Social class inequalities in self-rated health and their gender and age group differences in Japan

BACKGROUND: Few studies have examined social inequalities in self-rated health in Japan, and the issue of gender differences related to social inequalities in self-rated health remains inconclusive.METHODS: The data derived from interviews with 2987 randomly selected Japanese adults in four prefectures in Japan who completed the cross-national World Mental Health survey from 2002 through 2005. We calculated odds ratios (ORs) of having poor self-rated physical and mental health by two social class indicators independently with multivariate logistic regression models, adjusted for age, gender, marital status, and area. Stratified analyses by gender and age group were also conducted. RESULTS: The adjusted ORs of the lowest educational attainment category having poor self-rated physical and mental health were 1.42 (95% confidence interval [CI]: 1.15-1.76) and 1.37 (95% CI: 1.10-1.70), respectively. Among females, educational attainment had significant linear associations with self-rated physical and mental health. Adjusted household income was also significantly associated with self-rated physical health among female respondents. No associations were found among males. While educational attainment was associated with self-rated health among the young age group, adjusted household income was associated with self-rated physical health in the middle and old age group. CONCLUSION: These results indicated social inequalities in self-rated health and prominent social inequalities in self-rated health among females in Japan. Social inequalities in self-rated health seemed to exist across age groups. However, the mechanism of social inequalities in self-rated health could be different depending on the age group.     

Income inequality, social capital and self-rated health and dental status in older Japanese

The erosion of social capital in more unequal societies is one mechanism for the association between income inequality and health. However, there are relatively few multi-level studies on the relation between income inequality, social capital and health outcomes. Existing studies have not used different types of health outcomes, such as dental status, a life-course measure of dental disease reflecting physical function in older adults, and self-rated health, which reflects current health status. The objective of this study was to assess whether individual and community social capital attenuated the associations between income inequality and two disparate health outcomes, self-rated health and dental status in Japan. Self-administered questionnaires were mailed to subjects in an ongoing Japanese prospective cohort study, the Aichi Gerontological Evaluation Study Project in 2003. Responses in Aichi, Japan, obtained from 5715 subjects and 3451 were included in the final analysis. The Gini coefficient was used as a measure of income inequality. Trust and volunteering were used as cognitive and structural individual-level social capital measures. Rates of subjects reporting mistrust and non-volunteering in each local district were used as cognitive and structural community-level social capital variables respectively. The covariates were sex, age, marital status, education, individual- and community-level equivalent income and smoking status. Dichotomized responses of self-rated health and number of remaining teeth were used as outcomes in multi-level logistic regression models. Income inequality was significantly associated with poor dental status and marginally significantly associated with poor self-rated health. Community-level structural social capital attenuated the covariate-adjusted odds ratio of income inequality for self-rated health by 16% whereas the association between income inequality and dental status was not substantially changed by any social capital variables. Social capital partially accounted for the association between income inequality and self-rated health but did not affect the strong association of income inequality and dental status.     

Socioeconomic position and self-rated health: the contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources

OBJECTIVES: We examined socioeconomic inequalities in self-rated health by analyzing indicators of childhood socioeconomic circumstances, adult socioeconomic position, and current material resources. METHODS: We collected data on middle-aged adults employed by the City of Helsinki (n=8970; 67% response rate). Associations between 7 socioeconomic indicators and health self-ratings of less than "good" were examined with sequential logistic regression models. RESULTS: After adjustment for age, each socioeconomic indicator was inversely associated with self-rated health. Childhood economic difficulties, but not parental education, were associated with health independently of all other socioeconomic indicators. The associations of respondents' own education and occupational class with health remained when adjusted for other socioeconomic indicators. Home ownership and economic difficulties, but not household income, were the material indicators associated with health after full adjustment. CONCLUSIONS: Own education and occupational class showed consistent associations with health, but the association with income disappeared after adjustment for other socioeconomic indicators. The effect of parental education on health was mediated by the respondent's own education. Both childhood and adulthood economic difficulties showed clear associations with health and with conventional socioeconomic indicators.     

