Medical Information Center, Kyushu University Hospital, Fukuoka, Japan.
J Prev Med Public Health. 2021 Sep;54(5):352-359. doi: 10.3961/jpmph.21.215. Epub 2021 Aug 14.
The aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality.
Diabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis.
The geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile.
Socioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.
本研究旨在探讨日本糖尿病死亡率的地域分布，并确定影响市町村特异性糖尿病死亡率差异的社会经济因素。
从日本人口动态统计中提取了 2013 年至 2017 年按年度和市町村划分的糖尿病死亡率数据，并从政府统计数据中获取了市町村的社会经济特征。我们使用经验贝叶斯法计算了每个市町村的标准化死亡率比（SMR），并用日本地图表示了 SMR 的地域差异。通过多元线性回归，确定了影响 SMR 差异的社会经济因素。对具有统计学意义的社会经济因素进行了进一步评估，计算了根据每个社会经济因素的程度对市町村进行分类的五重分类的死亡率的相对风险，使用泊松回归分析。
糖尿病死亡率的地域分布因性别而异。在市町村特异性社会经济因素中，单身家庭比例高、失业率高、病床数多与男性的高 SMR 相关。父亲不在家庭比例高、蓝领工人比例高与女性的高 SMR 相关，而人均应税收入高、总人口多与女性的低 SMR 相关。五分位数分析显示，女性的应税收入与死亡率之间存在复杂的关系。最高和最低人均应税收入五分位数的死亡风险明显低于中等收入五分位数。
日本市町村的社会经济因素被发现会影响糖尿病死亡率的地域差异。
