| 1. |
- Fukuda, Yoshiharu, et al.
(författare)
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Association of income with symptoms, morbidities, and healthcare usage among Japanese adults
- 2011
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Ingår i: Environmental Health and Preventive Medicine. - : Springer Science and Business Media LLC. - 1342-078X .- 1347-4715. ; 17:4, s. 299-306
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Socioeconomic inequalities in healthcare services are major public health and healthcare concerns. We have examined the association of income with symptoms, morbidities and healthcare usage in a national sample of the Japanese population.Methods: For this study, data compiled on 21,929 men and 24,620 women from the Comprehensive Survey of the Living Conditions of People on Health and Welfare in 2007 were assessed. Among the survey respondents with symptoms, we compared the prevalences of symptoms and treatments and the number of respondents who received treatments for 16 groups of symptoms and disorders according to household income, from the highest to the lowest, using the relative index of inequalities (RII). The RIIs were computed by age groups [25–59 years (young group) and 60+ years (senior group)].Results: People with lower incomes had higher prevalences of symptoms and treatments for most of the disorders examined. The RIIs of symptoms and treatments were 1.19 [95% confidence interval (CI) 1.09–1.31] and 1.04 (95% CI 0.93–1.16) for the young group and 1.69 (1.53–1.87) and 1.51 (1.36–1.67) for the senior group, respectively. In terms of treatment prevalence among those with symptoms, the RII was not significantly lower than 1.0 except for a few disorders in the young group.Conclusions: Our results indicate that income inequalities can be related to the prevalences of various symptoms and morbidities in our Japanese sample population and that these inequalities were greater in the senior group than in the young group. Our results also suggest that lower income is not a substantial barrier to the use of healthcare services by older Japanese individuals, while it is related to lower healthcare usage by individuals of working age.
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| 2. |
- Fukuda, Yoshiharu, et al.
(författare)
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Associations of household expenditure and marital status with cardiovascular risk factors in Japanese adults : analysis of nationally representative surveys
- 2013
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Ingår i: Journal of Epidemiology. - Fokuoka, Japan : Japan Epidemiological Association. - 0917-5040 .- 1349-9092. ; 23:1, s. 21-7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Socioeconomic inequalities in health and social determinants of health are important issues in public health and health policy. We investigated associations of cardiovascular risk factors with household expenditure (as an indicator of socioeconomic status) and marital status in Japan.Methods: We combined data from 2 nationally representative surveys-the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, 2003-2007-and analyzed sex-specific associations of household expenditure quartiles and marital status with cardiovascular risk factors, including obesity, hypertension, dyslipidemia, and diabetes, among 6326 Japanese adults (2664 men and 3662 women) aged 40 to 64 years.Results: For men, there was no statistically significant association between household expenditure and cardiovascular risk factors. For women, lower household expenditure was significantly associated with obesity, hypertension, diabetes, and the presence of multiple risk factors: the ORs for the lowest versus the highest quartile ranged from 1.39 to 1.71. In a comparison of married and unmarried participants, the prevalence of cardiovascular risk factors was higher among married women and lower among married men.Conclusions: Lower socioeconomic status, as indicated by household expenditure, was associated with cardiovascular risk factors in Japanese women. Socioeconomic factors should be considered in health promotion and prevention of cardiovascular disease.
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| 3. |
- Fukuda, Yoshiharu, et al.
