Abstract
This study aims to use the conceptual framework of social determinants of health (SDH) to elucidate the social determinants that affect the use of complementary and alternative medicine (CAM) from the perspectives of both intermediary and structural determinants. Data were derived from a survey mailed to 1,500 randomly selected residents (20–69 years old; May–July 2009) of Sendai city in Japan. A generalized linear model was used in the analysis, with CAM use over the past one month as the dependent variable, SDH structural and intermediary determinants as independent variables, and demographic characteristics, indicators of health status, and the evaluation of health or healthcare systems as control variables. The prevalence of CAM usage was 62.1%. The generalized linear model showed that middle subjective social status (OR = 1.47; 95% CI: 1.04–2.07) as structural determinants was significantly associated with CAM usage. Adding the intermediary determinants, the same effect was observed. When demographic characteristics, indicators of health status, and the evaluation of health or healthcare systems were introduced as control variables, the associations of the structural determinants disappeared, revealing that hope (OR = 1.25; 95%CI: 1.04–1.50) as intermediary determinants was associated with the use of CAM. Female sex (OR = 1.47; 95% CI: 1.02–2.12) and health anxiety (OR = 1.68; 95% CI: 1.20–2.34) were associated with CAM usage. We found that intermediary rather than structural determinants were associated with CAM usage. Hope as an intermediary determinant was particularly associated with CAM usage.
Highlights
With respect to social determinants of health (SDH) structural determinants (Table 2), for equivalent household income the largest proportion of participants (38.8%) was from the category of between 2,000,000 and 4,000,000 yen, for educational level the largest proportion was from the completed high school category (46.2%), for occupation more than 40% were from the regular employment category, and for subjective social status the largest proportion was from the middle position category
In model 1, the model using the SDH structural determinants showed clearly that complementary and alternative medicine (CAM) usage was associated with middle subjective social status (OR = 1.47, 95% CI: 1.04–2.07)
The study aimed to elucidate the social determinants that affect the use of CAM from both intermediary and structural determinant perspectives in the conceptual framework of SDH, by analyzing social survey data from residents of Sendai, Japan
Summary
This study aims to use the conceptual framework of social determinants of health (SDH) to elucidate the social determinants that affect the use of complementary and alternative medicine (CAM) from the perspectives of both intermediary and structural determinants. Since we aimed to clarify the social determinants affecting the use of CAM in general, we employed a simple variable of whether CAM was used rather than variables such as type of CAM and frequency of CAM usage
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