Self-rated oral health among Brazilian adults and older adults in Southeast Brazil: results from the SB-Brasil Project, 2003

The aim of this study was to determine which characteristics (predisposing and enabling, oral health, perceived need for dental treatment, and behavior) are independently associated with self-rated oral health among adults and older adults in Southeast Brazil. The study was based on 3,240 participants in the SB-Brasil Project/ Southeast. The characteristics of those who rated their oral health as good/very good were compared to those who rated it as fair, poor, or very poor. The following characteristics were significantly and independently associated with better self-rated oral health among adults: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, place of residence in cities with > 50,000 inhabitants, and visit to the dentist > 3 years previously. Among older adults the factors were: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, and 1-19 permanent teeth. Our results confirm those observed in other countries, showing associations between self-rated oral health and predisposing and enabling factors, oral health, perceived need for dental treatment, and behavior.     

Income inequality and self-rated health in US metropolitan areas: A multi-level analysis

Income inequality has been found to affect health in a number of international and cross-national studies. Using data from a telephone survey of adults in the United States, this study analyzed the effect of metropolitan level income inequality on self-rated health. It combined individual data from the 2000 Behavioral Risk Factor Surveillance System with metropolitan level income data from the 2000 Census. After controlling for smoking, age, education, Black race, Hispanic ethnicity, sex, household income, and metropolitan area per capita income, this study found that for each 1 point rise in the GINI index (on a hundred point scale) the risk of reporting Fair or Poor self-rated health increased by 4.0% (95% confidence interval 1.6–6.5%). Given that self-rated health is a good predictor of morbidity and mortality, this suggests that metropolitan area income inequality is affecting the health of US adults.     

Self-rated health and indicators of SES among the ageing in three types of communities

AIMS: This paper examines associations between self-rated health, three indicators of SES (self-reported education, disposable household income, adequacy of income) and three types of communities (urban, densely or sparsely populated rural areas) among ageing men and women in the Province of P?ij?t-H?me, Southern Finland. There is a lack of knowledge regarding the magnitude of community type when examining the relation between subjective health and SES. METHODS: Cross-sectional questionnaire data gathered in the spring of 2002 for a prospective follow-up of community interventions were used. These data, together with a number of clinical and laboratory measurements, yielded the baseline for a 10-year community intervention study. A representative stratified (age, gender, area) sample of men and women living in the province and belonging to the birth cohorts 1926-1930, 1936-1940, and 1946-1950 was obtained from the National Population Registry. The target sample was 4,272, with 2,815 persons responding (66% response rate). RESULTS: Positive associations between indicators of SES and self-rated health were observed in all three community types. After adjusting for other factors, adequacy of income showed the strongest (positive) association with self-rated health in urban areas in all age groups. A similar pattern of associations, with varying statistical significance, though, was found in the two rural areas. CONCLUSIONS: This study supports the view that while actual income is positively correlated to health, adequacy of income is an even stronger predictor of it. Thus, there was a significant link between better financial standing and good health among ageing people, especially in urban areas.     

Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors

This study investigated the hypothesis that socioeconomic differences in health status change can largely be explained by the higher prevalence of individual health-risk behaviors among those of lower socioeconomic position. Data were from the Americans' Changing Lives study, a longitudinal survey of 3,617 adults representative of the US non-institutionalized population in 1986. The authors examined associations between income and education in 1986, and physical functioning and self-rated health in 1994, adjusted for baseline health status, using a multinomial logistic regression framework that considered mortality and survey nonresponse as competing risks. Covariates included age, sex, race, cigarette smoking, alcohol consumption, physical activity, and Body Mass Index. Both income and education were strong predictors of poor health outcomes. The four health-risk behaviors under study statistically explained only a modest portion of the socioeconomic differences in health at follow-up. For example, after adjustment for baseline health status, those in the lowest income group at baseline had odds of moderate/severe functional impairment in 1994 of 2.11 (95% C.I.: 1.40, 3.20) in an unadjusted model and 1.89 (95% C.I.: 1.23, 2.89) in a model adjusted for health-risk behaviors. The results suggest that the higher prevalence of major health-risk behaviors among those in lower socioeconomic strata is not the dominant mediating mechanism that can explain socioeconomic disparities in health status among US adults.     