(författare)
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High quality nutrient intake is associated with higher household expenditures by Japanese adults
- 2012
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Ingår i: Bioscience trends. - Tokyo, Japan : International Advancement Center for Medicine & Health Research Co., Ltd.. - 1881-7823 .- 1881-7815. ; 6:4, s. 176-82
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Tidskriftsartikel (refereegranskat)abstract
- There is little evidence of socioeconomic differences in dietary intake in the Japanese population. This study examined the association between household expenditures and dietary intake using nationally representative surveys of Japan. We analyzed data from the Comprehensive Survey of Living Conditions and National Health and Nutrition Survey, 2003-2007. For subjects ages 18 to 74 years (11,240 men and 11,472 women), the sex-specific association between household expenditure quartiles and selected nutrient intake was examined using comparison of means and prevalence of a healthy intake. Higher household expenditures were associated with an increase in the mean levels of total energy, fat, protein, carbohydrates, calcium, vitamins A and C, niacin, and fiber for both men and women and salt for men. Prevalence comparison indicated that most of the recommendations for dietary intake were met for people with higher household expenditures than for those with lower household expenditures. There was no clear association between fat intake and expenditures. Higher household expenditures were associated with a healthy and balanced nutrient intake in Japanese adults. The findings suggest that socioeconomic differences in dietary patterns contribute to socioeconomic inequalities in mortality and morbidity in Japan.
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| 4. |
- Fukuda, Yoshiharu, et al.
(författare)
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Influences of income and employment on psychological distress and depression treatment in Japanese adults
- 2011
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Ingår i: Environmental Health and Preventive Medicine. - Tokyo, Japan : Springer. - 1342-078X .- 1347-4715. ; 17:1, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Psychological distress is a health issue of critical importance, especially in people of working age in developed countries, including Japan. This study examined the relationships of income and employment arrangement with psychological distress and treatment of depression in a national sample of Japanese adults.Methods: Data for 10,959 men and 11,655 women 25–59 years of age, obtained from the Comprehensive Survey of the Living Conditions of People on Health and Welfare in 2007, were examined. Health outcomes were psychological distress measured by the Japanese version of the K6, subjective complaints and medical treatment of depression. Explanatory variables included marital status, employment arrangement, and household income. The relationships between health outcomes and explanatory variables were examined using multiple logistic regression analyses.Results: Lower income and unemployment were associated with a higher prevalence of psychological distress and treatment of depression. The association between psychological distress and income showed a threshold: the lowest income quintile had an especially high prevalence, while other quintiles had similar prevalences. The prevalence of depression treatment in those with psychological distress was significantly lower in the highest income quintile than in all the other income groups, and the prevalence was also significantly lower in employed than in unemployed respondents.Conclusions: This study showed clear relationships of lower income and unemployment with psychological distress and depression treatment. It has been suggested that people with higher socioeconomic status and full-time work may be reluctant to consult professionals and receive medical treatment, despite their psychological distress. Comprehensive mental health interventions are required to prevent psychological distress in all socioeconomic strata of the population.
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| 5. |
- Hiyoshi, Ayako, 1972-, et al.
(författare)
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A new theory-based social classification in Japan and its validation using historically collected information
- 2013
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Ingår i: Social Science and Medicine. - Oxford, United Kingdom : Pergamon-Elsevier Ltd.. - 0277-9536 .- 1873-5347. ; 87, s. 84-92
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Tidskriftsartikel (refereegranskat)abstract
- Studies of health inequalities in Japan have increased since the millennium. However, there remains a lack of an accepted theory-based classification to measure occupation-related social position for Japan. This study attempts to derive such a classification based on the National Statistics Socio-economic Classification in the UK. Using routinely collected data from the nationally representative Comprehensive Survey of the Living Conditions of People on Health and Welfare, the Japanese Socioeconomic Classification was derived using two variables - occupational group and employment status. Validation analyses were conducted using household income, home ownership, self-rated good or poor health, and Kessler 6 psychological distress (n ≈ 36,000). After adjustment for age, marital status, and area (prefecture), one step lower social class was associated with mean 16% (p < 0.001) lower income, and a risk ratio of 0.93 (p < 0.001) for home ownership. The probability of good health showed a trend in men and women (risk ratio 0.94 and 0.93, respectively, for one step lower social class, p < 0.001). The trend for poor health was significant in women (odds ratio 1.12, p < 0.001) but not in men. Kessler 6 psychological distress showed significant trends in men (risk ratio 1.03, p = 0.044) and in women (1.05, p = 0.004). We propose the Japanese Socioeconomic Classification, derived from basic occupational and employment status information, as a meaningful, theory-based and standard classification system suitable for monitoring occupation-related health inequalities in Japan.
