title: Effects of socioeconomic status on physical and mental health of hemodialysis patients in Japan: differences by age, period, and cohort.
abstract: OBJECTIVE
  Whether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients.
  
  
  METHODS
  Data were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients' association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors.
  
  
  RESULTS
  Relative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or depressive symptoms.
  
  
  CONCLUSIONS
  The number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period.
authors.affiliation: Graduate School of Gerontology, J.F. Oberlin University, Machida.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Sugisawa
authors.affiliation: Faculty of Nursing, The Jikei University School of Medicine, Chofu.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: School of Nursing, Osaka City University, Osaka.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Kumagai
authors.affiliation: Hachioji Azumacho Clinic, Hachioji.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sugisaki
authors.affiliation: Sapporo Kita Clinic, Sapporo.
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohira
authors.affiliation: Kawakita General Hospital, Suginami, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Shinoda
keywords: complications; cross classified random effects model; depressive symptoms; income status; raking adjustment