Social vulnerability and health status: a household survey in the central area of a Brazilian metropolis

The self-rated health in a sample of adults living in the central area of S?o Paulo, Brazil, was studied by comparing a group of residents in census tracts without social vulnerability, identified using an indicator developed by the SEADE Foundation, and a group of residents in census tracts with middle, high or very high social vulnerability. Subject age and sex were used as control variables while family income, education level, degree of happiness, adequacy of income, satisfaction with the neighborhood and sense of discrimination were the intervening variables selected. After adjustment in the hierarchical model the self-rated health status was inversely associated with social vulnerability, age and sense of discrimination, and directly related to income, education level and degree of happiness. Satisfaction with the neighborhood and adequacy of income lose significance after adjustment. The degree of happiness is the variable with the greatest strength of association with health status even after controlling for other variables.     

Socioeconomic differences in health among older adults in Mexico

Although the relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries, few studies have examined this association in developing countries, particularly among older cohorts. We use the Mexican Health and Aging Study (MHAS), a nationally representative survey of Mexicans age 50 and older, to investigate the linkages between three indicators of SES (education, income, and wealth) and a set of health outcomes and behaviors in more and less urban areas of Mexico. We consider three measures of current health (self-rated health and two measures of physical functioning) and three behavioral indicators (obesity, smoking, and alcohol consumption). In urban areas, we find patterns similar to those in industrialized countries: higher SES individuals are more likely to report better health than their lower SES counterparts, regardless of the SES measure considered. In contrast, we find few significant SES-health associations in less urban areas. The results for health behaviors are generally similar between the two areas of residence. One exception is the education-obesity relationship. Our results suggest that education is a protective factor for obesity in urban areas and a risk factor in less urban areas. Contrary to patterns in the industrialized world, income is associated with higher rates of obesity, smoking, and excessive alcohol consumption. We also evaluate age and sex differences in the SES-health relationship among older Mexicans. The results suggest that further economic development in Mexico may lead to a widening of socioeconomic inequalities in health. The study also provides insight into why socioeconomic gradients in health are weak among Mexican-Americans and underscores the importance of understanding health inequalities in Latin America for research on Hispanic health patterns in the US.     

Social inequality in perceived oral health among adults in Australia

OBJECTIVE: To establish population estimates of self-assessed tooth loss and subjective oral health and describe the social distribution of these measures among dentate adults in Australia. METHODS: Self-report data were obtained from a nationally representative sample of 3,678 adults aged 18-91 years who participated in the 1999 National Dental Telephone Interview Survey and completed a subsequent mail survey. Oral health was evaluated using (1) self-assessed tooth loss, (2) the 14-item Oral Health Impact Profile, and (3) a global six-point rating of oral health. RESULTS: While the absolute difference in tooth loss across household income levels increased at each successive age group (18-44 years, 45-64 years, 65+ years) from 0.7 teeth to 6.1 teeth, the magnitude of the difference was approximately twofold at each age group. For subjective oral health measures, the magnitude of difference across income groups was most pronounced in the 18-44 years age group. In multivariate analysis, low household income, blue-collar occupation, and high residential area disadvantage were positively associated with social impact from oral conditions and pathological tooth loss. Speaking other than English at home (relative to English), low household income (relative to high income), and vocational relative to tertiary education were each associated with more than twice the odds of poor self-rated oral health. CONCLUSIONS: Significant social differentials in perceived oral health exist among dentate adults. Inequalities span the socio-economic hierarchy. IMPLICATIONS: In addition to improving overall levels of oral health in the adult community, goals and targets should aim to reduce social inequalities in the distribution of outcomes.     

