BACKGROUND: Worldwide trends in health risks, lifestyle behaviors, health perceptions, and health-seeking patterns suggest alarming disparities among individuals from low- and middle-income countries. Such international comparisons are particularly troubling for older individuals (≥60 years). OBJECTIVES: This study aims to compare health risks, lifestyle behaviors, health perceptions, and health-seeking patterns between younger (<60) and older (≥60) Filipinos from rural communities in the Philippines. METHODS: A comparative cross-sectional study was employed with 863 younger and 427 older Filipinos. Data were analyzed using frequencies, chi-squares, and T-tests. RESULTS: Older participants were more likely to be single/widowed, ≤ high school education and had higher rates of hypertension, high cholesterol, diabetes, and depression. They reported poorer health status and went to the village health center when sick. Furthermore, they were less likely to drink alcohol and see a physician. CONCLUSION There were significant differences in modifiable health risks and lifestyle behaviors and differences in health perceptions between younger and older cohorts of Filipinos living in rural areas in the Philippines. Our findings suggest the need to design separate health promotion interventions that target older and younger Filipinos' unique needs from rural communities.
Low-Middle-Income Countries ; Aging ; Cross-sectional ; Population Health ; Philippines

Objective: To investigate and understand the medical security and quality of life of migrant workers with pneumoconiosis, so as to provide scientific basis for the prevention and control countermeasures of migrant workers with pneumoconiosis and targeted poverty alleviation. Methods: Using a stratified random sampling method, 200 migrant workers diagnosed with pneumoconiosis at the Shandong Academy of Occupational Health and Occupational Medicine from January 2016 to December 2021 were selected as the observation group, while 200 non migrant workers diagnosed with pneumoconiosis were selected as the control group. St. George's Respiratory Questionnaire (SGRQ) and Pneumoconiosis Questionnaire were used to collect and compare information on the age, working age of dust exposure, economic sources, employment status, income, medical security and quality of life of two groups of patients. Results: The age of migrant worker pneumoconiosis patients in the observation group was (58.1±8.1) years old, and the working age of dust exposure was (19.3±10.1) years. The main source of income was children support (85.5%, 171/200), employment status was mainly wait for employment or unemployed (69.0%, 138/200), personal monthly income was mainly non income (90.0%, 180/200), and family annual income was mainly less than 10000 yuan (48.0%, 96/200). The average personal annual medical expenditure of 5000-<10000 yuan accounted for 42.0% (84/200). The age of pneumoconiosis patients in the control group was (59.2±8.9) years old, and the working age of dust exposure was (20.2±10.5) years. The main source of income was retirement pension or salary (99.0%, 198/200), with retirement as the main employment status (66.0%, 132/200), the main personal monthly income was 2000-<4000 yuan (61.5%, 123/200), the main family annual income was 20000-<40000 yuan (44.0%, 88/200), and the average personal annual medical expenditure was mostly non-expenditure (92.0%, 184/200). There were statistically significant differences in the distribution of economic sources, employment status, personal monthly income, family annual income and average personal annual medical expenditure between the two groups (P<0.001). The main type of insurance for the observation group was rural cooperative medical care (68.5%, 137/200), and 87.0% (174/200) had no medical reimbursement and a proportion less than 50%. There were statistically significant differences in insurance type and medical reimbursement proportion between the two groups (P<0.001). The respiratory symptoms, activity ability, daily life influence and total quality of life scores of pneumoconiosis patients in the observation group were significantly higher than those in the control group, the differences were statistically significant (P<0.001) . Conclusion: Migrant workers with pneumoconiosis have low income, high medical expenditure, low medical reimbursement proportion and poor quality of life. Therefore, it is necessary to draw high attention from relevant departments and provide timely attention and assistance to improve the quality of life of migrant workers with pneumoconiosis.
Child ; Humans ; Middle Aged ; Aged ; Adolescent ; Young Adult ; Adult ; Quality of Life ; Pneumoconiosis ; Income ; Employment ; Dust ; China

