Abstract
Compared to the large volume of research focused on mortality differentials within Japan, relatively little is known about regional variations in health expectancy, particularly among older people. This article has two interrelated objectives. The first objective is to estimate prefecture-specific disability-free life expectancy (DFLE) at 65 years of age in 2010. DFLE at 65 by gender and prefecture was computed using the Sullivan method, which was applied to prefecture-specific life tables and prevalence of disability from Kokumin Seikatsu Kiso Chosa (Comprehensive Survey of Living Conditions) of 2010. The second objective is to investigate macro-level factors associated with DFLE at 65 across 47 Japanese prefectures. Our results indicate regional disparities in DFLE at older ages. Importantly, we note close relationships between a prefecture’s wealth, labor, and welfare characteristics and DFLE at 65. Income per capita, the proportion of workers older than 65, and welfare expenditures are positively related to DFLE, whereas unemployment and long-term care insurance expenditures per-capita are inversely associated with DFLE for both genders. The proportion of older adults relying on public assistance is negatively related only to women’s DFLE. These results suggest that narrowing socioeconomic disparities may contribute to the health of Japanese elders. Reducing regional health disparities therefore requires policy makers to take into account the broader socioeconomic conditions of each prefecture.
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Notes
The average exchange rate of 2010 was 1 USD = 88.81 JPY.
References
Cabinet Office, Government of Japan (2014) Kourei shakai hakusho (gaiyo ban) [Annual report on the ageing society: 2014 (Summary)].http://www8.cao.go.jp/kourei/whitepaper/w-2015/gaiyou/27pdf_indexg.html. Accessed 13 December 2016
Crimmins EM, Saito Y, Hayward MD (1993) Sullivan and multistate methods of estimating active life expectancy: Two methods, two answers. In: Robine JM et al (eds) Calculation of health expectancies: Harmonization, consensus achieved and future perspectives. John Libbey Eurotext, Montrouge, pp 155–160
Fouweather T, Gillies C, Wohland P, Van Oyen H, Nusselder W, Robine JM, Cambois E, Jagger C, JA: EHLEIS Team (2015) Comparison of socio-economic indicators explaining inequalities in healthy life years at age 50 in Europe: 2005 and 2010. Eur J Public Health 25(6):978–983
Gutierrez-Fisac JL, Gispert R, Sola J (2000) Factors explaining the geographical differences in disability free life expectancy in Spain. J Epidemiol Community Health 54(6):451–455
Hashimoto S (1999) Kenko jumyo no chiii shihyo santei no hyojunka ni kansuru kenkyu (heisei 19-heisei 20 nen do) [Research on standardization of health-expectancy related regional indicators (1999–2000)]. http://toukei.umin.jp/kenkoujyumyou/#h19. Accessed 13 December 2016
Hayashi M (2016) The Japanese voluntary sector’s responses to the increasing unmet demand for home care from an ageing population. Ageing Soc 36(3):508–533
Hurst L, Stafford M, Cooper R, Hardy R, Richards M, Kuh D (2013) Lifetime socioeconomic inequalities in physical and cognitive aging. Am J Public Health 103(9):1641–1648
Imai K, Soneji S (2007) On the estimation of disability-free life expectancy: sullivan’s method and its extension. J Am Stat Assoc 102(480):1199–1211
Ishida H, Slater D (2011) Social class in contemporary Japan: Structures, sorting and strategies. Routledge Japanese Studies, London
Jagger C, Gillies C, Moscone F, Cambois E, Van Oyen H, Nusselder W, Robine JM, The EHLEIS Team (2008) Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis. Lancet 372(9656):2124–2131
Kondo N, Mizutani T, Minai J, Kazama M, Imai H, Takeda Y, Yamagata Z (2005) Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses. J Epidemiol 15(6):219–227
Link BG, Phelan J (1995) Social conditions as fundamental causes of disease. J Health Soc Behav 35:80–94
Liu J, Chen G, Chi I, Wo J, Pei L, Song X, Zhang L, Pang L, Han Y, Zheng X (2010) Regional variations in and correlates of disability-free life expectancy among older adults in China. BMC Public Health 10(446):1–8
Ministry of Health, Labour, and Welfare (2014) Heisei 26 nendo ban kosei rodo hakusho [Annual Health, Labour and Welfare Report 2014 (Summary)]
Ministry of Health, Labour, and Welfare (2015) Kenko nihon 21 dai ni ji [Healthy Japan 21 Second Phase]. http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/kenkounippon21.html. Accessed 13 December 2016
Ministry of Health, Labour, and Welfare (2016) Heisei 27 nendo kani seimeihyo no gaikyo [Overview of life tables of 2015] http://www.mhlw.go.jp/toukei/saikin/hw/life/life15/. Accessed 9 December 2016
Mirowsky J, Ross CE (2001) Age and the effect of economic hardship on depression. J Health Soc Behav 42(June):132–150
Muramatsu N, Akiyama H (2011) Japan: super-aging society preparing for the future. Gerontologist 51(4):425–432
Nakane C (1970) Japanese Society. Weidenfeld and Nicholson, London
Raymo JM, Liang J, Sugisawa H, Kobayashi E, Sugihara Y (2004) Work at older ages in Japan: variation by gender and employment status. J Gerontol Soc Sci 59(3):S154–S163
Reynolds SL (2008) Successful aging in spite of bad habits: introduction to the special section on ‘life style and health expectancy’. Eur J Ageing 5:275–278
Robine JM, Herrmann FR, Arai Y, Willcox DC, Gondo Y, Hirose N, Suzuki M, Saito Y (2012) Exploring the impact of climate on human longevity. Exp Gerontol 47(9):660–671
Sullivan DF (1971) A single index of mortality and morbidity. HSMHA Health Rep 86:347–354
Suzuki E, Kashima S, Kawachi I, Subramanian SV (2012a) Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005. BMJ Open 2(2):e000425
Suzuki E, Kashima S, Kawachi I, Subramanian SV (2012b) Geographic Inequalities in All-Cause Mortality in Japan: compositional or contextual? PLoS One 7(6):e39876
Tsutsui T, Muramatsu N (2005) Care-needs certification in the long-term care insurance system of Japan. J Am Geriatr Soc 53:522–527
Wohland P, Rees P, Gillies C, Alvanides S, Matthews FE, O’Neill V, Jagger C (2014) Drivers of inequality in disability-free expectancy at birth and age 85 across space and time in Great Britain. J Epidemiol Community Health 68(9):826–833
World Health Organization (2015) Word Health Statistics 2015. http://www.who.int/gho/publications/world_health_statistics/2015/en/. Accessed 13 December 2016
Yong V, Saito Y (2012) National long-term care insurance policy in Japan a decade after implementation: some lessons for aging countries. Ageing Int 37(3):271–284
Acknowledgements
Support for this research was provided by the Japan Society for the Promotion of Science (Grant-in-Aid for Scientific Research 20638621). We acknowledge the Ministry of Health, Labour, and Welfare for providing us access to the Comprehensive Survey of Living Conditions data.
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Minagawa, Y., Saito, Y. An analysis of factors related to disability-free life expectancy at 65 years of age across Japanese prefectures in 2010. Eur J Ageing 15, 15–22 (2018). https://doi.org/10.1007/s10433-017-0433-4
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DOI: https://doi.org/10.1007/s10433-017-0433-4