Association between recommended levels of physical activity and depressive symptoms among Japanese adults: A cross-sectional study

BackgroundDepression, a common mental illness, has a high global incidence. Regular physical activity at recommended levels is inversely associated with depression; however, this association has not yet been studied in the Japanese population. The present study examines the association between recommended physical activity criteria and depression, and depression score differences between physical activity groups and sociodemographic variables among Japanese adults.MethodsSociodemographic data (gender, age, educational level, employment status, marital status, living conditions, and household income), the Japanese short version of the International Physical Activity Questionnaire (IPAQ), and the Center for Epidemiologic Studies Depression Scale were used to estimate the participants’ physical activity and depression levels, respectively, via an Internet-based survey. A representative sample of 3000 Japanese adults answered the survey, stratified by gender and age. The present study followed current Japanese exercise guidelines to categorize respondents as “meeting” or “not meeting” the recommended criteria. Analysis of covariance, logistic regression, and two-way univariate analysis of covariance were performed.ResultsRespondents not meeting the recommendations for physical activity had significantly higher depression scores than those meeting the recommendations. Individuals not meeting the recommended criteria had significantly higher depression scores than those meeting the criteria across the following variables: age, marital status, living conditions, and household income in men; and age, marital status, education level, employment status, and household income in women. Men who were unmarried and had low household income levels and women who were young, unmarried, and had lower household income levels had higher depression scores.ConclusionThe present study is one of the first studies to report on the cross-sectional associations among depression scores, physical activity levels, and various sociodemographic factors in the Japanese population.     

Analysis of items missing in responses to a series of follow-up surveys in Japanese elderly

PURPOSES: We examined whether the percentage of items missing and the factors related to item missing differ across follow-up surveys, Variables targeted to examine missing items included health indicators (activities of daily living, cognitive function, self-rated health, Center for Epidemiologic Studies--Depression, and PGC Morale Scale), health habits (cigarette smoking, alcohol consumption, physical exercise, and relative weight), and socioeconomic indicators (educational attainment, income, and social networks). METHODS: Longitudinal data were collected at intervals of three years since 1987 through a national survey of Japanese adults aged 60 and over, At the baseline survey, a total of 2,200 interviews were completed from the list of 3,288 names. At the following three follow-up surveys, 1,671, 1,369, and 1,068 persons were reinterviewed respectively. Possible factors related to appearance of a missing item consisted of five aspects; 1) demographic variables (age and sex), 2) social status (educational attainment, existence of a spouse, and job status), 3) health status (activities of daily living and cognitive function), 4) cooperative attitude toward a survey, and 5) whether an item had been missing at the previous survey (s). Those factors were analyzed for each variable respectively. If a group with scaled or collective items had one or more missing items, we classified that group as a missing item group. RESULTS: 1. The percentage of cases with items missing was 5 percent or more for four variables; CES-D, PGC Morale Scale, income, and health habits. Those percentages were almost constant over the four surveys. 2. Factors related to appearance of items missing differed by psychological variables such as, CES-D and PGC Morale Scale, income, or health habits. Those factors had constant impact on appearance of items missing over follow-up surveys. 3. Regarding CES-D, PGC Morale Scale, income, or health habits, persons with an item missing at a previous survey, or who did not have a cooperative attitude toward the survey had a significant impact on an increase in the percentage of missing items. CONCLUSION: Characteristics of persons with items missing differs among the variables, and those characteristics may contribute to the incidence of items missing in subsequent surveys.     