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| 6. |
- Hiyoshi, Ayako, 1972-, et al.
(författare)
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Health inequalities in Japan : the role of material, psychosocial, social relational and behavioural factors
- 2014
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Ingår i: Social Science and Medicine. - Oxford, United Kingdom : Pergamon-Elsevier Science Ltd. - 0277-9536 .- 1873-5347. ; 104, s. 201-209
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Tidskriftsartikel (refereegranskat)abstract
- The extent that risk factors, identified in Western countries, account for health inequalities in Japan remains unclear. We analysed a nationally representative sample (Comprehensive Survey of Living Conditions surveyed in 2001 (n = 40,243)). The cross-sectional association between self-rated fair or poor health and household income and a theory-based occupational social class was summarised using the relative index of inequality [RII]. The percentage attenuation in RII accounted for by candidate contributory factors - material, psychosocial, social relational and behavioural - was computed. The results showed that the RII for household income based on self-rated fair or poor health was reduced after including the four candidate contributory factors in the model by 20% (95% CI 2.1, 43.6) and 44% (95% CI 18.2, 92.5) in men and women, respectively. The RII for the Japanese Socioeconomic Classification [J-SEC] was reduced, not significantly, by 22% (95% CI -6.3, 100.0) in men in the corresponding model, while J-SEC was not associated with self-rated health in women. Material factors produced the most consistent and strong attenuation in RII for both socioeconomic indicators, while the contributions attributable to behaviour alone were modest. Social relational factors consistently attenuated the RII for both socioeconomic indicators in men whereas they did not make an independent contribution in women. The influence of perceived stress was inconsistent and depended on the socioeconomic indicator used. In summary, social inequalities in self-rated fair or poor health were reduced to a degree by the factors included. The results indicate that the levelling of health across the socioeconomic hierarchy needs to consider a wide range of factors, including material and psychosocial factors, in addition to the behavioural factors upon which the current public health policies in Japan focus. The analyses in this study need to be replicated using a longitudinal study design to confirm the roles of different factors in health inequalities.
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| 7. |
- Hiyoshi, Ayako, 1972-, et al.
(författare)
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Inequalities in self-rated health in Japan 1986-2007 according to household income and a novel occupational classification : national sampling survey series
- 2013
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Ingår i: Journal of Epidemiology and Community Health. - London, United Kingdom : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 67:11, s. 960-5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Japan, for the past two decades, has seen economic stagnation and substantial social change. We examined whether health inequalities increased over this period.Methods: Using eight triennial waves of a series of large nationally representative surveys between 1986 and 2007 (n=398 303), temporal trends in relative and slope indices of inequality (RII, SII, respectively) were tested based on self-rated health in relation to theory-based social class and household income.Results: Age-standardised prevalence of self-rated fair or poor health showed V-shaped time trends in both sexes with the lowest prevalence in early/mid-1990s. In 1986, RII and SII in household social class and income were significant for both sexes. In men, RII and SII according to income showed significant narrowing of temporal trends in poor health (-1.4% and -0.1% annually, respectively), but these were stable in women. After multilevel multiple imputation for missing income data, the findings in men were not altered but narrowing trends became evident and significant in women (-1% and -0.1% annually, respectively). Inequality indices for social class remained constant over the study period in both sexes.Conclusions: Relative and absolute health inequalities for social class and income based on self-rated fair or poor health narrowed or remained stable between 1986 and 2007, despite the economic stagnation and adverse social changes. Overall population health across socioeconomic groups initially improved but then worsened. The positive finding regarding the health inequality trend seen in the Japanese context is informative for the wider international community during this period of economic uncertainty.
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