Inequalities in self-rated health in Japan 1986-2007 according to household income and a novel occupational classification: national sampling survey series
Inequalities in self-rated health in Japan 1986-2007 according to household income and a novel occupational classification: national sampling survey series
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DOI：
10.1136/jech-2013-202608
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发表时间：
2013-11-01
影响因子：
6.3
通讯作者：
Brunner, Eric J.
中科院分区：
文献类型：
--
作者：
Hiyoshi, Ayako;Fukuda, Yoshiharu;Brunner, Eric J.
背景日本在过去的二十年里经历了经济停滞和重大的社会变革。方法利用1986年至2007年期间八次三年一次的大型全国代表性调查，（n=398303），不平等的相对和斜率指数的时间趋势（RII，SII，分别）进行了测试的基础上自测健康与理论为基础的社会阶层和家庭收入。被评为健康状况一般或较差的人在男女两性中均呈V形时间趋势，1990年代早期/中期的流行率最低。1986年，家庭社会阶层和收入的RII和SII对男女都有显著影响。在男性中，按收入划分的RII和SII显示健康状况不佳的时间趋势显著缩小（每年分别为-1.4%和-0.1%），但在女性中保持稳定。在对缺失的收入数据进行多级多重插补后，男性的调查结果没有改变，但女性的缩小趋势变得明显和显著（每年分别为-1%和-0.1%）。社会阶层的不平等指数在研究期间保持不变，在both sexual.Conclusions相对和绝对的健康不平等的社会阶层和收入的基础上自我评价的公平或不良的健康缩小或保持稳定，1986年至2007年，尽管经济停滞和不利的社会变化。各社会经济群体的总体人口健康状况最初有所改善，但随后恶化。在日本背景下看到的关于健康不平等趋势的积极调查结果在经济不确定时期为更广泛的国际社会提供了信息。
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=398303), 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.