Article: Income Inequality Becomes Health Inequality (Public Assistance Research Quarterly)

Naoki Kondo and Daisuke Nishioka (visiting researcher) have published an article in the latest issue of the Quarterly Journal of Public Assistance Research.

Click here for the table of contents of the Quarterly Journal of Public Assistance Research No. 261 (in Japanese).
Click here to purchase.

Daisuke Nishioka will continue to write a series of articles.

Special Feature: Income Inequality Becomes Health Inequality
Why Health Care Assistance is Necessary: A Perspective from the Concept of Capital
Naoki Kondo, Graduate School of Kyoto University

Toward Effective Implementation of Health Management Support Program for Protected Persons
Daisuke Nishioka, Osaka Medical College Graduate School of Medicine

Reference
The Power of Accompaniment: A Survey Study on the Actual Conditions of Medical Service Use by the Needy and the Effectiveness of Accompaniment Support for Medical Consultations(PDF, in Japanese)

Daisuke Nishioka’s website is here.

New Paper: Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries

We published a paper from Scientific Reports.

Oh J, Lee HY, Khuong QL, Markuns JF, Bullen C, Barrios OEA, Hwang SS, Suh YS, McCool J, Kachur SP, Chan CC, Kwon S, Kondo N, Hoang VM, Moon JR, Rostila M, Norheim OF, You M, Withers M, Li M, Lee EJ, Benski C, Park S, Nam EW, Gottschalk K, Kavanagh MM, Tran TGH, Lee JK, Subramanian SV, McKee M, Gostin LO. Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries. Sci Rep. 2021 Jul 2;11(1):13717. doi: 10.1038/s41598-021-92766-z. PMID: 34215764.

Abstract

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country’s 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective ‘pool’ in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic.

New Paper: Disability and psychological distress in nine countries of the former Soviet Union

We published a paper from J Affect Disord.

Stickley A, Kondo N, Roberts B, Kizilova K, Waldman K, Oh H, Inoue Y, Shin JI, Shakespeare T, McKee M. Disability and psychological distress in nine countries of the former Soviet Union. J Affect Disord. 2021 Jun 2;292:782-787. doi: 10.1016/j.jad.2021.05.061. Epub ahead of print. PMID: 34175591.

Abstract

Background: People with disabilities (PWD) are at increased risk of poor mental health. However, this association and the pathways involved remain under-researched in many parts of the world. This study examined the association between disability and psychological distress in nine countries of the former Soviet Union (FSU).

Methods: Data were analysed from 18,000 adults aged ≥18 years collected during the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2010 and 2011. Information was obtained on disability status, the severity of the disability and psychological distress. Logistic regression analysis was used to estimate associations.

Results: In a fully adjusted combined country analysis, disability was associated with over two times higher odds for psychological distress (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.86-2.58). The strength of the association varied across the individual countries. Among PWD more severe disability was associated with significantly higher odds for psychological distress (OR: 2.12, 95%CI: 1.26-3.55).

Limitations: The data were cross-sectional and disability status was self-reported, possibly resulting in underreporting.

Conclusions: Disability is associated with worse psychological health in FSU countries, especially among those with more severe disabilities. As poor mental health may also increase the risk of negative outcomes in PWD, this finding highlights the importance of the early detection and treatment of mental disorders in PWD in these countries.

New paper: Disability and loneliness in nine countries of the former Soviet Union

We published a paper from Disabil Health J.

Stickley A, Kondo N, Richardson E, Leinsalu M, Waldman K, Oh H, Inoue Y, Shakespeare T, McKee M. Disability and loneliness in nine countries of the former Soviet Union. Disabil Health J. 2021 May 28:101123. doi: 10.1016/j.dhjo.2021.101123. Epub ahead of print. PMID: 34147415.

Abstract

Background: People with disabilities (PWD) often face structural and other barriers to community involvement and may therefore be at risk of loneliness. Yet, so far, this issue has received little attention.

Objective: This cross-sectional study aimed to examine the association between disability and loneliness in nine countries of the former Soviet Union (FSU).

Methods: Data were analyzed from 18000 respondents aged ≥18 that came from the Health in Times of Transition (HITT) survey that was undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2010/11. Respondents reported on whether they had a disability (no/yes) and its severity. A single-item question was used to assess loneliness. Logistic regression analysis was used to examine the associations.

Results: Across the countries, 6.8% of respondents reported being disabled. In a fully adjusted combined country analysis, disability was associated with higher odds for loneliness (odds ratio: 1.30, 95% confidence interval: 1.06-1.60). In an analysis restricted to PWD, individuals in the most severe disability category (Group 1) had over two times higher odds for loneliness when compared to those in the least severe disability category (Group 3).

Conclusions: Disability is associated with higher odds for reporting loneliness in the FSU countries and this association is especially strong among those who are more severely disabled. An increased focus on the relationship between disability and loneliness is now warranted given the increasing recognition of loneliness as a serious public health problem that is associated with a number of detrimental outcomes.

