地域診断のための健康格差指標の検討とその活用
保健活動の現場における健康格差の評価に有用な指標について文献レビューを行い，候補指標について，既存のデータを用いて試算し，活用に向けた課題抽出を行った。データには，2010年から11年に全国28自治体117,494名の高齢者（65歳以上）を対象に行われた調査（回収率66%）：日本老年学的評価研究（JAGES）を用いた。レビューの結果，健康指標値の差やその比に加え，それらと類似の解釈でありながらバイアス制御や比較可能性の点で有利な指標として格差勾配指数（Slope Index of Inequality：SII）格差相対指数（Relative Index of Inequality：RII）およ...
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| Published in | 医療と社会 Vol. 24; no. 1; pp. 47 - 55 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 医療科学研究所
2014
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0916-9202 1883-4477 |
| DOI | 10.4091/iken.24.47 |
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| Abstract | 保健活動の現場における健康格差の評価に有用な指標について文献レビューを行い，候補指標について，既存のデータを用いて試算し，活用に向けた課題抽出を行った。データには，2010年から11年に全国28自治体117,494名の高齢者（65歳以上）を対象に行われた調査（回収率66%）：日本老年学的評価研究（JAGES）を用いた。レビューの結果，健康指標値の差やその比に加え，それらと類似の解釈でありながらバイアス制御や比較可能性の点で有利な指標として格差勾配指数（Slope Index of Inequality：SII）格差相対指数（Relative Index of Inequality：RII）およびその変法（Kunst-Machkenbach's RII（RIIKM））を状況に応じて使い分けることが妥当であると考えられた。JAGESデータを学校区別に集計し，市町村単位で抑うつリスク者割合，閉じこもり者割合について値の差・値の比・SII・RII・RIIKMを算出した。等価世帯所得・学歴・最長職の主成分得点を学校区の社会経済的な困窮度指数として，そのランクによる健康格差を算出した。SII，RII，RIIKMは安定的に算出されたが，値の差や比は偶然誤差の影響を強く受けた。各指標の特性・利点・欠点を踏まえたうえで，これら指標の活用法について普及を進めていくべきである。 |
|---|---|
| AbstractList | 保健活動の現場における健康格差の評価に有用な指標について文献レビューを行い，候補指標について，既存のデータを用いて試算し，活用に向けた課題抽出を行った。データには，2010年から11年に全国28自治体117,494名の高齢者（65歳以上）を対象に行われた調査（回収率66%）：日本老年学的評価研究（JAGES）を用いた。レビューの結果，健康指標値の差やその比に加え，それらと類似の解釈でありながらバイアス制御や比較可能性の点で有利な指標として格差勾配指数（Slope Index of Inequality：SII）格差相対指数（Relative Index of Inequality：RII）およびその変法（Kunst-Machkenbach's RII（RIIKM））を状況に応じて使い分けることが妥当であると考えられた。JAGESデータを学校区別に集計し，市町村単位で抑うつリスク者割合，閉じこもり者割合について値の差・値の比・SII・RII・RIIKMを算出した。等価世帯所得・学歴・最長職の主成分得点を学校区の社会経済的な困窮度指数として，そのランクによる健康格差を算出した。SII，RII，RIIKMは安定的に算出されたが，値の差や比は偶然誤差の影響を強く受けた。各指標の特性・利点・欠点を踏まえたうえで，これら指標の活用法について普及を進めていくべきである。 |
| Author | 近藤, 尚己 |
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| Copyright | 2014 公益財団法人 医療科学研究所 |
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| DOI | 10.4091/iken.24.47 |
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| References | Fukuda Y, Nakamura K and Takano T (2005a) “Accumulation of Health Risk Behaviours is Associated with Lower Socioeconomic Status and Women's Urban Residence : A Multilevel Analysis in Japan,” BMC Public Health 5 (1) : 53. WHO Commission on Social Determinants of Health (2008) Closing the Gap in a Generation : Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. World Health Organization. Huisman M, Kunst AE, Bopp M et al. (2005) “Educational Inequalities in Cause-specific Mortality in Middle-aged and Older Men and Women in Eight Western European Populations,” Lancet. 365 (9458) : 493-500. Fukuda Y, Nakamura K and Takano T (2005b) “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,” International Journal of Epidemiology. 34 (1) : 100. Mackenbach JP, Martikainen P, Looman CWN et al. (2005) “The Shape of the Relationship between Income and Self-assessed Health : An International Study,” International Journal of Epidemiology. 3 (42) : 286-293. 近藤克則，吉井清子，松田亮三，他（2007）『検証「健康格差社会」－介護予防に向けた社会疫学的大規模調査』医学書院 Kondo N, Kawachi I, Hirai H et al. (2009) “Relative Deprivation and Incident Functional Disability among Older Japanese Women and Men : Prospective Cohort Study,” Journal of Epidemiology and Community Health. 63 (6) : 461-467. Mackenbach JP, Stirbu I, Roskam A-JR et al. (2008) “Socioeconomic Inequalities in Health in 22 European Countries” New England Journal of Medicine. 358 (23) : 2468-2481. Fukuda Y, Nakao H, Yahata Y et al. (2007) “Are Health Inequalities Increasing in Japan? The Trends of 1955 to 2000,” Bio Science Trend. 1 (1) : 38-42. 近藤克則，健康の不平等研究会（2007）『検証「健康格差社会」－介護予防に向けた社会疫学的大規模調査』医学書院 Fukuda Y, Nakamura K and Takano T (2004b) “Wide Range of Socioeconomic Factors Associated with Mortality among Cities in Japan,” Health Promotion International. 19 (2) : 177-187. Fukuda Y, Nakamura K and Takano T (2007) “Higher Mortality in Areas of Lower Socioeconomic Pmeasured by a Single Index of Deprivation in Japan,” Public Health. 