Objective: To investigate the relationship between socioeconomic status (SES) and all-cause mortality in patients with type 2 diabetes. Methods: A total of 17 553 patients with type 2 diabetes were recruited under the National Basic Public Health Service Project in Changshu county, Qingjiangpu district, and Huai'an district in Huai'an city of Jiangsu province as participants. Latent class analysis was applied to classify the individuals based on five socioeconomic indicators. Then, Cox proportional hazards regression models were used to estimate the associations of different levels of SES with all-cause mortality, and stratified analysis was performed according to age and area. Results: Among 100 529.08 person-years of the fo1low-up, the median follow-up time was 5.7 years, and 1 829 deaths occurred during the follow-up period. According to the relevant results of the latent class model, the model of the "three classes" was the best. The related population was then divided into low SES (8 256 people, 47.0%), medium SES (4 427 people, 25.2%), and high SES groups (4 870 people, 27.8%). Compared to patients with high SES, the multivariate-adjusted hazard ratio (95%CI) of all-cause mortality associated with low SES for males and females were 1.84 (1.53-2.21) and 1.41 (1.51-1.72), respectively. Stratified analysis showed that the hazard ration (95%CI) of all-cause mortality associated with low SES for males and females were 1.99 (1.12-2.95) and 2.01 (1.20-3.23), respectively, in people younger than 60 years old, and were 1.90 (1.57-2.31) and 1.40 (1.13-1.73) in people over 60 years old. The HR values (95%CI) for all-cause mortality associated with low SES for the male and females were 1.54 (1.17-2.04) and 1.27 (1.02-1.59) in the urban population with 2.11 (1.55-2.85) and 2.64 (1.17-3.35) in rural population, respectively. Conclusions: Lower SES increased the risk of all-cause mortality in type 2 diabetic patients, which is more significant in younger and rural populations.
United States ; Female ; Humans ; Male ; Middle Aged ; Latent Class Analysis ; Diabetes Mellitus, Type 2 ; Prospective Studies ; Social Class ; Income

BACKGROUND: Although the postpartum period is suggested to provide an ideal opportunity for interventions to prevent hazardous drinking, evidence on the associations of education and income with hazardous drinking during this period is limited, including in Japan. METHODS: We analyzed data from 11,031 women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan. Hazardous drinking was defined as ethanol intake of ≥20 g/day 1 year after delivery. We conducted multiple logistic regression analyses to examine whether educational attainment or equivalent household income was associated with hazardous drinking, adjusting for age, parity, drinking status during pregnancy, work status, postpartum depression, breastfeeding, and income/education. We also conducted stratified analyses by income and education groups. RESULTS: The prevalence of hazardous drinking 1 year after delivery was 3.6%. Lower education was associated with hazardous drinking; the odds ratio (95% confidence interval) of high school education or lower compared with university education or higher was 2.17 (1.59-2.98). Lower income was also associated with hazardous drinking, but this association disappeared after further adjustments for education; the odds ratios (95% confidence intervals) of the lowest compared with highest level of income were 1.42 (1.04-1.94) and 1.12 (0.81-1.54), respectively. A significant interaction was detected; lower education and lower income were associated with increased risks of hazardous drinking only in a lower income group and lower education group, respectively. CONCLUSIONS Postpartum women with lower education and lower income had higher risks of hazardous drinking in Japan.
Adult ; Alcohol Drinking/psychology* ; Cohort Studies ; Educational Status ; Female ; Humans ; Income/statistics & numerical data* ; Japan/epidemiology* ; Postpartum Period ; Pregnancy ; Risk Factors ; Young Adult

BACKGROUND: Regional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors' workload, wages, and popularity among medical students by city population sizes. METHODS: We targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents' monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital's information and each hospital's website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance. RESULTS: The average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas. CONCLUSIONS Hospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians' working conditions in Japan, and such disparities need to be corrected.
Cities/statistics & numerical data* ; Geography ; Hospitals, Teaching/statistics & numerical data* ; Japan ; Physicians/statistics & numerical data* ; Population Density ; Salaries and Fringe Benefits/statistics & numerical data* ; Students, Medical/psychology* ; Workload/statistics & numerical data*

BACKGROUND: Epidemiological evidence for the relationship between education and income and carotid intima-media thickness (CIMT) has been limited and inconsistent. The present cross-sectional study investigated this issue using baseline data from the Aidai Cohort Study. METHODS: Study subjects were 2012 Japanese men and women aged 34-88 years. Right and left CIMT were measured at the common carotid artery using an automated carotid ultrasonography device. Maximum CIMT was defined as the largest CIMT value in either the left or right common carotid artery. Carotid wall thickening was defined as a maximum CIMT value > 1.0 mm. RESULTS: The prevalence of carotid wall thickening was 13.0%. In participants under 60 years of age (n = 703) and in those aged 60 to 69 years (n = 837), neither education nor household income was associated with carotid wall thickening or with maximum CIMT. Among those aged 70 years or older (n = 472), however, higher educational level, but not household income, was independently related to a lower prevalence of carotid wall thickening: the multivariate-adjusted odds ratio for high vs. low educational level was 0.43 (95% confidence interval 0.21-0.83, p for trend = 0.01). A significant inverse association was observed between education, but not household income, and maximum CIMT (p for trend = 0.006). CONCLUSIONS Higher educational level may be associated with a lower prevalence of carotid wall thickening and a decrease in maximum CIMT only in participants aged 70 years or older.
Adult ; Aged ; Aged, 80 and over ; Carotid Intima-Media Thickness ; Cohort Studies ; Cross-Sectional Studies ; Educational Status ; Female ; Humans ; Income ; Japan/epidemiology* ; Male ; Middle Aged ; Odds Ratio ; Prevalence

