors in men (77.3% vs. 71.7%, 1.21 (1.01-1.45)) but not in women (76.1% vs. 74.9%).

CONCLUSIONS

Working cancer survivors had worse SRHS and more restricted physical functional capacity than cancer-free workers. In men, working cancer survivors felt happiness more frequently than cancer-free workers.

IMPLICATIONS FOR CANCER SURVIVORS

Continuous support to improve cancer survivors' SRHS and physical functional capacity would be necessary even while they are working.

Association between housing tenure and self-rated health in Japan: Findings from a nationwide cross-sectional survey

Background

Many studies have reported that housing tenure (HT) is associated with health, but little is known about its association in Japan. We investigated the cross-sectional association between HT and self-rated health (SRH) among Japanese adults, taking demographic characteristics and socioeconomic status (SES) into consideration.

Methods

We used data from a nationally representative survey conducted by the Japanese Ministry of Health, Labour and Welfare (28,641 men and 31,143 women aged ≥20 years). HT was divided into five categories: owner-occupied, privately rented, provided housing, publically subsidized, and rented rooms. SRH was evaluated using a single-item inventory and dichotomized into poor (very poor/poor) and good (very good/good/fair). We calculated adjusted odds ratios (OR) and their 95% confidence intervals (CI) for poor SRH with logistic regression models. Covariates included demographic factors (i.e., age, gender, marital status, family size, smoking status, and chronic medical conditions) and SES factors (i.e., education, equivalent household expenditures, and occupation).

Results

Among analyzed participants, 75.9% were owner-occupiers and 14.6% reported poor SRH. After adjustment for all covariates, compared with owner-occupiers, private renters (OR = 1.36, 95% CI = 1.26–1.47), publically subsidized renters (OR = 1.33, 95% CI = 1.19–1.48), and residents in rented rooms (OR = 1.41, 95% CI = 1.22–1.62) were more likely to report poor SRH. Stratified analyses by SES factors showed that the association between HT and poor SRH was stronger in the socially disadvantaged than in the higher socioeconomic group.

Conclusions

Our results show a significant association between HT and SRH, independent of socio-demographic factors. HT may deserve greater attention as an indicator of socioeconomic position in Japan.

Educational level as a predictor of the incidences of non-communicable diseases among middle-aged Japanese: a hazards-model analysis

Background

It is well known that there are educational inequalities in incidences of non-communicable diseases (NCDs). Unlike most preceding studies, this study examined this issue using a hazards model analysis, with specific reference to the potential mediating effects of socioeconomic status (SES), other than educational level, and health behaviour as well as gender differences.

Methods

Data were obtained from a 12-wave longitudinal nationwide survey conducted from 2005 to 2016 with middle-aged individuals in Japan. Participants included 31,210 individuals (15,127 men and 16,083 women) who were aged 50–59 years at wave 1. Incidences of six NCDs (diabetes, heart disease, stroke, hypertension, hyperlipidaemia, and cancer), initially diagnosed between waves 2 and 12, were considered. Cox proportional hazards models were estimated to examine their associations with educational level, adjusted for baseline SES and health behaviour. Educational inequalities were measured by the relative indices of inequality (RII).

Results

Lower educational level was associated with higher incidences of diabetes and stroke among both men and women, and with hypertension only among women. After controlling for baseline SES, health behaviour, and regional areas, the RII ranged from 1.37 (95% confidence interval [CI]: 1.02–1.85) for stroke among men to 2.65 (95% CI, 2.09–3.36) for diabetes among women. Small to moderate parts (0.0–32.7%) of the RII were explained by baseline SES and health behaviour. A negative association with education was observed for diabetes and hypertension among women.

Conclusions

Results underscored the importance of educational level as a predictor of the incidences of selected NCDs, especially among women, with limited mediating effects of other SES and health behaviour.

The Association Between Education and Smoking Prevalence, Independent of Occupation: A Nationally Representative Survey in Japan

Background

Higher smoking prevalence in less educated persons and manual workers is well known. This study examines the independent relationship of education and occupation with tobacco use.

Methods

We used anonymized data from a nationwide population survey (30,617 men and 33,934 women). Education was divided into junior high school, high school, or university attainment. Occupation was grouped into upper non-manual, lower non-manual, and manual. Poisson regression models stratified by age and gender were used to estimate adjusted prevalence ratio (PR) and 95% confidence interval (CI) for current smoking.

Results

After adjustment for covariates, education, and occupation, education was significantly related to current smoking in both genders; compared to university graduates, PRs of junior high school graduates aged 20–39, 40–64, and ≥65 were 1.74 (95% CI, 1.53–1.98), 1.50 (95% CI, 1.36–1.65), and 1.28 (95% CI, 1.08–1.50) among men, and 3.54 (95% CI, 2.92–4.30), 2.72 (95% CI, 2.29–3.23), and 1.74 (95% CI, 1.14–2.66) among women, respectively. However, significantly higher smoking prevalence in manual than in upper non-manual was found only in men aged 20–64; compared to upper non-manual, the PRs of manual workers aged 20–39, 40–64, and ≥65 were 1.11 (95% CI, 1.02–1.22), 1.18 (95% CI, 1.10–1.27), and 1.10 (95% CI, 0.89–1.37) among men, and 0.95 (95% CI, 0.75–1.20), 0.92 (95% CI, 0.75–1.12), and 0.46 (95% CI, 0.22–0.95) among women, respectively.

Conclusions

Independent of occupation, educational disparities in smoking existed, regardless of age and gender. Occupation-smoking relationship varied with age and gender. Our study suggests that we should pay attention to social inequality in smoking as well as national smoking prevalence.

Association of Financial Burden With Self-Rated and Mental Health in Older Adults With Cancer

Objective: Financial problems in cancer survivors are associated with distress and reduced quality of life. Most studies have been cross-sectional, and a longitudinal study is needed to guide clinical interventions. Method: We used data from two surveys of the National Health and Aging Trends Study (NHATS). Participants (n = 307) reported whether they experienced six indicators of financial burden. The Patient Health Questionnaire 4 assessed depressive symptoms and general anxiety. Cross-lagged panel analyses assessed whether financial burden predicted distress and health or vice versa. Results: In the total sample, financial burden at the first survey predicted depressive symptoms (p < .01), general anxiety (p < .01), and self-rated health (p < .01) at the second survey. Depressive symptoms, general anxiety, and self-rated health at the first survey did not predict later financial burden (ps > .05). Discussion: Results suggest financial problems predict later distress and poor health. This study highlights the need to address financial burden in cancer survivors.