121 (3) : 163-173. World Health Organization Regional Office for Europe (2013) “How the World Health Organization is Using Data Visualisation to Present Information on Inequalities in Health System Performance across the European Union.” <http://www.instantatlas. com/WHO_Europe_Story.xhtml> Accessed December 30, 2013. Fukuda Y, Nakamura K and Takano T (2005e) “Socioeconomic Pattern of Smoking in Japan：Income Inequality and Gender and Age Differences,” American College of Epidemiology. 15 (5) : 365-372. Kunst A and Mackenbach J (1995) Measuring Socioeconomic Inequalities in Health. Copenhagen, Denmark : World Health Organization, Regional Office for Europe. Mackenbach JP and Kunst AE (1997) “Measuring the Magnitude of Socio-economic Inequalities in Health : An Overview of Available Measures Illustrated with Two Examples from Europe,” Social Science & Medicine. 44 (6) : 757-771. Fukuda Y, Nakao H and Imai H (2007) “Different Income Information as an Indicator for Health Inequality among Japanese Adults,” Journal of Epidemiology / Japan Epidemiological Association. 17 (3) : 93-99. 近藤尚己，近藤克則（2012）「『健康格差の是正』にどう取り組むか」『保健師ジャーナル』 68（6）：468-473 Fukuda Y and Imai H (2007) “Review of Research on Social Inequalities in Health in Japan,” Journal of the National Institute of Public Health. 56 (2) : 56-62. World Health Organization (2013) “Global Health Observatory.” <http://www.who.int/gho/en/> Accessed December 30, 2013. Sihvonen AP, Kunst AE, Lahelma E et al. (1998) “Socioeconomic Inequalities in Health Expectancy in Finland and Norway in the late 1980s,” Social Science & Medicine. 47 (3) : 303-315. Kunst AE, Bos V, Lahelma E et al. (2005) “Trends in Socioeconomic Inequalities in Self-assessed Health in 10 European Countries,” International Journal of Epidemiology. 34 (2) : 295-305. Kondo N, Subramanian SV, Kawachi I et al. (2008) “Economic Recession and Health Inequalities in Japan : Analysis with a National Sample, 1986-2001,” Journal of Epidemiology and Community Health. 62 (10) : 869-875. Fukuda Y, Nakamura K and Takano T (2005d) “Reduced Likelihood of Cancer Screening among Women in Urban Areas and with Low Socioeconomic Status : A Multilevel Analysis in Japan,” Public Health. 119 (10) : 875-884. Mackenbach JP, Kunst AE, Cavelaars A et al. (1997) “Socioeconomic in Morbidity and Mortality in Western Europe,” Lancet. 349 (9066) : 1655-1659. Fukuda Y, Nakamura K and Takano T (2005c) “Municipal Health Expectancy in Japan : Decreased Healthy Longevity of Older People in Socioeconomically Disadvantaged Areas,” BMC Public Health 5 (1) : 65. Fukuda Y, Nakamura K and Takano T (2004a) “Municipal Socioeconomic Status and Mortality in Japan : Sex and Age Differences, and Trends in 1973-1998,” Social Science & Medicine. 59 (12) : 2435. 市田行信，近藤尚己，近藤克則（2011）「高齢者の健康と介護における公正性の評価指標の開発」厚生労働科学研究費補助金（長寿科学総合研究事業）「介護保険の総合的政策評価ベンチマークシステムの開発」分担研究報告書 |
| References_xml | – reference: Kondo N, Subramanian SV, Kawachi I et al. (2008) “Economic Recession and Health Inequalities in Japan : Analysis with a National Sample, 1986-2001,” Journal of Epidemiology and Community Health. 62 (10) : 869-875. – reference: Sihvonen AP, Kunst AE, Lahelma E et al. (1998) “Socioeconomic Inequalities in Health Expectancy in Finland and Norway in the late 1980s,” Social Science & Medicine. 47 (3) : 303-315. – reference: Kunst AE, Bos V, Lahelma E et al. (2005) “Trends in Socioeconomic Inequalities in Self-assessed Health in 10 European Countries,” International Journal of Epidemiology. 34 (2) : 295-305. – reference: World Health Organization Regional Office for Europe (2013) “How the World Health Organization is Using Data Visualisation to Present Information on Inequalities in Health System Performance across the European Union.” <http://www.instantatlas. com/WHO_Europe_Story.xhtml> Accessed December 30, 2013. – reference: Kondo N, Kawachi I, Hirai H et al. (2009) “Relative Deprivation and Incident Functional Disability among Older Japanese Women and Men : Prospective Cohort Study,” Journal of Epidemiology and Community Health. 