Economic recession and health inequalities in Japan: analysis with a national sample, 1986-2001.
OBJECTIVE
Little is known about whether economic crises widen health inequalities. Japan experienced more than 10 years of economic recession beginning in the 1990s. The question of whether socioeconomic-based inequality in self-rated health widened after the economic crisis was examined.


METHODS
Repeated cross-sectional survey design. Two pooled datasets from 1986 and 1989 and from 1998 and 2001 were analysed separately, and temporal change was examined. The study took place in Japan among the working-age population (20-60 years old). The two surveys consisted of 168 801 and 150 016 people, respectively, with about an 80% response rate.


RESULTS
The absolute percentages of people reporting poor health declined across all socioeconomic statuses following the crisis. However, after controlling for confounding factors, the odds ratio (OR) for poor self-rated health (95% confidence intervals) among middle-class non-manual workers (clerical/sales/service workers) compared with the highest class workers (managers/administrators) was 1.02 (0.92 to 1.14) before the crisis but increased to 1.14 (1.02 to 1.29) after the crisis (p for temporal change = 0.02). The association was stronger among males. The adjusted ORs among professional workers and young female homemakers also marginally increased over time. Unemployed people were twice as likely to report poor health compared with the highest class workers throughout the period. Self-rated health of people with middle to higher incomes deteriorated in relative terms following the crisis compared with that of lower income people.


CONCLUSIONS
Self-rated health improved in absolute terms for all occupational groups even after the economic recession. However, the relative disparity increased between the top and middle occupational groups in men.
Kondo
N
N
Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA. nkondo@hsph.harvard.edu
Subramanian
S V
SV
Kawachi
I
I
Takeda
Y
Y
Yamagata
Z
Z
D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004467:Economics; D005260:Female; D006304:Health Status; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data / Q000639:trends; D055815:Young Adult
Soc Sci Med. 1997 Mar;44(6):757-71
9080560
Occup Environ Med. 2000 Apr;57(4):284-5
10819565
Nihon Ronen Igakkai Zasshi. 1999 Jul;36(7):472-8
10536454
J Health Soc Behav. 1997 Mar;38(1):21-37
9097506
J Epidemiol Community Health. 2004 Apr;58(4):308-14
15026444
BMJ. 2000 Sep 2;321(7260):528
10968804
Lancet. 2006 Apr 8;367(9517):1143
16616555
Soc Sci Med. 2004 Sep;59(6):1287-95
15210099
Biosci Trends. 2007 Aug;1(1):38-42
20103865
J Epidemiol. 2006 Nov;16(6):223-32
17085872
J Epidemiol Community Health. 2000 Jun;54(6):437-43
10818119
Int J Epidemiol. 2005 Dec;34(6):1291-301
16338946
Public Health. 2006 Oct;120(10):966-75
16949626
Soc Sci Med. 2005 Dec;61(11):2280-92
16115712
Lancet. 2006 Feb 4;367(9508):383
16463440
BMJ. 1998 Oct 3;317(7163):917-21
9756809
Suicide Life Threat Behav. 2005 Apr;35(2):227-37
15843339
Soc Sci Med. 2005 Jun;60(12):2865-75
15820592
Soc Sci Med. 2004 Jul;59(1):69-81
15087144
Crisis. 2005;26(1):12-9
15762079
Lancet. 1999 Oct 9;354(9186):1273
10520646
J Health Soc Behav. 1997 Mar;38(1):38-54
9097507
Soc Sci Med. 2003 Dec;57(12):2281-9
14572837
BMJ. 1989 Dec 23-30;299(6715):1547-51
2514896
Soc Sci Med. 1997 Mar;44(6):789-99
9080562
J Epidemiol Community Health. 2002 Jun;56(6):434-5
12011199
Soc Sci Med. 2004 Mar;58(6):1159-70
14723910
Health Policy Plan. 2003 Jun;18(2):172-81
12740322
BMJ. 2002 Jan 5;324(7328):16-9
11777798
J Atheroscler Thromb. 2006 Aug;13(4):202-8
16908953