Keywords: Adult population; Disabled; HITT survey; Lonely.

New paper: Sociodemographic inequities in dental care utilisation among governmental welfare recipients in Japan: a retrospective cohort study

We published a paper from Int J Equity Health.

Nishioka D, Ueno K, Kino S, Aida J, Kondo N. Sociodemographic inequities in dental care utilisation among governmental welfare recipients in Japan: a retrospective cohort study. Int J Equity Health. 2021 Jun 16;20(1):141. doi: 10.1186/s12939-021-01473-8. PMID: 34134717.

Abstract

Background: Maintaining oral health is one of the global public health challenges. Income and out-of-pocket payments for dental care services are predictors of dental care utilisation. Although public assistance programmes guarantee income security for impoverished people, access barriers other than financial costs may cause unmet dental care needs. We aimed to explore the potential sociodemographic factors determining dental care utilisation among recipients of public assistance in Japan using linkage data of public assistance database and medical assistance claim data administered by municipalities.

Methods: This was a retrospective cohort study involving a sample of public assistance recipients. We extracted the recipients’ sociodemographic data (age, sex, household number, employment status, nationality, disability certificates, and long-term care status) in January 2016 and observed them until December 2016 to identify incidences of dental care utilisation as outcomes. We performed a multivariable modified Poisson regression analysis with a robust standard error estimator to calculate the incidence ratio (IR) of dental care utilisation in each variable.

Results: We identified a total of 4497 recipients at risk. Among them, 839 recipients used dental care services. Younger age was associated with a higher incidence of dental care utilisation. The female recipients had a higher incidence of dental care utilisation when compared to the male ones (adjusted IR, 1.22; 95% confidence interval [CI], 1.08-1.38). Immigrant recipients had a higher incidence of dental care utilisation than the Japanese ones (IR, 1.53; 95% CI, 1.16-2.01). Recipients with mental disabilities had higher incidences than those without disability certificates (IR, 1.30; 95% CI, 1.08-1.56).

Conclusions: Non-financial sociodemographic inequities in dental care utilisation stemming from age, sex, nationality, and presence of mental disability were found despite minimum income protection and equitable financial dental service access amongst public assistance recipients in Japan. Providing targeted preventive care and treatments for dental care among underserved populations is required to tackle oral health inequities.

Keywords: Free dental care access, Japan; Oral health inequities; Poverty; Public assistance.

New paper: Disability and loneliness in nine countries of the former Soviet Union

We published a paper from Disability and Health Journal.

Stickley, A., Kondo, N., Richardson, E., Leinsalu, M., Waldman, K., Oh, H., … & McKee, M. (2021). Disability and loneliness in nine countries of the former Soviet Union. Disability and Health Journal, 101123.

Abstract

Background

People with disabilities (PWD) often face structural and other barriers to community involvement and may therefore be at risk of loneliness. Yet, so far, this issue has received little attention.

Objective

This cross-sectional study aimed to examine the association between disability and loneliness in nine countries of the former Soviet Union (FSU).

Methods

Data were analyzed from 18000 respondents aged ≥ 18 that came from the Health in Times of Transition (HITT) survey that was undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2010/11. Respondents reported on whether they had a disability (no/yes) and its severity. A single item question was used to assess loneliness. Logistic regression analysis was used to examine the associations.

Results

Across the countries, 6.8% of respondents reported being disabled. In a fully adjusted combined country analysis, disability was associated higher odds for loneliness (odds ratio: 1.30, 95% confidence interval: 1.06-1.60). In an analysis restricted to PWD, individuals in the most severe disability category (Group 1) had over two times higher odds for loneliness when compared to those in the least severe disability category (Group 3).

Conclusions

Disability is associated with higher odds for reporting loneliness in the FSU countries and this association is especially strong among those who are more severely disabled. An increased focus on the relationship between disability and loneliness is now warranted given the increasing recognition of loneliness as a serious public health problem that is associated with a number of detrimental outcomes.

Keywords

Disabled
Lonely
HITT survey
Adult population

New paper: Non-financial social determinants of diabetes among public assistance recipients in Japan: A cohort study.

We publshed a paper from J Diabetes Investig.

Nishioka D, Saito J, Ueno K, Kondo N. Non-financial social determinants of diabetes among public assistance recipients in Japan: A cohort study. J Diabetes Investig. 2021 Jun;12(6):1104-1111. doi: 10.1111/jdi.13435. Epub 2020 Nov 18. PMID: 33047513.

Abstract

Aims/introduction: Poverty is an important social determinant of diabetes. Poverty is a multidimensional concept including non-financial difficulties, such as social isolation and exclusion from communities. Many countries provide financial social assistance programs for those in need. This study aimed to explore non-financial social determinants of diabetes among public assistance recipients in Japan, by using linkage data of two municipal public assistance databases and medical assistance claim data.

Materials and methods: We carried out a retrospective cohort study. Public assistance is provided to households below the poverty line to ensure their income security. We extracted recipients’ sociodemographic factors of January 2016 (household number and employment status as non-financial social determinants of diabetes) and identified the incidence of diabetes diagnosis until December 2016 as the outcome.

