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Background It is well known that there are educational inequalities in incidences of non-communicable diseases (NCDs). Unlike most preceding studies, this study examined this issue using a hazards model analysis, with specific reference to the potential mediating effects of socioeconomic status (SES), other than educational level, and health behaviour as well as gender differences. Methods Data were obtained from a 12-wave longitudinal nationwide survey conducted from 2005 to 2016 with middle-aged individuals in Japan. Participants included 31,210 individuals (15,127 men and 16,083 women) who were aged 50–59 years at wave 1. Incidences of six NCDs (diabetes, heart disease, stroke, hypertension, hyperlipidaemia, and cancer), initially diagnosed between waves 2 and 12, were considered. Cox proportional hazards models were estimated to examine their associations with educational level, adjusted for baseline SES and health behaviour. Educational inequalities were measured by the relative indices of inequality (RII). Results Lower educational level was associated with higher incidences of diabetes and stroke among both men and women, and with hypertension only among women. After controlling for baseline SES, health behaviour, and regional areas, the RII ranged from 1.37 (95% confidence interval [CI]: 1.02–1.85) for stroke among men to 2.65 (95% CI, 2.09–3.36) for diabetes among women. Small to moderate parts (0.0–32.7%) of the RII were explained by baseline SES and health behaviour. A negative association with education was observed for diabetes and hypertension among women. Conclusions Results underscored the importance of educational level as a predictor of the incidences of selected NCDs, especially among women, with limited mediating effects of other SES and health behaviour.

BackgroundIt is well known that informal caregiving negatively affects caregivers’ mental health, while social activities improve mental health outcomes among middle-aged and elderly individuals. The goal of the present study was to examine how participation in social activities affected the trajectory of an informal caregiver’s psychological distress.MethodsWe used the data from a nationwide nine-wave panel survey of the middle-aged individuals (aged 50–59 years at baseline) in Japan conducted in 2005–13 (N = 24,193 individuals;12,352 women and 11,841 men), mainly focusing on the respondents beginning to provide informal caregiving during the survey period. We employed linear mixed-effects models to explain how the trajectory of psychological distress, measured by Kessler 6 (K6) scores, was associated with caregiving commencement and duration, as well as social activity participation.ResultsParticipation in social activities was associated with mitigated K6 scores at caregiving commencement by 66.2 and 58.2 % for women and men, respectively. After caregiving started, participation in social activities reduced the average rise in K6 scores, per year, by 65.6 and 89.6 % for women and men, respectively. We observed similar results when focusing on participation before caregiving commencement to avoid endogeneity problems.ConclusionResults suggest that participation in social activities can alleviate caregivers’ psychological distress. Policy measures to support social activities are recommended for the health and well-being of current and potential caregivers.

IntroductionIt is well known that lower income is associated with poorer health, but poverty has several dimensions other than income. In the current study, we investigated the associations between multidimensional poverty and health variables.MethodsUsing micro data obtained from a nationwide population survey in Japan (N = 24,905), we focused on four dimensions of poverty (income, education, social protection, and housing conditions) and three health variables (self-rated health (SRH), psychological distress, and current smoking). We examined how health variables were associated with multidimensional poverty measures, based on descriptive and multivariable logistic regression analyses.ResultsUnions as composite measures of multiple poverty dimensions were more useful for identifying individuals in poor SRH or psychological distress than a single dimension such as income. In comparison, intersections of poverty dimensions reduced the coverage of individuals considered to be in poverty and tend to be difficult to justify without any explicit policy objective. Meanwhile, education as a unidimensional poverty indicator could be useful for predicting current smoking.ConclusionsResults obtained from the current study confirmed the practical relevance of multidimensional poverty for health.

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