title: Socioeconomic status and self-rated health of Japanese people, based on age, cohort, and period.
abstract: Differences in health resulting from differences in socioeconomic status (SES) have been identified around the world. Age, period, and cohort (A-P-C) differences in health are vital factors which are associated with disparities in SES. However, few studies have examined these differences simultaneously. Moreover, although self-rated health (SRH) has been frequently used as an indicator of health, biases in reporting SRH that depend on the socioeconomic characteristics of respondents have been scarcely adjusted in the previous studies. To overcome these limitations, we investigated the associations between disparities in SES and adjusted SRH based on A-P-C, by using a repeated, cross-sectional survey of a nationally representative sample of Japanese people. In addition, we further investigated how exogenous (macroeconomic) conditions unique to a period or cohort would explain trends across successive periods and cohorts.
  
  
  
  Data were obtained from a sample of 653,132 Japanese people that responded to the Comprehensive Survey of Living Conditions (CSLC), which is a cross-sectional survey that had been conducted every three years from 1986 to 2013, on over 10 occasions. In the CSLC, SES has been assessed by household income. We simultaneously controlled for each A-P-C dimension by using the model for cross-classification of random effects, and adjusting SRH data for reporting biases caused by differences in income and A-P-C.
  
  
  
  Differences in adjusted SRH associated with income differences decreased with age and reversed after 76 years of age. Period differences indicated that income differences peaked in 1992 and 2007. Moreover, differences in adjusted SRH associated with income differences decreased in periods with high unemployment across all periods. Furthermore, there were no cohort differences in adjusted SRH that were associated with income differences.
  
  
  
  In Japan, there are age and period variations associated with adjusted differences in SRH as assessed by income. Moreover, exogenous conditions in each period could help explain periodic trends across successive periods.
authors.affiliation: Graduate School of Gerontology, J. F. Oberlin University, 3758 Tokiwa-machi, Machida-shi, Tokyo, 194-0294 Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Sugisawa
authors.affiliation: Jissen Women's University, 1-1-49 Higashi, Shibuya-ku, Tokyo, 150-8538 Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Harada
authors.affiliation: Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, 192-0397 Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Sugihara
authors.affiliation: Tokushima University, 3-18-15 Kuramoto-cho, Tokushima-shi, Tokushima 770-8503 Japan.
authors.forename: Shizuko
authors.initials: S
authors.lastname: Yanagisawa
authors.affiliation: Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015 Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Shinmei
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005191:Family Characteristics; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D007564:Japan; D008297:Male; D008875:Middle Aged; D012923:Social Class; D012924:Social Conditions; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Adjusted self-rated health; Age-period-cohort; Health inequalities; Income differences; Japan; Model for cross-classified random effects