Abstract
IntroductionDespite having very high life expectancy, Japan has relatively poor self-rated health, compared to other high-income countries. We studied trends and socioeconomic inequalities in self-rated health in Japan using nationally representative data.MethodsThe Comprehensive Survey of Living Conditions was analyzed, every 3 years (n ≈ 0.6–0.8 million/year) from 1986 to 2016. Whereas previous studies dichotomized self-rated health as an outcome, we used four categories: very good, good, fair, and bad/very bad. Proportional odds ordinal logistic regression models are used, with ordinal scale self-rated health as an outcome, and age category, survey year and occupational class or educational level as independent variables.ResultsIn 2016, the age-adjusted percentages for self-rated health categorized as very good, good, fair, and bad/very bad, were 24.0, 17.1, 48.7, and 10.2% among working-age men, and 21.6, 17.5, 49.4, and 11.5% among working-age women, respectively. With 1986 as the reference year, the odds ratios (ORs) of less good self-rated health were lowest in 1995 (0.69; 95% Confidence Interval [95% CI]: 0.66–0.71 of working-age men), and highest in 2010 (1.23 [95% CI: 1.19–1.27]). The ORs of male, lower non-manual workers (compared to upper non-manual) increased from 1.12 (95% CI: 1.07–1.17) in 2010 to 1.20 (95% CI: 1.15–1.26) in 2016. Between 2010 and 2016, the ORs of working-age men with middle and low levels of education (compared to a high level of education) increased from 1.22 (95% CI: 1.18–1.27) to 1.34 (95% CI: 1.29–1.38), and from 1.47 (95% CI: 1.39–1.56) to 1.75 (95% CI: 1.63–1.88), respectively. The ORs of working-age women with middle and low levels of education also increased from 1.22 (95% CI: 1.17–1.28) to 1.32 (95% CI: 1.26–1.37), and from 1.74 (95% CI: 1.61–1.88) to 2.03 (95% CI: 1.87–2.21) during the same period.ConclusionJapan has the unique feature that approximately 50% of the survey respondents rated their self-rated health as fair, but with important variations over time and between socioeconomic groups. In-depth studies of the role of socioeconomic conditions may shed light on the reasons for the high prevalence of poor self-rated health in Japan.
Highlights
Despite having very high life expectancy, Japan has relatively poor self-rated health, compared to other high-income countries
According to the statistics reported by the Organization for Economic Cooperation and Development (OECD), the Japanese population had relatively poor self-rated health in the 2010s compared to other high-income countries [13]
In an effort to address the gap in the literature on population health and trends in health inequalities, we focused on the self-rated health of the Japanese population over three decades
Summary
Despite having very high life expectancy, Japan has relatively poor self-rated health, compared to other high-income countries. Mortality inequalities among occupational classes—differences between upper non-manual workers and manual workers— were smaller in Japan than in European countries during the 2010s [6] These data suggest that people in Japan enjoy a relatively high life expectancy with small variations in health between socioeconomic groups. Japan’s economy underwent a long recession, the so-called “lost two decades” after the collapse of the “bubble economy” in the early 1990s This resulted in instability in the Japanese labor market; the unemployment rate and the proportion of non-regular workers increased gradually during that period [12]. There are some health indicators that show Japan has had a relatively poor record for health and health inequalities (e.g., high suicide rates and large socioeconomic inequalities in smoking prevalence) in recent decades [14, 15]. The overall picture of health inequalities in Japan is not yet clear
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