Dataset Information

Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005.

ABSTRACT:

Objectives

To examine trends in social and geographic inequalities in all-cause premature adult mortality in Japan.

Design

Observational study of the vital statistics and the census data.

Setting

Japan.

Participants

Entire population aged 25 years or older and less than 65 years in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005. The total number of decedents was 984?022 and 532?223 in men and women, respectively.

Main outcome measures

For each sex, ORs and 95% CIs for mortality were estimated by using multilevel logistic regression models with 'cells' (cross-tabulated by age and occupation) at level 1, 8 years at level 2 and 47 prefectures at level 3. The prefecture-level variance was used as an estimate of geographic inequalities of mortality.

Results

Adjusting for age and time-trends, compared with production process and related workers, ORs ranged from 0.97 (95% CI 0.96 to 0.98) among administrative and managerial workers to 2.22 (95% CI 2.19 to 2.24) among service workers in men. By contrast, in women, the lowest odds for mortality was observed among production process and related workers (reference), while the highest OR was 12.22 (95% CI 11.40 to 13.10) among security workers. The degree of occupational inequality increased in both sexes. Higher occupational groups did not experience reductions in mortality throughout the period and was overtaken by lower occupational groups in the early 1990s, among men. Conditional on individual age and occupation, overall geographic inequalities of mortality were relatively small in both sexes; the ORs ranged from 0.87 (Okinawa) to 1.13 (Aomori) for men and from 0.84 (Kanagawa) to 1.11 (Kagoshima) for women, even though there is a suggestion of increasing inequalities across prefectures since 1995 in both sexes.

Conclusions

The present findings suggest that both social and geographic inequalities in all-cause mortality have increased in Japan during the last 3 decades.

SUBMITTER: Suzuki E

PROVIDER: S-EPMC3293144 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005.

Suzuki Etsuji E Kashima Saori S Kawachi Ichiro I Subramanian S V SV

BMJ open 20120302 2

<h4>Objectives</h4>To examine trends in social and geographic inequalities in all-cause premature adult mortality in Japan.<h4>Design</h4>Observational study of the vital statistics and the census data.<h4>Setting</h4>Japan.<h4>Participants</h4>Entire population aged 25 years or older and less than 65 years in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005. The total number of decedents was 984 022 and 532 223 in men and women, respectively.<h4>Main outcome measures</h4>For each sex, ORs and ...[more]

PMID: 22389360

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Project description:OBJECTIVES:To investigate potential geographical and socioeconomic patterning of allostatic load (AL) in China. DESIGN:Multilevel longitudinal study of the 2010 Chronic Disease Risk Factor Surveillance linked to the National Death Surveillance up to 31 December 2015. SETTING:All 31 provinces in China, not including Hong Kong, Macao or Taiwan. PARTICIPANTS:96 466 ≥ 18 years old (women=54.3%). EXPOSURES:Person-level educational attainment and mean years of education in counties. OUTCOME:AL was measured using clinical guidelines for nine biomarkers: body mass index; waist circumference; systolic blood pressure; diastolic blood pressure; fasting blood glucose; total cholesterol; triglycerides; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol. RESULTS:Multilevel logistic regressions adjusted for sex, age, marital status, person-level education, county mean years of education and urban/rural reported ORs of 1.22 (95% CI 1.08 to 1.38) for 5-year all-cause mortality (n=3284) and 1.20 (1.04-1.37) for deaths from non-communicable diseases (n=2891) among people in AL quintile 5 (high) compared with quintile 1 (low). The median rate ratio estimated from unadjusted multilevel negative binomial regression showed AL clustered geographically (province=1.14; county=1.12; town=1.11; village=1.14). After adjusting for aforementioned confounders, AL remained higher with age (rate ratio 1.02, 95% CI 1.02 to 1.02), higher in women compared with men (1.17, 1.15 to 1.19), lower among singletons (0.83, 0.81 to 0.85) and widowers (0.96, 0.94 to 0.98). AL was lower among people with university-level compared with no education (0.92, 0.89 to 0.96), but higher in counties with higher mean education years (1.03, 1.01 to 1.05). A two-way interaction suggested AL was higher (1.04, 1.02 to 1.06) among those with university-level compared with no education within counties with higher mean years of education. Similar results were observed for alternative constructions of AL using 75th and 80th percentile cut-points. CONCLUSIONS:AL in China is patterned geographically. The degree of association between AL and person-level education seems to be dependent on area-level education, which may be a proxy for other contextual factors that warrant investigation.

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Dataset Information

Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005.

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005.

Similar Datasets

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