BACKGROUND: Chronic kidney disease (CKD) is an independent risk factor for progression to an end-stage renal disease requiring dialysis or kidney transplantation. We investigated the association of lifestyle behaviors with the initiation of renal replacement therapy (RRT) among CKD patients using an employment-based health insurance claims database linked with specific health checkup (SHC) data. METHODS: This retrospective cohort study included 149,620 CKD patients aged 40-74 years who underwent a SHC between April 2008 and March 2016. CKD patients were identified using ICD-10 diagnostic codes and SHC results. We investigated lifestyle behaviors recorded at SHC. Initiation of RRT was defined by medical procedure claims. Lifestyle behaviors related to the initiation of RRT were identified using a Cox proportional hazards regression model with recency-weighted cumulative exposure as a time-dependent covariate. RESULTS: During 384,042 patient-years of follow-up by the end of March 2016, 295 dialysis and no kidney transplantation cases were identified. Current smoking (hazard ratio: 1.87, 95% confidence interval, 1.04─3.36), skipping breakfast (4.80, 1.98─11.62), and taking sufficient rest along with sleep (2.09, 1.14─3.85) were associated with the initiation of RRT. CONCLUSIONS Among CKD patients, the lifestyle behaviors of smoking, skipping breakfast, and sufficient rest along with sleep were independently associated with the initiation of RRT. Our study strengthens the importance of monitoring lifestyle behaviors to delay the progression of mild CKD to RRT in the Japanese working generation. A substantial portion of subjects had missing data for eGFR and drinking frequency, warranting verification of these results in prospective studies.
Aged ; Cohort Studies ; Databases, Factual ; Disease Progression ; Female ; Health Benefit Plans, Employee ; Humans ; Japan/epidemiology* ; Life Style ; Male ; Meals ; Middle Aged ; Proportional Hazards Models ; Renal Insufficiency, Chronic/therapy* ; Renal Replacement Therapy ; Retrospective Studies ; Sleep ; Smoking/epidemiology*

OBJECTIVE: To analyze the inequality of early marriage and adolescent fertility with respect to local economic development among Chinese females aged 15-19 years from 1990 to 2010. METHODS: Aggregated data were extracted from the Chinese National Census from 1990 to 2010. We calculated the ever-married rate and fertility rate of female adolescents aged 15-19 years. Using gross domestic product (GDP) per capita as an indicator for socio-economic status of a province, we calculated the slope index of inequality (SII) and the concentration index (CI) to analyze the subnational inequalities of early marriage and adolescent fertility. Weighted linear regression models were also established to assess the associations between GDP per capita and the ever-married rate/fertility rate. RESULTS: The ever-married rate for Chinese female adolescents aged 15-19 years decreased from 4.7% in 1990 to 1.2% in 2000, and rebounded to 2.1% in 2010. From 1990 to 2000, the fertility rate decreased from 22.0 per 1 000 to 6.0 per 1 000, and further decreased to 5.9 per 1 000 in 2010. In 1990, the socio-economic inequalities of the ever-married rate and fertility rate for female adolescents aged 15-19 years were not statistically significant (P for SII or CI>0.05). The values of SII revealed that, in 2000 and 2010, female adolescents with the lowest GDP per capita had an ever-married rate 2.4% (95%CI: 0.4-4.4) and 2.3% (95%CI: 0.3-4.2) higher than those with the highest GDP per capita, respectively. In the meantime, in 2000 and 2010, female adolescents with the lowest GDP per capita had a fertility rate 12.9 per 1 000 (95%CI: 5.4-20.5) and 9.3 per 1 000 (95%CI: 4.6-14.0) higher than those with the highest, respectively. In 2000 and 2010, the CIs for marriage were -0.32 (P=0.02) and -0.17 (P=0.03), respectively, and the CIs for childbirth were -0.37 (P<0.01) and -0.26 (P<0.01), respectively. In 2000, the ever-married rate and the fertility rate were estimated to increase by 1.4% (95%CI: 0.1-2.7) and 7.9 per 1 000 (95%CI: 2.9-12.8) with 100% increase in GDP per capita, respectively; in 2010, the numbers were 1.5% (95%CI: 0.1-2.9) and 6.7 per 1 000 (95%CI: 3.2-10.1), respectively. CONCLUSION Subnational socio-economic inequality of early marriage and adolescent fertility existed in 2000 and 2010. Female adolescents residing in less-developed areas were more likely to engage in early marriage and childbirth. Reducing income inequality and increasing education investment for poverty-stricken areas seem to be effective measures to reduce this inequality.
Adolescent ; Adult ; Economic Development ; Female ; Fertility ; Humans ; Income ; Marriage ; Socioeconomic Factors ; Young Adult

