Abstract
ABSTRACTSBackgroundArea differences in life expectancy (LE) and healthy life expectancy (HLE) in large geographical units have been monitored around the world. Area characteristics may be based on culture, history, socioeconomic status and discrimination in smaller geographical units, so it is important to consider these when looking at health inequality. We aimed to evaluate LE, HLE, and non-healthy life expectancy (NHLE) in 1707 municipalities using Areal Deprivation Index (ADI) in Japan for the first time.MethodsWe calculated the observed LE, HLE, and NHLE using death, population, and Long-term care insurance data for 2010-2014 and applied the variance weighted least squares model to estimate LE, HLE, and NHLE by 100 percentiles using the standardized ADI.FindingsThe estimated LE, HLE, and NHLE became lower as the deprivation index worsened: the differences between the most and least deprived areas for HLE were 2·49 years for LE and 2·32 years for HLE in males; 1·22 years for LE and 0·93 years for HLE in females. The observed LE and HLE in the most deprived areas were much lower than other areas.InterpretationUsing ADI has enabled us to see the disparity within municipalities precisely. LE and HLE outlier for the 100th percentile might be linked to historical areal deprivation and marginalization. Precise monitoring of socioeconomic status-based health inequalities could help manage these inequalities by identifying the groups most in need of intervention.FundingThe Ministry of Education, Science and Culture of Japan (a Grant-in-Aid for Scientific Research [A] No. 20H00040 and 18H04071).
Highlights
Health promotion intervention should target global and national policies and local-level social determinants of health. [1] While interventions for global and national policy can be very powerful in improving the health situation of a large number of people at the same time, a more tailored approach, based on a deeper understanding of the link between historical and cultural contexts and health inequality in small areas could reach overlooked and discriminated communities [2]
The basic local government unit responsible for planning and conducting actions for Health Japan 21 is the municipality [9], most previous monitoring of health inequalities in HLE has reported at prefecture level and examined the association with prefecture-level areal socioeconomic status (SES) only. [10,11,12,13] No study has reported on the SES-based inequalities in LE, HLE, and non-healthy life expectancy (NHLE) across municipalities
Area SES:The population-weighted ADI which can be divided between 1st to 100th percentile, and we show the results of selected area SES percentile groups ADI: Areal Deprivation Index which is a composite indicator of geographical socioeconomic position defined as the weighted sum of eight census-based variables Unhealthy: The median number of people certified as needing nursing care and assigned care levels 2-5 under long-term care insurance in September between 2010 and 2014
Summary
Health promotion intervention should target global and national policies and local-level social determinants of health. [1] While interventions for global and national policy can be very powerful in improving the health situation of a large number of people at the same time, a more tailored approach, based on a deeper understanding of the link between historical and cultural contexts and health inequality in small areas could reach overlooked and discriminated communities [2]. Since previous observation of socioeconomic deprivation at municipality-level showed large variability as well as the existence of strongly discriminated and marginalized areas [14], we expected that our observation of the SES-based inequalities of HLE and other health measures at municipality-level could identify the cities/town that were marginalized and unhealthy. This could draw the attention of central and prefectural governments towards the highest priority cities/towns and enable them to provide further counter measures to tackle the areal social issues beyond health problems, such as the drastic economic assistance and welfare programs needed to solve area-specific social problems. We aimed to evaluate LE, HLE, and non-healthy life expectancy (NHLE) in 1707 municipalities using Areal Deprivation Index (ADI) in Japan for the first time
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