Socioeconomic status and smoking: analysing inequalities with multiple indicators

BACKGROUND AND AIMS: Socioeconomic differences in smoking have been well established. While previous studies have mostly relied on one socioeconomic indicator at a time, this study examined socioeconomic differences in smoking by using several indicators that reflect different dimensions of socioeconomic position. DATA AND METHODS: Data derive from Helsinki Health Study baseline surveys conducted among the employees of the City of Helsinki in 2000 and 2001. The data include 6243 respondents aged 40-60 years (response rate 68%). Six socioeconomic indicators were used: education, occupational status, household income per consumption unit, housing tenure, economic difficulties and economic satisfaction. Their associations with current smoking were examined by fitting sequential logistic regression models. RESULTS: All socioeconomic indicators were strongly associated with smoking among both men and women. When the indicators were examined simultaneously their associations with smoking attenuated, especially when education and occupational status were considered together, and when income and housing tenure were introduced into the models already containing education and occupational status. After mutual adjustment for all socioeconomic indicators, housing tenure and economic satisfaction remained associated with smoking in men. In women, all indicators except income and economic difficulties were inversely associated with smoking after adjustments. CONCLUSIONS: Smoking was associated with structural, material as well as perceived dimensions of socioeconomic disadvantage. Attempts to reduce smoking among the socioeconomically disadvantaged need to target several dimensions of socioeconomic position.     

Social capital and self-rated health: a contextual analysis.

OBJECTIVES: Social capital consists of features of social organization--such as trust between citizens, norms of reciprocity, and group membership--that facilitate collective action. This article reports a contextual analysis of social capital and individual self-rated health, with adjustment for individual household income, health behaviors, and other covariates. METHODS: Self-rated health ("Is your overall health excellent, very good, good, fair, or poor?") was assessed among 167,259 individuals residing in 39 US states, sampled by the Behavioral Risk Factor Surveillance System. Social capital indicators, aggregated to the state level, were obtained from the General Social Surveys. RESULTS: Individual-level factors (e.g., low income, low education, smoking) were strongly associated with self-rated poor health. However, even after adjustment for these proximal variables, a contextual effect of low social capital on risk of self-rated poor health was found. For example, the odds ratio for fair or poor health associated with living in areas with the lowest levels of social trust was 1.41 (95% confidence interval = 1.33, 1.50) compared with living in high-trust states. CONCLUSIONS: These results extend previous findings on the health advantages stemming from social capital.     

An investigation of the longitudinal relationship between neighbourhood income inequality and individual self-rated health in England

There are mixed findings on whether neighbourhood income inequality leads to better self-rated health (SRH) or not. This study considers two hypotheses: individuals living in more unequal neighbourhoods have better SRH and the level of neighbourhood income inequality and its impact on SRH is moderated by household and neighbourhood level income related variables. Data from Waves 8–10 of the UK Household Longitudinal Study for respondents living in England at wave 8 were used. Neighbourhood income inequality was measured using Gini coefficients of household income from the Pay As You Earn and benefits systems for Lower Super Output Areas. Longitudinal ordinal multilevel models predicted self-rated health in 2016–18, 2017–19 and 2019-20 by income inequality and its interaction with household income, neighbourhood median income and neighbourhood deprivation, conditional on individual educational attainment, age, sex, ethnic group, years lived in current residence, region of residence and study wave. There were 24,889 respondents analysed over three waves. SRH was worse for those living in more income equal neighbourhoods. There was no indication that neighbourhood inequality was moderated by household income, neighbourhood median income or neighbourhood deprivation. These findings are in line with the balance of existing evidence and support policy interventions that aim to create mixed communities for the purpose of improving population health.     

Associations of Household Expenditure and Marital Status With Cardiovascular Risk Factors in Japanese Adults: Analysis of Nationally Representative Surveys

Background

Socioeconomic inequalities in health and social determinants of health are important issues in public health and health policy. We investigated associations of cardiovascular risk factors with household expenditure (as an indicator of socioeconomic status) and marital status in Japan.

