TY - JOUR
T1 - Influence of Municipal- and Individual-level Socioeconomic Conditions on Mortality in Japan
AU - Honjo, Kaori
AU - Iso, Hiroyasu
AU - Fukuda, Yoshiharu
AU - Nishi, Nobuo
AU - Nakaya, Tomoki
AU - Fujino, Yoshihisa
AU - Tanabe, Naohito
AU - Suzuki, Sadao
AU - Subramanian, S. V.
AU - Tamakoshi, Akiko
N1 - Funding Information:
Acknowledgments This study was supported by grants-in-aid for scientific research from the Ministry of Education, Science, Sports, and Culture of Japan (Monbusho): 61010076, 62010074, 63010074, 1010068, 2151065, 3151064, 4151063, 5151069, 6279102, 11181101, 17015022, 18014011, and 20014026. The authors thank all staff members who were involved in this study for their valuable help in conducting the baseline survey and follow-up. Members of the Japan Study (JACC Study) Group are as follows: Dr. Akiko Tamakoshi (present chairperson of the study group), Aichi Medical University School of Medicine; Drs. Mitsuru Mori and Fumio Sakauchi, Sapporo Medical University School of Medicine; Dr. Yutaka Motohashi, Akita University School of Medicine; Dr. Ichiro Tsuji, Tohoku University Graduate School of Medicine; Dr. Yosikazu Nakamura, Jichi Medical School; Dr. Hiroyasu Iso, Osaka University School of Medicine; Dr. Haruo Mikami, Chiba Cancer Center; Dr. Michiko Kurosawa, Juntendo University School of Medicine; Dr. Yoshiharu Hoshiyama, University of Human Arts and Sciences; Dr. Naohito Tanabe, Niigata University School of Medicine; Dr. Koji Tamakoshi, Nagoya University Graduate School of Health Science; Dr. Kenji Wakai, Nagoya University Graduate School of Medicine; Dr. Shinkan Tokudome, National Institute of Health and Nutrition; Dr. Koji Suzuki, Fujita Health University School of Health Sciences; Dr. Shuji Hashimoto, Fujita Health University School of Medicine; Dr. Shogo Kikuchi, Aichi Medical University School of Medicine; Dr. Yasuhiko Wada, Faculty of Human Life and Environmental Science, Kochi Women's University; Dr. Takashi Kawamura, Kyoto University Center for Student Health; Dr. Yoshiyuki Watanabe, Kyoto Prefectural University of Medicine Graduate School of Medical Science; Dr. Kotaro Ozasa, Radiation Effects Research Foundation; Dr. Tsuneharu Miki, Kyoto Prefectural University of Medicine Graduate School of Medical Science; Dr. Chigusa Date, Faculty of Human Environmental Sciences, Nara Women's University; Dr. Kiyomi Sakata, Iwate Medical University; Dr. Yoichi Kurozawa, Tottori University Faculty of Medicine; Dr. Takesumi Yoshimura, Fukuoka Institute of Health and Environmental Sciences; Dr. Yoshihisa Fujino, University of Occupational and Environmental Health; Dr. Akira Shibata, Kurume University School of Medicine; Dr. Naoyuki Okamoto, Kanagawa Cancer Center; and Dr. Hideo Shio, Moriyama Municipal Hospital.
Funding Information:
This study used a cohort of 110,792 individuals (46,465 men and 64,327 women) aged 40 to 79 living in 45 municipalities across Japan who participated in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) sponsored by the Ministry of Education, Science, Sports, and Culture. In 22 of 45 areas, we invited all residents living in the given target area to be study subjects. In the other areas, the study subjects consisted of health checkup examinees plus volunteers. During 1988–1990, study participants completed self-administered questionnaires, including aspects of lifestyle and medical history of cardiovascular disease and cancer at baseline. Response rates were approximately 83 % [19]. The vital status of each participant was followed using data held at regional health centers, with permission from the Ministry of Public Management, Home Affairs, Post and Telecommunications of Japan to review population registration entries and death certificates. Details of the study procedure were described previously [19, 20].
Publisher Copyright:
© 2013, International Society of Behavioral Medicine.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background: The health effect of area socioeconomic conditions has been evident especially in Western countries; however, limited research has focused on the effect of municipal-level socioeconomic conditions, especially in Asia.Purpose: Multilevel research using data from the Japan Collaborative Cohort Study, a large cohort study followed from 1990 to 2006, was conducted to examine individual as well as municipal socioeconomic conditions on risk of death, adjusting for each other.Conclusion: Municipal and individual socioeconomic conditions were independently and interactively associated with premature death; this suggests that reducing social inequalities in health demands a focus on municipal conditions in addition to those of individuals.Method: We included 24,460 men and 32,649 women aged 40 to 65 years at baseline in 35 municipalities as our study population. Primary predictors were municipal socioeconomic conditions (proportion of college graduates, per capita income, unemployment rate, and proportion of households receiving public assistance) and individual socioeconomic conditions (education level and occupation).Results: Among men, the multilevel logistic estimate (standard errors) of proportion of college graduates and unemployment rate for mortality from cardiovascular disease were −0.399 (0.094) and −0.343 (0.122), respectively. Among women, the multilevel logistic estimate (standard errors) of proportion of college graduates and per capita annual income for mortality from injuries were −0.386 (0.171) and −1.069 (0.407). Individual education level and occupation were associated with all-cause mortality, in particular, mortality from cardiovascular disease or injuries. Interactions between individual education level and indicators of municipal socioeconomic conditions were observed for mortality from cancer and cardiovascular disease among men and mortality from injuries among women.
AB - Background: The health effect of area socioeconomic conditions has been evident especially in Western countries; however, limited research has focused on the effect of municipal-level socioeconomic conditions, especially in Asia.Purpose: Multilevel research using data from the Japan Collaborative Cohort Study, a large cohort study followed from 1990 to 2006, was conducted to examine individual as well as municipal socioeconomic conditions on risk of death, adjusting for each other.Conclusion: Municipal and individual socioeconomic conditions were independently and interactively associated with premature death; this suggests that reducing social inequalities in health demands a focus on municipal conditions in addition to those of individuals.Method: We included 24,460 men and 32,649 women aged 40 to 65 years at baseline in 35 municipalities as our study population. Primary predictors were municipal socioeconomic conditions (proportion of college graduates, per capita income, unemployment rate, and proportion of households receiving public assistance) and individual socioeconomic conditions (education level and occupation).Results: Among men, the multilevel logistic estimate (standard errors) of proportion of college graduates and unemployment rate for mortality from cardiovascular disease were −0.399 (0.094) and −0.343 (0.122), respectively. Among women, the multilevel logistic estimate (standard errors) of proportion of college graduates and per capita annual income for mortality from injuries were −0.386 (0.171) and −1.069 (0.407). Individual education level and occupation were associated with all-cause mortality, in particular, mortality from cardiovascular disease or injuries. Interactions between individual education level and indicators of municipal socioeconomic conditions were observed for mortality from cancer and cardiovascular disease among men and mortality from injuries among women.
KW - Geographic context
KW - Japan
KW - Mortality
KW - Socioeconomic condition
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U2 - 10.1007/s12529-013-9337-7
DO - 10.1007/s12529-013-9337-7
M3 - Article
C2 - 24057408
AN - SCOPUS:84919904822
VL - 21
SP - 737
EP - 749
JO - International Journal of Behavioral Medicine
JF - International Journal of Behavioral Medicine
SN - 1070-5503
IS - 5
ER -