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Subjective social status and trajectories of self-rated health status: a comparative analysis of Japan and the United States.

ABSTRACT: Background:Japanese society is more egalitarian than the United States as is reflected by the lower degree of prevalence of social inequalities in health. We examined whether subjective socioeconomic status is associated with different trajectories of self-rated health (SRH), and whether this relationship differs between the United States and Japan. Methods:We analyzed the responses of 3968 Americans from the survey Midlife in the United States, 2004-06, and the responses of 989 Japanese from the survey Midlife in Japan, 2008. We conducted a multilevel analysis with three self-ratings of health (10 years ago, current and 10 years in the future) nested within individuals and nested within 10 levels of subjective social status. Age, sex, educational level and subjective financial situation were adjusted. Results:After making statistical adjustments for confounding variables, respondents in Japan continued to report lower average levels of health. However, the rate of expected decline in SRH over the next decade was strongly socially patterned in the United States, whereas it was not in Japan. Conclusion:The Japanese showed no disparity in the anticipated trajectory of SRH over time, whereas the Americans showed a strong social class gradient in future trajectories of SRH.

SUBMITTER: Takahashi Y

PROVIDER: S-EPMC6306092 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Subjective social status and trajectories of self-rated health status: a comparative analysis of Japan and the United States.

Takahashi Yoshimitsu Y Fujiwara Takeo T Nakayama Takeo T Kawachi Ichiro I

Journal of public health (Oxford, England) 20181201 4

<h4>Background</h4>Japanese society is more egalitarian than the United States as is reflected by the lower degree of prevalence of social inequalities in health. We examined whether subjective socioeconomic status is associated with different trajectories of self-rated health (SRH), and whether this relationship differs between the United States and Japan.<h4>Methods</h4>We analyzed the responses of 3968 Americans from the survey Midlife in the United States, 2004-06, and the responses of 989 J ...[more]

PMID: 29190395

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Project description:Introduction:Although education is among the major socioeconomic status (SES) resources that influence populations' and individuals' health, social marginalization may reduce the health gain that follows access to SES indicators such as education, a pattern called marginalization-related diminished return (MDR). The literature on MDRs, however, has been mainly derived from studies that have defined marginalization based on race, ethnicity, and sexual orientation. Thus, more research is needed on MDRs that may follow as a result of immigration. To extend what is known on immigration status related MDRs, this study compared a national sample of immigrants and non-immigrants for the effect of education on the poor self-rated health (SRH) of adults in the United States. Methods:With a cross-sectional design, this study employed data from the 2015 National Health Interview Survey (NHIS), a survey that had enrolled 33,654 adults who were either immigrants (n = 6225; 18.5%) or non-immigrants (n = 27 429; 81.5%). The independent variable was education level, treated as a categorical variable. The dependent variable was SRH treated as a dichotomous variable. Race, ethnicity, age, gender, marital status, and region were the confounders. Immigration (nativity) was the moderator. Logistic regression was used for data analysis. Results:Higher education credentials were associated with better SRH in the pooled sample; however, immigration showed a significant statistical interaction with education level (college graduation) on the outcome. This interaction was indicative of a smaller protective effect of college graduation on poor SRH among immigrants than non-immigrant adults. Conclusion:In line with the MDRs framework, the effect of education on SRH is weaker for immigrants than for non-immigrant adults. There is a need to help highly educated immigrants to mobilize their human capital to secure their best health outcomes, similar to non-immigrants. Such strategies may require bold and innovative policy solutions to reduce discrimination against immigrants, so they can more effectively translate their education and human capital into tangible outcomes such as health.

Project description:BackgroundLife expectancy is increasingly incorporated in evidence-based screening and treatment guidelines to facilitate patient-centered clinical decision-making. However, life expectancy estimates from standard life tables do not account for health status, an important prognostic factor for premature death. This study aims to address this research gap and develop life tables incorporating the health status of adults in the United States.MethodsData from the National Health Interview Survey (1986-2004) linked to mortality follow-up through to 2006 (age ≥ 40, n = 729,531) were used to develop life tables. The impact of self-rated health (excellent, very good, good, fair, poor) on survival was quantified in 5-year age groups, incorporating complex survey design and weights. Life expectancies were estimated by extrapolating the modeled survival probabilities.ResultsLife expectancies incorporating health status differed substantially from standard US life tables and by health status. Poor self-rated health more significantly affected the survival of younger compared to older individuals, resulting in substantial decreases in life expectancy. At age 40 years, hazards of dying for white men who reported poor vs. excellent health was 8.5 (95% CI: 7.0,10.3) times greater, resulting in a 23-year difference in life expectancy (poor vs. excellent: 22 vs. 45), while at age 80 years, the hazards ratio was 2.4 (95% CI: 2.1, 2.8) and life expectancy difference was 5 years (5 vs. 10). Relative to the US general population, life expectancies of adults (age < 65) with poor health were approximately 5-15 years shorter.ConclusionsConsiderable shortage in life expectancy due to poor self-rated health existed. The life table developed can be helpful by including a patient perspective on their health and be used in conjunction with other predictive models in clinical decision making, particularly for younger adults in poor health, for whom life tables including comorbid conditions are limited.

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Subjective social status and trajectories of self-rated health status: a comparative analysis of Japan and the United States.

Publications

Subjective social status and trajectories of self-rated health status: a comparative analysis of Japan and the United States.

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