Methods

We combined data from 2 nationally representative surveys—the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, 2003–2007—and analyzed sex-specific associations of household expenditure quartiles and marital status with cardiovascular risk factors, including obesity, hypertension, dyslipidemia, and diabetes, among 6326 Japanese adults (2664 men and 3662 women) aged 40 to 64 years.

Results

For men, there was no statistically significant association between household expenditure and cardiovascular risk factors. For women, lower household expenditure was significantly associated with obesity, hypertension, diabetes, and the presence of multiple risk factors: the ORs for the lowest versus the highest quartile ranged from 1.39 to 1.71. In a comparison of married and unmarried participants, the prevalence of cardiovascular risk factors was higher among married women and lower among married men.

Conclusions

Lower socioeconomic status, as indicated by household expenditure, was associated with cardiovascular risk factors in Japanese women. Socioeconomic factors should be considered in health promotion and prevention of cardiovascular disease.Key words: health inequalities, socioeconomic factor, household expenditure, cardiovascular risk factor, marital status     

Determinants of self-rated health among elderly persons in S?o Paulo, Brazil]

OBJECTIVES: To investigate the influence that demographic determinants, socioeconomic determinants, chronic diseases, and functional capacity have on self-rated health among elderly persons (60 years and older) living in the city of S?o Paulo, S?o Paulo, Brazil, and to investigate the existence of differences between men and women in terms of their self-rated health. METHODS: The study was carried out using data collected in the city of S?o Paulo as part of a project called Health, Well-being, and Aging in Latin America and the Caribbean (the "SABE project"). We analyzed data on 2,135 elderly individuals (58.6% women; mean age, 69.4 years; median age, 68.0 years). The dependent variable was self-rated health (good or poor). The following independent variables were considered: (1) demographic ones (age, sex, marital status, and living arrangements (whether the elderly person lived alone or with others)), (2) socioeconomic ones (schooling and income), (3) the number of chronic diseases (hypertension, arthritis or rheumatism, cardiovascular disease, diabetes, asthma, bronchitis or emphysema, embolism or stroke, and cancer), and (4) functional capacity. To estimate the association between self-rated health and the independent variables and to study gender differences, a multiple binary logistic regression analysis was performed. RESULTS: The presence of chronic diseases in association with gender was the strongest determinant of self-rated health among the elderly in S?o Paulo. Among men with four or more chronic diseases, they were 10.53 times as likely to characterize their health as poor; among women with four or more chronic diseases, the ratio was 8.31. Functional capacity, schooling, and income were also strongly associated with self-rated health, and the influence of age was significant. The elderly women were more likely to report good self-rated health than were men when the women or men either had no chronic diseases or had two or more. CONCLUSIONS: Our results indicate the need for simultaneous, comprehensive actions in the health sector, social services, and the economic sector to address the main determinants of self-rated health in order to promote well-being and quality of life among the elderly.     

Comparison of characteristics between respondents and nonrespondents in a national survey of Japanese elderly using six year follow-up study]

PURPOSES: The purpose of this study were twofold: 1) to examine differences between respondents and nonrespondents in sociodemographic or health characteristics, 2) to study nonresponse effects on relationships between variables, using a 6 year follow-up study for both respondents and nonrespondents at the initial survey. METHODS: The data were collected in 1987 through a national survey of Japanese adults aged 60 and over. A total of 2,200 interviews were completed from the list of 3,288 names. In 1993, 1,010 nonrespondents excluding persons who had died, moved, or whose addresses were unknown in the prior interview, were recontacted through a mail questionnaire. A total of 559 persons completed the mail questionnaire. Of the original 2,200 baseline interviewees, some by proxy interviews, 2,260 persons were reinterviewed, at the same time as the mail survey. Sociodemographic and health variables (age and sex), social indicators (educational attainment, marital status, and job status), health status (mortality, existence of diseases, and activities of daily living), subjective well-being (life satisfaction, self-rated health, and economic satisfaction) were compared between respondents and nonrespondents. Relationships between self-rated health and sociodemographic or health variables were examined by multiple regression analysis. RESULTS: 1. Compared to people who participated in the survey, norespondents were likely to be male, in the lower age categories, and with higher educational attainment at the follow-up survey. Also, life satisfaction and self-rated health were lower in nonrespondents than in respondents. Reasons for nonresponse varied but appeared to be somewhat related to characteristics of nonrespondents. 2. No significant relationships between self-rated health and sociodemographic or health variables appeared for the respondent group and also when including the nonrespondent group. CONCLUSION: While differences between respondents and nonrespondents on certain variables were significant, relationships between self-rated health and sociodemographic variables were not observed.     

