Individualized and institutionalized residential place-based discrimination and self-rated health: A cross-sectional study of the working-age general population in Osaka city, Japan

Takahiro Tabuchi, Tomoki Nakaya, Wakaba Fukushima, Ichiro Matsunaga, Satoko Ohfuji, Kyoko Kondo, Miki Inui, Yuka Sayanagi, Yoshio Hirota, Eiji Kawano, Hiroyuki Fukuhara

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Background: Several studies have reported that individualized residential place-based discrimination (PBD) affects residents' health. However, studies exploring the association between institutionalized PBD and health are scarce, especially in Asian countries including Japan. Methods. A cross-sectional study was conducted with random two-stage sampling of 6191 adults aged 25-64 years in 100 census tracts across Osaka city in 2011. Of 3244 respondents (response rate 52.4%), 2963 were analyzed using multilevel logistic regression to examine the association of both individualized and institutionalized PBD with self-rated health (SRH) after adjustment for individual-level factors such as socioeconomic status (SES). An area-level PBD indicator was created by aggregating individual-level PBD responses in each tract, representing a proxy for institutionalized PBD, i.e., the concept that living in a stigmatized neighborhood affects neighborhood health. 100 tracts were divided into quartiles in order. The health impact of area-level PBD was compared with that of area-level SES indicators (quartile) such as deprivation. Results: After adjustment for individual-level PBD, the highest and third area-level PBD quartiles showed odds ratio (OR) 1.57 (95% credible interval: 1.13-2.18) and 1.38 (0.99-1.92), respectively, for poor SRH compared with the lowest area-level PBD quartile. In a further SES-adjusted model, ORs of area-level PBD (highest and third quartile) were attenuated to 1.32 and 1.31, respectively, but remained marginally significant, although those of the highest area-level not-home-owner (census-based indicator) and deprivation index quartiles were attenuated to 1.26 and 1.21, respectively, and not significant. Individual-level PBD showed significant OR 1.89 (1.33-2.81) for poor SRH in an age, sex, PBD and SES-adjusted model. Conclusion: Institutionalized PBD may be a more important environmental determinant of SRH than other area-level SES indicators such as deprivation. Although it may have a smaller health impact than individualized PBD, attention should be paid to invisible and unconscious aspects of institutionalized PBD to improve residents' health.

Original languageEnglish
Article number449
JournalBMC Public Health
Volume14
Issue number1
DOIs
Publication statusPublished - 2014 May 13

Keywords

  • Individualized and institutionalized pathways
  • Multilevel analysis
  • Osaka city in Japan
  • Place-based discrimination
  • Self-rated health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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