Hiyoshi, A;
(2013)
Health inequalities in Japan between 1986 and 2007.
Doctoral thesis (PhD), UCL (University College London).
Preview |
Text
Hiyoshi_Thesis__redacted.pdf Download (2MB) | Preview |
Abstract
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.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | PhD |
| Title: | Health inequalities in Japan between 1986 and 2007 |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Third party copyright material has been removed from ethesis. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/1400824 |
Archive Staff Only
 |
View Item |
