title: Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study.
abstract: The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0-74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40-59-year-old men and 60-69-year-old women, and in duration of hospitalization among 40-59 and 60-69-year-olds of both sexes and 70-74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts.
authors.affiliation: Chiba University Graduate School of Medicine, Department of Public Health, Chiba City, Chiba, Japan.
authors.forename: Misuzu
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Chiba University Graduate School of Medicine, Department of Global Clinical Research, Chiba City, Chiba, Japan.|Chiba University Hospital, Clinical Research Center, Chiba City, Chiba, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Chiba University Graduate School of Medicine, Department of Global Clinical Research, Chiba City, Chiba, Japan.|Chiba University Hospital, Clinical Research Center, Chiba City, Chiba, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: Chiba University Hospital, Clinical Research Center, Chiba City, Chiba, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Chiba University Graduate School of Medicine, Department of Public Health, Chiba City, Chiba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hata
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009313:National Health Programs; D012189:Retrospective Studies; D014505:Urban Population / Q000706:statistics & numerical data