Fukuda et al's Cause-Specific Mortality Differences Across Socioeconomic Position of Municipalities

Fukuda et al's Cause-Specific Mortality Differences Across Socioeconomic Position of Municipalities

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IJE vol.34 no.1 © International Epidemiological Association 2004; all rights reserved. International Journal of Epidemiology 2005; 34 :100–109 Advance Access publication 23 November 2004 doi:10.1093/ije/dyh283 INJURIES Cause-specific mortality differences across socioeconomic position of municipalities in Japan, 1973–1977 and 1993–1998: increased importance of injury and suicide in inequality for ages under 75 Yoshiharu Fukuda, Keiko Nakamura and Takehito Takano Accepted 18 June 2004 Background Socioeconomic inequality in health has been a major concern in public health. This study examined socioeconomic inequality in regional mortality and the impact on inequality by cause of deaths in 1973–1977 and 1993–1998 using municipal statistics in Japan. Methods The municipalities across the country (N = 3244 in 1973–1977 and 3334 in 1993–1998) were classified into quintiles according to the index of socioeconomic position (SEP) obtained by principal component analysis of municipal indicators related to income and education. Mortality gradient by SEP for selected major causes of death in the population aged 0–74 years was examined using standardized mortality ratio by quintile and rate ratio of mortality across quintiles. As a measure of cause-specific impact on inequality, the number of excess deaths from each cause in the lower four SEP quintiles compared with the highest quintile was calculated. Results Mortality gradient by SEP and excess deaths in the lower SEP quintiles due to injury and suicide markedly increased from 1973–1977 to 1993–1998 for both males and females. In contrast, stroke, especially cerebral haemorrhage, showed a decrease in mortality gradient and excess deaths. For females in 1993–1998, a negative gradient of mortality by SEP was found, and cancer contributed the higher all-cause mortality in the higher SEP quintile. Conclusions The relative importance of socioeconomic inequality in regional mortality of stroke decreased, while that of injury and suicide increased. The prevention of injury and suicide, in addition to stroke, in socioeconomically disadvantaged regions, and cancer in urban areas with higher SEP should be given priority. Keywords Socioeconomic factors, small-area study, cause-specific mortality, health inequality, Japan 100 people living in socioeconomically disadvantaged areas commonly show a poorer health status. 5 This study addressed the variation of mortality among regions according to their socioeconomic position (SEP); that is, socioeconomic inequality in regional mortality. In Japan, previous studies have revealed substantial regional variation in health levels among administrative units, and the variation was strongly related to area socioeconomic indicators. 6,7 The following study in Japan showed higher Regional variation in health levels has been demonstrated between and within countries.
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Fukuda et al's Cause-Specific Mortality Differences Across Socioeconomic Position of Municipalities

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