Socioeconomic Status and Overweight: A Population-Based Cross-Sectional Study of Japanese Children and Adolescents

Background

Socioeconomic status (SES) as a determinant of obesity has received scant attention in Japan. This study examined the association between SES and overweight among Japanese children and adolescents.

Methods

Cross-sectional analyses of a representative sample of Japanese children (6–11 years: n = 397) and adolescents (12–18 years: n = 397) were performed, with measured heights and weights from the 2010 National Health and Nutrition Examination Survey and the 2010 Comprehensive Survey of Living Conditions. Overweight, including obesity, was defined by International Obesity Task Force cut-offs. SES indicators included household income, equivalent household expenditure, parental educational attainment, and parental occupational class.

Results

Overweight prevalence was 12.3% in children and 9.1% in adolescents. Adolescents living in middle-income households were more likely to be overweight than those living in high-income households (OR 2.26, 95% CI, 1.01–5.67) after adjustment for age, sex, and parental weight status. Similarly, adolescents living in households with low expenditure levels were more likely to be overweight than those living in households with high expenditure levels (OR 3.40, 95% CI, 1.20–9.60). In contrast, no significant association was observed among children.

Conclusions

Our results indicated that low household economic status was associated with being overweight, independent of parental weight status, among Japanese adolescents.Key words: socioeconomic status, overweight, children, adolescent, Japan     

Functional health literacy and health-promoting behaviour in a national sample of British adults

OBJECTIVES: To measure the prevalence of limited functional health literacy in the UK, and examine associations with health behaviours and self-rated health. DESIGN: Psychometric testing using a British version of the Test of Functional Health Literacy in Adults (TOFHLA) in a population sample of adults. SETTING: UK-wide interview survey (excluding Northern Ireland and the Scottish Isles). PARTICIPANTS: 759 adults (439 women, 320 men) aged 18-90 years (mean age _ 47.6 years) selected using random location sampling. MAIN OUTCOME MEASURES: Functional health literacy, self-rated health, fruit and vegetable consumption, physical exercise and smoking. RESULTS: We found that 11.4% of participants had either marginal or inadequate health literacy. Multivariable logistic regression analysis indicated that the risk of having limitations in health literacy increased with age (adjusted odds ratio 1.04; 95% confidence interval 1.02 to 1.06), being male (odds ratio _ 2.04; 95% confidence interval 1.16 to 3.55), low educational attainment (odds ratio _ 7.46; 95% confidence interval 3.35 to 16.58) and low income (odds ratio _ 5.94; 95% confidence interval 1.87 to 18.89). In a second multivariable logistic regression analysis, every point higher on the health literacy scale increased the likelihood of eating at least five portions of fruit and vegetables a day (odds ratio _ 1.02; 95% confidence interval 1.003 to 1.03), being a non-smoker (odds ratio _ 1.02; 95% confidence interval 1.0003 to 1.03) and having good self-rated health (odds ratio _ 1.02; 95% confidence interval 1.01 to 1.04), independently of age, education, gender, ethnicity and income. CONCLUSIONS: The results encourage efforts to monitor health literacy in the British population and examine associations with engagement with preventative health behaviours.