Department of Interdisciplinary Science and Innovation, School of Interdisciplinary Science and Innovation, Kyushu University, Fukuoka, Japan; Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan.
Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Soc Sci Med. 2023 Jul;328:115981. doi: 10.1016/j.socscimed.2023.115981. Epub 2023 May 22.
Economic stability is thought to be associated with health outcomes. Income changes may affect the occurrence of herpes zoster (HZ), which is a neurocutaneous disease caused by the varicella-zoster virus. This retrospective cohort study aimed to examine the associations between annual income changes and incident HZ in a Japanese population. The analysis was conducted using a database of public health insurance claims data linked with administrative data containing income levels. The study population comprised 48,317 middle-aged persons aged 45-64 years from five municipalities, and participants were followed-up from April 2016 until March 2020. Income changes were categorized as income unchanged (income in the year of interest remained within 50% of income in the previous year), income rise (income increased by more than 50% from the previous year to the year of interest), and income drop (income decreased by more than 50% from the previous year to the year of interest). Cox proportional hazards regression analyses were performed to calculate the hazard ratios of HZ for income drop and income rise (reference: income unchanged) as time-varying variables. Covariates included age, sex, and immune-related conditions. The results showed that income drop was significantly associated with a higher hazard ratio (1.15, 95% confidence interval: 1.00-1.31) for HZ. In contrast, income rise was not associated with HZ. A subgroup analysis revealed that the lowest baseline income group had a significantly higher risk of HZ when experiencing an income drop (HR: 1.56, 95% CI: 1.13-2.15). As zoster vaccination is voluntary and vaccination coverage in middle-aged persons is low in Japan, our findings indicate that it may be advantageous to promote and subsidize voluntary vaccinations for middle-aged people with low baseline income who have experienced substantial income reductions in order to reduce the risk of HZ.
经济稳定被认为与健康结果有关。收入变化可能会影响带状疱疹（HZ）的发生，HZ 是一种由水痘-带状疱疹病毒引起的神经皮肤疾病。这项回顾性队列研究旨在研究日本人群中年收入变化与带状疱疹发病之间的关系。该分析使用了公共医疗保险索赔数据库和包含收入水平的行政数据链接的数据库进行。研究人群包括来自五个市的 48317 名 45-64 岁的中年人，参与者从 2016 年 4 月开始随访至 2020 年 3 月。收入变化分为收入不变（当年的收入在去年收入的 50%以内）、收入增加（当年的收入比前一年增加了 50%以上）和收入下降（当年的收入比前一年下降了 50%以上）。采用 Cox 比例风险回归分析计算 HZ 的收入下降和收入上升（参考：收入不变）的危险比作为时变变量。协变量包括年龄、性别和免疫相关疾病。结果表明，收入下降与 HZ 的危险比显著升高（1.15，95%置信区间：1.00-1.31）相关。相比之下，收入上升与 HZ 无关。亚组分析显示，基线收入最低的组在收入下降时 HZ 的风险显著升高（HR：1.56，95%CI：1.13-2.15）。由于带状疱疹疫苗接种是自愿的，并且日本中年人的疫苗接种率较低，因此我们的研究结果表明，对于经历了大幅收入减少的基线收入较低的中年人群，促进和补贴自愿疫苗接种可能有利于降低 HZ 的风险。
