Effects of socioeconomic indicators on coronary risk factors, self-rated health and psychological well-being among urban Japanese civil servants
Introduction
Socioeconomic gradients in risk factors and mortality from coronary heart diseases have been studied in developed countries (Marmot et al., 1991; Kaplan & Keil, 1993; Brunner et al., 1997; Gonzalez, Artalejo, & del Rey Calero, 1998; Kunst et al., 1999) and in less-developed countries (Anonymous, 1994; Song & Byeon, 2000; Yu et al., 2000). Associations between socioeconomic status and coronary risk factors in Japan have also been reported (Morikawa et al., 1997; Ishizaki et al., 1999; Anzai, Ohkubo, Nishino, Tsuji, & Hisamichi, 2000; Ishizaki, Martikainen, Nakagawa, & Marmot, 2000; Nakamura, Nakamura, & Tanaka, 2000; Martikainen, Ishizaki, Marmot, Nakagawa, & Kagamimori, 2001). Morikawa et al. (1997) found from the results of a 10-year follow-up study that there was an inverse relationship between occupation and development of noninsulin-dependent diabetes mellitus. Nakamura et al. (2000) reported that blue-collar workers were more obese and had less healthy lifestyles than did white-collar workers. Thus, all previous studies in Japan, except one (Anzai et al., 2000), have been conducted in occupational settings with occupational social class being the main socioeconomic indicator examined.
Different effects of socioeconomic indicators on coronary risk factors and mortality have been discussed (Winkleby, Jatulis, Frank, & Fortmann, 1992; Stronks, van de Mheen, van den Bos, & Mackenbach, 1997; Davey Smith et al., 1998; Lantz et al., 1998; Geyer & Peter, 2000; Miech & Hauser, 2001; Zimmer & Amornsirisomboon, 2001). Winkleby et al. (1992) examined associations of education, income and occupation with coronary risk factors and found that education was the only socioeconomic indictor significantly associated with coronary risk factors. Davey Smith et al. (1998) found that education has a stronger association than does occupational social class with cardiovascular mortality. Ishizaki et al. (2000) reported that low employment grade and low educational background were associated with increased age-adjusted plasma fibrinogen level in workers in a metal-products factory in a rural area of Japan. They used several biological factors for adjustment, but they did not show a direct relationship between those factors and education or employment grade. Martikainen et al. (2001) examined socioeconomic differences in behavioral and biological risk factors using the same cohort as that used in the study by Ishizaki et al. (2000) in comparison with English civil servants. In the Japanese cohort, inverse relationships between socioeconomic status and coronary risk factors were not observed, but subjects with higher employment grades had higher body mass indexes (BMI), higher waist-to-hip ratios, and lower high-density lipoprotein (HDL) cholesterol levels. They also found similar results for education. The reason for the positive relationships between these biological risk factors and socioeconomic status might be because the cohort was a rural population.
The aim of this study was to compare the effects of education level and employment grade on coronary risk factors and subjective well-being of civil servants living in an urban area of Japan.
Section snippets
Study population
The subjects of this study were 1652 civil servants (1153 men and 499 women, aged 35 years or older as of March 31, 1998) working in Takarazuka City (population 210,000). Screening examinations were conducted from April 1997 to March 1998, and 1543 (93.4%) of the subjects screened participated in the study. A questionnaire survey was conducted in February 1998, and 1378 (83.4%) of the subjects responded.
Screening examinations
All of the subjects underwent physical examinations at Takarazuka City Health Promotion
Results
The subjects for the analyses were 1361 civil servants (968 men and 393 women). Table 1 shows the demographic and socioeconomic characteristics of the subjects. Age distributions of the men and women were different; more than half of the men were in the age group of 45–54 years, whereas the percentages of women in the age groups of 35–44 and 45–54 years were almost the same. Distributions of educational levels of the men and women were similar. The percentage of female manual workers was about
Discussion
We compared the effects of level of education and employment grade on coronary risk factors and self-rated health in an urban population of Japanese civil servants. The main findings of this study were (1) among behavioral risk factors, smoking showed a clear inverse association with level of education, but alcohol drinking and physical inactivity showed both inverse and positive associations with socioeconomic status; (2) among biological risk factors, diabetes was inversely associated with
Acknowledgements
We thank Professor Sir Michael Marmot, Dr. Eric Brunner and Dr. Pekka Martikainen of University College London for their valuable comments on our study.
References (29)
Smoking prevalence among women in the European community 1950–1990
Social Science & Medicine
(1996)- et al.
The relationship between employment grade and plasma fibrinogen level among Japanese male employees
Atherosclerosis
(2000) - et al.
Health inequalities among British civil servantsThe Whitehall II study
Lancet
(1991) - et al.
Socioeconomic status and health at midlifeA comparison of educational attainment with occupation-based indicators
Annals of Epidemiology
(2001) - et al.
Socioeconomic status and health among older adults in ThailandAn examination using multiple indicators
Social Science & Medicine
(2001) - Anonymous. (1994). Socio-economic status and risk factors for cardiovascular disease: A multicentre collaborative study...
- et al.
Relationship between health practices and education level in the rural Japanese population
Journal of Epidemiology
(2000) The structure of psychological well-being
(1969)- et al.
Social inequality in coronary risk: Central obesity and the metabolic syndromeEvidence from the Whitehall II study
Diabetologia
(1997) - et al.
Educational differences in smokingInternational comparison
BMJ
(2000)
Education and occupational social classWhich is the more important indicator of mortality risk?
Journal of Epidemiology & Community Health
Income, occupational position, qualification and health inequalities—Competing risks? (Comparing indicators of social status)
Journal of Epidemiology & Community Health
Relationship between socioeconomic status and ischemic heart disease in cohort and case-control studies1960–1993
International Journal of Epidemiology
Self-rated health and mortalityA review of twenty-seven community studies
Journal of Health & Social Behavior
Cited by (62)
Increased income over time predicts better self-perceived mental health only at a population level but not for individual changes: An analysis of a longitudinal cohort using cross-lagged models
2021, Journal of Affective DisordersCitation Excerpt :Men and women may experience different social inequalities. Men may benefit from social capital in different ways than women (Martikainen et al., 2004; Nishi et al., 2004). However, this effect has not been consistently found in the literature with some researchers failing to find a differential impact of social class inequalities among men and women (Matthews et al., 1999).
A new theory-based social classification in Japan and its validation using historically collected information
2013, Social Science and Medicine