Municipal socioeconomic status and mortality in Japan: sex and age differences, and trends in 1973-1998.
The purpose of this study was to examine the sex and age differences and the time trends in the association between municipal socioeconomic status (SES) and all-cause mortality across Japan from 1973 to 1998. Sex-specific mortality of municipalities (N=3319 in 1995) by age groups (total, under 75-year, and over 75-year populations) was linked to municipal SES indicators related to income, education, unemployment and living space, and two SES composite indices formulated by principle component analysis (Index 1 related to lower income and education, and Index 2 related to unemployment and overcrowding). The relation was assessed using mortality gradients by SES quintiles and Bayesian hierarchical Poisson regression. The results showed that a lower SES was related to higher mortality for all SES indicators and composite indices. The mortality gradient was steeper for the under 75-year population than the total and over 75-year populations, and the relation between mortality and income- and education-related indicators/index was stronger for males than for females. The time trend showed an increase in the relation for Index 2, while a decrease for Index 1. This study demonstrated that lower municipal SES had an adverse influence on population health, and the influence was marked for males and premature death. Although a substantial health disadvantage still remained in lower SES areas, the impact of SES factors on geographical health variation changed over time; the association with mortality has weakened for income and education, while it has strengthened for unemployment and living space.
Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Yoshiharu
Y
Fukuda
Keiko
K
Nakamura
Takehito
T
Takano
D017677:Age Distribution; D000368:Aged; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009026:Mortality / Q000639:trends*; D012044:Regression Analysis; D017678:Sex Distribution; D012923:Social Class; D014504:Urban Health / Q000706:statistics & numerical data / Q000639:trends*