Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study.
Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study.
复制标题
DOI：
10.1371/journal.pone.0151690
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Hata A
中科院分区：
文献类型：
--
作者：
Fujita M;Sato Y;Nagashima K;Takahashi S;Hata A
这项回顾性队列研究的目的是分析日本收入水平和医疗保健可及性之间的关系。对2012年4月至2014年3月期间在千叶市申报国民健康保险、申报2012年1月1日至12月31日纳税期间收入的222，259名受试者（年龄范围，0-74岁）的数据进行了整合和分析。将家庭定义为一个簇群，使用广义估计方程来评估等效收入与住院和门诊服务利用和持续时间之间的关系。在所有年龄组的男女中，收入水平与门诊就诊率之间存在显著的正线性关系;然而，在某些低收入亚组中，观察到明显较高的住院率和较长的住院时间以及较长的门诊治疗时间。为了控制由于住院而导致的收入减少，排除了前一年住院的受试者，然后重新分析数据。40-59岁男性和60-69岁女性的住院率，以及40-59岁和60-69岁男性和70-74岁女性的住院时间仍存在显著的负相关。这些结果表明，在日本低收入的人有更差的门诊服务和更严重的健康状况比他们的高收入同行。
The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0–74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40–59-year-old men and 60–69-year-old women, and in duration of hospitalization among 40–59 and 60–69-year-olds of both sexes and 70–74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts.