Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Health Economics & Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Public Health. 2021 Jun;195:112-117. doi: 10.1016/j.puhe.2021.01.022. Epub 2021 Jun 1.
In Japan, it is mandatory for employers to provide general health checkup opportunities to employees. Although many companies have subsidized checkups for employees' dependent family members, their participation is low. We assessed income-based inequality in the participation of employees' dependents in the general health checkup.
This is a cross-sectional descriptive study. Annual participation rate in general health checkup and various factors including income, age, and sex were collected and analyzed to examine the income-based inequality of participation rate in general health checkup.
The data for the present study were sourced from the Fukuoka Branch of the Japan Health Insurance Association, a large medical insurer in Japan. We extracted data of 196,057 dependents aged 40-74 years. We conducted a multiple logistic regression analysis using participation from April 2015 to March 2016 as dependent variable and income category ranging from 1 (lowest) to 4 (highest) between April and June 2015 as independent variable (adjusted for sex and age). We computed slope index of inequality (SII) and relative index of inequality (RII) based on income category.
Higher the income, the more likely were dependents to participate in the general health checkup. SII for the participation rate of general health checkup ranged between -0.02 (95% confidence interval [CI]: -0.07 to 0.03) and 0.06 (0.03-0.09) for men; 0.03 (0.01-0.06) and 0.10 (0.09-0.11) for women. RII for the participation rate of general health checkup ranged between -0.19 (95% CI: -0.66 to 0.29) and 0.88 (0.15-1.61) for men; 0.22 (0.05-0.39) and 0.68 (0.60-0.76) for women. The highest inequality existed for men in their 50s and 60s and women in their 50s; the lowest inequality was among men and women aged 70-74 years.
There was income-based inequality in participation in the general health checkup among dependents (family members) of the insured persons. The degree of inequality differed with age group. It cannot be explained solely by financial barrier among low-income group, rather it may reflect Japanese unique context in medical insurance system.
在日本，雇主为员工提供全面健康检查机会是强制性的。尽管许多公司为员工的家属提供了补贴体检，但他们的参与率却很低。我们评估了员工家属参与全面健康检查的收入不平等情况。
这是一项横断面描述性研究。我们收集了年度参与全面健康检查的比率以及包括收入、年龄和性别在内的各种因素，并进行了分析，以检查参与全面健康检查的收入不平等情况。
本研究的数据来自日本健康保险协会福冈分会，这是日本一家大型医疗保险机构。我们提取了年龄在 40-74 岁之间的 196057 名家属的数据。我们使用 2015 年 4 月至 2016 年 3 月的参与情况作为因变量，2015 年 4 月至 6 月的收入类别（1 表示最低，4 表示最高）作为自变量进行多因素逻辑回归分析（调整性别和年龄）。我们根据收入类别计算了不平等斜率指数（SII）和相对不平等指数（RII）。
收入越高，家属参与全面健康检查的可能性就越大。男性全面健康检查参与率的 SII 范围在-0.02（95%置信区间[CI]：-0.07 至 0.03）至 0.06（0.03 至 0.09）之间；女性的 SII 范围在 0.03（0.01 至 0.06）至 0.10（0.09 至 0.11）之间。男性全面健康检查参与率的 RII 范围在-0.19（95%CI：-0.66 至 0.29）至 0.88（0.15 至 1.61）之间；女性的 RII 范围在 0.22（0.05 至 0.39）至 0.68（0.60 至 0.76）之间。男性 50 多岁和 60 多岁以及女性 50 多岁的不平等程度最高；70-74 岁的男性和女性的不平等程度最低。
参保人员家属（家庭成员）参与全面健康检查存在收入不平等。不平等程度因年龄组而异。这不能仅仅用低收入群体的经济障碍来解释，而可能反映了日本医疗保险制度的独特背景。