Results: We included the data of 2,698 younger individuals (aged <65 years) and 3,019 older individuals (aged >65 years). A multivariable Poisson regression, with a robust standard error estimator, showed that among 2,144 younger recipients at risk, unemployment and living alone were slightly associated with 1-year cumulative incidence of diabetes diagnosis (adjusted incidence ratio 1.20, 95% confidence interval 0.93-1.54 and adjusted incidence ratio 1.15, 95% confidence interval 0.89-1.48, respectively). Among 2,181 older recipients at risk, there was no strong association between their sociodemographic factors and incidence of diabetes diagnosis.

Conclusions: Unemployment and living alone might be additional risk factors for diabetes among younger public assistance recipients. Multidimensional supports assuring financial and non-financial securities are required to prevent diabetes among people living in poverty.

Keywords: Poverty; Public assistance; Social determinants of health.

New paper: Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES.

We published a paper from Int J Environ Res Public Health.

Hirai H, Saito M, Kondo N, Kondo K, Ojima T. Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES. Int J Environ Res Public Health. 2021 May 9;18(9):5004. doi: 10.3390/ijerph18095004. PMID: 34065052.

Abstract

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI’s cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity.

Keywords: care cost; older adults; physical activity.

New paper: Differences in Cumulative Long-Term Care Costs by Community Activities and Employment: A Prospective Follow-Up Study of Older Japanese Adults.

We published a paper from Int J Environ Res Public Health.

Saito M, Kondo N, Aida J, Saito J, Anezaki H, Ojima T, Kondo K. Differences in Cumulative Long-Term Care Costs by Community Activities and Employment: A Prospective Follow-Up Study of Older Japanese Adults. Int J Environ Res Public Health. 2021 May 19;18(10):5414. doi: 10.3390/ijerph18105414. PMID: 34069391.

Abstract

We evaluated differences in the cumulative benefit costs of public long-term care (LTC) insurance services by employment status and frequency of community activities. A baseline survey was conducted on functionally independent older people from 12 municipalities as a nationwide survey from 2010 to 2011. Employment status was dichotomized, and community activity was assessed based on the frequency of participation in hobbies, sports clubs, or volunteering. We followed the respondents’ LTC service costs over a period of 6 years using public LTC claim records (n = 46,616). We adopted a classical linear regression analysis and an inverse probability weighting estimation with multiple imputation for missing values. Compared with non-participation in each community activity, the cumulative LTC costs among individuals who participated in hobbies or sports group activities at least twice a week were 1.23 (95% confidence interval: 0.73-1.72) to 1.18 (0.68-1.67) thousand USD lower per person over the 6-year period (28.7% to 30.1% lower, respectively). Similarly, the costs for employed persons were 0.55 (0.20-0.90) to 0.64 (0.29-0.99) thousand USD per person lower than among retirees (14.5% to 16.9% lower). Promoting employment opportunities and frequent participation in community activities among older adults may help reduce future LTC costs by around 20% as a result of extending healthy longevity.

Keywords: community activities; cumulative cost; employment; older adults; public long-term care insurance.

New paper: Working from home and dietary changes during the COVID-19 pandemic: A longitudinal study of health app (CALO mama) users.

We published a paper from Appetite.

Sato K, Kobayashi S, Yamaguchi M, Sakata R, Sasaki Y, Murayama C, Kondo N. Working from home and dietary changes during the COVID-19 pandemic: A longitudinal study of health app (CALO mama) users. Appetite. 2021 May 15:105323. doi: 10.1016/j.appet.2021.105323. Epub ahead of print. PMID: 34004241.

Abstract

It is plausible that the coronavirus disease pandemic and related changes in work and life patterns affected dietary patterns, but existing studies have limitations owing to a cross-sectional design. Using longitudinal data, we examined dietary changes in people due to the pandemic and work and life patterns. We conducted an online survey on changes in work and life patterns during the pandemic from April 30, 2020, to May 8, 2020, among users of a health app called CALO mama provided in Japan. We retrieved and linked the dietary data for 5,929 participants from January 1, 2020, to May 13, 2020. Generalized linear mixed models were used to estimate the frequencies of food intake associated with the pandemic and work and life patterns. During the state of emergency, the frequency of intake of vegetables, beans, seaweeds, fish, meats, dairy products, and snacks increased, whereas alcohol intake decreased. Working from home was associated with increased intake of vegetables, fruits, dairy products, and snacks but decreased intake of seaweeds, meats, and alcohol. Time spent on childcare was associated with decreased intake of vegetables and fruits but increased intake of meats. Probable depressive symptoms were negatively associated with the frequency of food intake other than snacks and alcohol. We conclude that diet quality improved during the pandemic in general, but attention must be paid to overconsumption of snacks and negative factors such as increased burden of childcare and depression for healthy eating.

Keywords: COVID-19; dietary change; fruit and vegetable intake; snacking; work and life pattern; working from home.