OBJECTIVE: To examine whether community socioeconomic status is associated with self-rated health independent of individual socioeconomic status for urban and rural residents, and to provide policy implications for improving the health status of the socioeconomically underdeveloped communities in China. METHODS: Based on the baseline data of China Family Panel Studies (CFPS) in 2010, principal component analysis was used to construct community socioeconomic index (SEI) based on average years of schooling, average income and average wealth at the community level. Community SEI was defined as the standardized first principal component score. In combination with the adult data from CFPS 2012 follow-up data, the multilevel Logistic regression model was used to analyze whether the community socioeconomic status had an independent contextual effect on the self-rated health of urban residents and rural residents after controlling individual-level socioeconomic status. RESULTS: In the final analysis, 31 321 adult residents in 577 communities were included, of whom 8 423 were urban residents and 22 898 were rural residents. Community SEI ranged from -2.41 to 3.16, with a mean of 0 and a stan-dard deviation of 1. As the community SEI increased, the incidence of deprivations in different dimensions decreased, indicating the community socioeconomic status increased. The multilevel Logistic model controlling for both individual sociodemographic factors and community socioeconomic status showed that as the community SEI increased, the probability of poor self-rated health decreased, which indicated community SEI had a contextual effect on poor self-rated health. The contextual effect of community SEI on poor self-rated health was statistically significant for the rural residents (OR=0.84, 95%CI: 0.76-0.94) but not statistically significant for the urban adults (OR=0.94, 95%CI: 0.83-1.06). CONCLUSION After controlling for individual socioeconomic status, community socioeconomic status was associa-ted with poor self-rated health for rural residents independent of individual socioeconomic status. Therefore, in order to improve the health status of the rural population, it needs not only individual-based health interventions, but also community-based health interventions.
Adult ; China/epidemiology* ; Health Status ; Humans ; Income ; Rural Population ; Social Class ; Socioeconomic Factors ; Urban Population

Objective: To determine the factors influencing insomnia and construct early insomnia warning tools for rescuers to informbest practices for early screening and intervention. Methods: Cluster sampling was used to conduct a cross-sectional survey of 1,133 rescuers from one unit in Beijing, China. Logistic regression modeling and R software were used to analyze insomnia-related factors and construct a PRISM model, respectively. Results: The positive rate of insomnia among rescuers was 2.74%. Accounting for participants' age, education, systolic pressure, smoking, per capita family monthly income, psychological resilience, and cognitive emotion regulation, logistic regression analysis revealed that, compared with families with an average monthly income less than 3,000 yuan, the odds ratio ( ) values and the [95% confidence interval ( )] for participants of the following categories were as follows: average monthly family income greater than 5,000 yuan: 2.998 (1.307-6.879), smoking: 4.124 (1.954-8.706), and psychological resilience: 0.960 (0.933-0.988). The ROC curve area of the PRISM model (AUC) = 0.7650, specificity = 0.7169, and sensitivity = 0.7419. Conclusion Insomnia was related to the participants' per capita family monthly income, smoking habits, and psychological resilience on rescue workers. The PRISM model's good diagnostic value advises its use to screen rescuer early sleep quality. Further, advisable interventions to optimize sleep quality and battle effectiveness include psychological resilience training and smoking cessation.
Adolescent ; Adult ; China ; epidemiology ; Cross-Sectional Studies ; Humans ; Incidence ; Income ; statistics & numerical data ; Male ; Models, Theoretical ; Occupational Diseases ; epidemiology ; etiology ; Rescue Work ; statistics & numerical data ; Resilience, Psychological ; Risk Factors ; Sleep Initiation and Maintenance Disorders ; epidemiology ; etiology ; Smoking ; epidemiology ; Socioeconomic Factors ; Young Adult