title: [Differences in factors associated with health checkup participation between persons with differing income levels. A cross-sectional analysis using residential taxation as a measure of household income].
abstract: OBJECTIVE
  Health insurers in Japan are required to provide health checkups specifically designed to detect signs of metabolic syndrome. Since National Health Insurance organizations have been increasing their numbers of low-income beneficiaries, this observational study was carried out to investigate the differences between persons with differing household income levels based on the factors associated with their participation in health checkups.
  
  
  METHODS
  The data source for this study was a database of scored answers in collected, unsigned questionnaires provided by the National Health Insurance of Sapporo City. The survey was conducted in 2009, approaching 3000 beneficiaries aged 40-74 years and sampling 4 groups divided by household income and participation in the 2008 health checkup. The survey included questions about demographics, awareness of the details of the health checkup, and knowledge of lifestyle-related diseases. Valid answers from 1656 respondents were analyzed using multiple logistic regression analysis.
  
  
  RESULTS
  After analyzing the level of awareness of health checkup details among subjects and its association with checkup participation, knowledge of the locations where the checkups were held showed the highest adjusted odds ratios. Multivariate logistic regression analysis showed that the following factors were associated with participation in checkups in both lower- and higher-income groups: previous and regular participation in health checkups, willingness to attend the next checkup, and status of family or friends regarding checkup participation. In addition, that a substantial out-of-pocket cost for the checkup was not levied had a significant relationship with checkup attendance in lower-income beneficiaries, while personal obligation to undergo regular health checkups regardless of the busyness of their schedules was found to have a significant relationship in higher-income beneficiaries. In addition, logistic models that excluded factors of previous and future health checkup participation indicated that participation in health checkups in the lower-income group was associated with an interest in health checkup test items, smoking habits, and the perception of the importance of undergoing health checkups even without specific symptoms, while an interest in healthy lifestyles was found to have a significant relationship with participation in health checkups in the higher-income group.
  
  
  CONCLUSIONS
  The study showed that awareness of checkup locations and regular attendance at health check-ups are strongly related to participation. Some differences in factors associated with health checkup participation were detected among individuals with differing income levels.
authors: Office of Education, Hokkaido Government.
authors: Eri
authors: E
authors: Tsukishima
authors: Kyoko
authors: K
authors: Takahashi
authors: Koichi
authors: K
authors: Yano
authors: Mitsuru
authors: M
authors: Mori
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D007564:Japan; D008875:Middle Aged; D010808:Physical Examination / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013660:Taxes