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Title: Health inequalities in Japan between 1986 and 2007
Author: Hiyoshi, A.
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2013
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Background: Despite concerns about widening social inequalities during the past 20 years of economic stagnation in Japan, evidence on health inequalities is sparse. Whether health inequalities are widening or narrowing, and what factors contribute to inequalities, remains unclear. Aim: To describe temporal trends in health inequalities between 1986 and 2007 and to investigate the contribution of material, behavioural, psychosocial and social relational factors to health inequalities in Japan. Methods: A series of eight triennial nationally representative sample surveys was analysed (n=398,303). Household income and a novel theory-driven social classification were used to calculate trends in relative and slope indices of inequality [RII and SII, respectively] in self-rated fair or poor [suboptimal] health. The contribution of mediating factors to the social gradient in suboptimal health was investigated in the 2001 sample. Results: In men, temporal trends in income RII narrowed over the period (RII declined 1.2% per year, p=0.008). Stable inequalities were observed in women’s income SII. Men’s income SII and women’s income RII showed marginally significant narrowing time trends. Inequalities by social class were constant in both genders. After imputation for missing household income, narrowing trends in income RII and SII were evident (annual declines: men 1.2%, women 1.1% for RII; both genders 0.1% for SII; all p<0.05, n=490,632). Overall, there were V-shaped time trends in age-standardised self-rated suboptimal health in both genders (quadratic term: men p<0.001, women p=0.005), with the lowest prevalence in early/mid 1990s. Mediating factors analysed altogether accounted for 20% in men’s and 44% in women’s income inequalities in self-rated suboptimal health in 2001. Conclusions: Health inequalities according to household income showed narrowing trends, but persisted over the study period. The prevalence of suboptimal health increased since the early/mid 1990s. Changes in the distribution of mediating factors over the period might have influenced the time trends observed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available