Sugisawa Hidehiro, Shimizu Yumiko, Kumagai Tamaki, Shishido Kanji, Shinoda Toshio
International Graduate School for Advanced Studies, J. F. Oberlin University, Machida-city, Tokyo, Japan.
The Jikei University School of Nursing, Chofu-city, Tokyo, Japan.
Int J Nephrol Renovasc Dis. 2022 Feb 27;15:63-75. doi: 10.2147/IJNRD.S352174. eCollection 2022.
This study analyzed the influence of financial strains over the life course before initiating hemodialysis on the health outcomes of older Japanese patients. This study was limited to financial strains over the life course before initiating hemodialysis to eliminate the influence of financial strains resulting from resignation from paid jobs. We examined which of the four life course models-pathway, latent, social mobility, and accumulation-were appropriate to describe the influences of financial strains over the life course on older patients' health.
Data were obtained from a cross-sectional survey of 6,644 outpatients in dialysis facilities across Japan. We selected participants aged 60 years and older at the time of the survey. Numbers of dialysis complications, activities of daily living (ADL) disability, and depressive symptoms were selected as health outcomes. Benchmark periods over the life course were constructed in three parts: less than 18 years (childhood), 18-35 years (young adults), and 35-50 years (middle-aged). We retrospectively measured financial strains over the life course.
Pathway models best described the influence of financial strains over the life course on the three types of health outcomes. Experiences of financial strains as young adults had a direct influence on ADL disability of older patients. This result supports latent models. Social mobility models (upward and downward mobility) and accumulation models explained the number of dialysis complications, ADL disability, and depressive symptoms in older patients.
These results suggest that socioeconomic disadvantages over the life course before initiating hemodialysis were significantly associated with health outcomes in older patients.
本研究分析了开始血液透析前一生中的经济压力对日本老年患者健康结局的影响。本研究仅限于开始血液透析前一生中的经济压力，以消除因辞去有薪工作导致的经济压力的影响。我们研究了四种生命历程模型——路径模型、潜在模型、社会流动模型和积累模型——中哪一种适合描述一生中的经济压力对老年患者健康的影响。
数据来自对日本各地透析机构6644名门诊患者的横断面调查。我们选择了调查时年龄在60岁及以上的参与者。将透析并发症的数量、日常生活活动（ADL）能力残疾和抑郁症状作为健康结局。生命历程中的基准期分为三个部分：18岁以下（儿童期）、18 - 35岁（青年期）和35 - 50岁（中年期）。我们回顾性地测量了一生中的经济压力。
路径模型最能描述一生中的经济压力对三种健康结局类型的影响。青年期经历的经济压力对老年患者的ADL能力残疾有直接影响。这一结果支持潜在模型。社会流动模型（向上和向下流动）和积累模型解释了老年患者的透析并发症数量、ADL能力残疾和抑郁症状。
这些结果表明，开始血液透析前一生中的社会经济劣势与老年患者的健康结局显著相关。