63 (6) : 461-467. – reference: Fukuda Y, Nakamura K and Takano T (2005d) “Reduced Likelihood of Cancer Screening among Women in Urban Areas and with Low Socioeconomic Status : A Multilevel Analysis in Japan,” Public Health. 119 (10) : 875-884. – reference: 近藤尚己，近藤克則（2012）「『健康格差の是正』にどう取り組むか」『保健師ジャーナル』 68（6）：468-473 – reference: 近藤克則，吉井清子，松田亮三，他（2007）『検証「健康格差社会」－介護予防に向けた社会疫学的大規模調査』医学書院 – reference: Mackenbach JP, Martikainen P, Looman CWN et al. (2005) “The Shape of the Relationship between Income and Self-assessed Health : An International Study,” International Journal of Epidemiology. 3 (42) : 286-293. – reference: Mackenbach JP, Kunst AE, Cavelaars A et al. (1997) “Socioeconomic in Morbidity and Mortality in Western Europe,” Lancet. 349 (9066) : 1655-1659. – reference: 市田行信，近藤尚己，近藤克則（2011）「高齢者の健康と介護における公正性の評価指標の開発」厚生労働科学研究費補助金（長寿科学総合研究事業）「介護保険の総合的政策評価ベンチマークシステムの開発」分担研究報告書 – reference: Fukuda Y, Nakamura K and Takano T (2005a) “Accumulation of Health Risk Behaviours is Associated with Lower Socioeconomic Status and Women's Urban Residence : A Multilevel Analysis in Japan,” BMC Public Health 5 (1) : 53. – reference: WHO Commission on Social Determinants of Health (2008) Closing the Gap in a Generation : Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. World Health Organization. – reference: Mackenbach JP and Kunst AE (1997) “Measuring the Magnitude of Socio-economic Inequalities in Health : An Overview of Available Measures Illustrated with Two Examples from Europe,” Social Science & Medicine. 44 (6) : 757-771. – reference: Fukuda Y, Nakao H and Imai H (2007) “Different Income Information as an Indicator for Health Inequality among Japanese Adults,” Journal of Epidemiology / Japan Epidemiological Association. 17 (3) : 93-99. – reference: World Health Organization (2013) “Global Health Observatory.” <http://www.who.int/gho/en/> Accessed December 30, 2013. – reference: Fukuda Y, Nakamura K and Takano T (2004b) “Wide Range of Socioeconomic Factors Associated with Mortality among Cities in Japan,” Health Promotion International. 19 (2) : 177-187. – reference: Fukuda Y, Nakamura K and Takano T (2005b) “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,” International Journal of Epidemiology. 34 (1) : 100. – reference: Fukuda Y, Nakamura K and Takano T (2005c) “Municipal Health Expectancy in Japan : Decreased Healthy Longevity of Older People in Socioeconomically Disadvantaged Areas,” BMC Public Health 5 (1) : 65. – reference: Fukuda Y, Nakamura K and Takano T (2004a) “Municipal Socioeconomic Status and Mortality in Japan : Sex and Age Differences, and Trends in 1973-1998,” Social Science & Medicine. 59 (12) : 2435. – reference: Mackenbach JP, Stirbu I, Roskam A-JR et al. (2008) “Socioeconomic Inequalities in Health in 22 European Countries” New England Journal of Medicine. 358 (23) : 2468-2481. – reference: Fukuda Y and Imai H (2007) “Review of Research on Social Inequalities in Health in Japan,” Journal of the National Institute of Public Health. 56 (2) : 56-62. – reference: Fukuda Y, Nakamura K and Takano T (2007) “Higher Mortality in Areas of Lower Socioeconomic Pmeasured by a Single Index of Deprivation in Japan,” Public Health. 121 (3) : 163-173. – reference: Fukuda Y, Nakao H, Yahata Y et al. (2007) “Are Health Inequalities Increasing in Japan? The Trends of 1955 to 2000,” Bio Science Trend. 1 (1) : 38-42. – reference: 近藤克則，健康の不平等研究会（2007）『検証「健康格差社会」－介護予防に向けた社会疫学的大規模調査』医学書院 – reference: Fukuda Y, Nakamura K and Takano T (2005e) “Socioeconomic Pattern of Smoking in Japan：Income Inequality and Gender and Age Differences,” American College of Epidemiology. 15 (5) : 365-372. – reference: Huisman M, Kunst AE, Bopp M et al. (2005) “Educational Inequalities in Cause-specific Mortality in Middle-aged and Older Men and Women in Eight Western European Populations,” Lancet. 365 (9458) : 493-500. – reference: Kunst A and Mackenbach J (1995) Measuring Socioeconomic Inequalities in Health. Copenhagen, Denmark : World Health Organization, Regional Office for Europe. |
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| SubjectTerms | JAGES 健康格差 地域診断 格差勾配指数 格差相対指数 |
| Title | 地域診断のための健康格差指標の検討とその活用 |
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