Lingering Impact of Starting Working Life During a Recession: Health Outcomes of Survivors of the “Employment Ice Age” (1993–2004) in Japan

Abstract

Background: A growing amount of evidence demonstrates the adverse impacts of economic downturns on population health.However, the extent to which the macroeconomic conditions at labor market entry affect health outcomes in later life remains relatively understudied. This study focused on the health outcomes of the cohort who entered the labor market during the "employment ice age" (EIA;1993-2004 in Japan, when young people had difficulty finding jobs after graduating from college or high school. Methods: We used repeated cross-sectional data (N = 3,054,782; 1,500,618 men and 1,554,164 women) obtained from an 11wave population-based nationwide survey conducted every 3 years from 1986 through 2016. We considered three health outcomes: being in hospital, subjective symptoms, and self-rated health (SRH). We employed two types of statistical analyses: an age-period-cohort (APC) analysis, which controlled for age and period (wave) effects, and a difference-in-differences (DiD) analysis, in which the EIA experience was regarded as a treatment. Results: The APC analysis confirmed the relative disadvantage of the EIA cohort for all three outcomes; for instance, the odds ratio of poor SRH for the EIA cohort was 1.29 (95% confidence interval [CI], 1.21-1.38) for men and 1.25 (95% CI, 1.17-1.34) for women. The DiD analysis confirmed the robustness of these results, especially for men. Conclusions: The results underscored the lingering impact of the macroeconomic conditions at labor market entry on health outcomes in later life in Japan.

Trends and socioeconomic inequalities in self-rated health in Japan, 1986–2016

“…This study incorporated the following features to overcome the limitations of previous studies: (1) we used an ordinal scale to measure self-rated health as an outcome variable [ 31 ], as opposed to dichotomized results [ 7 – 11 ]; (2) this study included an assessment of educational inequalities using internationally comparable classifications, which has not been previously addressed by studies in Japan, and (3) the data for the present study represents a long study period and includes a large dataset in terms of the number of survey participants included. In this study, data analysis demonstrates that Japanese self-rated health trends fluctuated during the study period.…”

“…1 ). Thus, unfavorable changes in self-rated health between 1995 and 2010 may be due to the physical and psychological state of the Japanese people, caused by the prolonged economic stagnation [ 7 – 11 ]. This implies self-rated health deterioration may mediate high suicide rate, especially during the economic crisis.…”

“…However, people of all social circumstances have not benefited uniformly in Japan in the last three decades because population health, particularly that of working-age men and women, was influenced by the restructuring of the national economy from the 1990s through the 2010s [ 7 – 11 ]. Japan’s economy underwent a long recession, the so-called “lost two decades” after the collapse of the “bubble economy” in the early 1990s.…”

“…Self-rated measures of health, shown to be reliable indicators of general health and mortality, are widely used in population health monitoring [ 16 , 17 ]. Studies on Japan’s socioeconomic inequalities in self-rated health have been conducted using the nationwide Comprehensive Survey of Living Conditions (CSLC) with dichotomized self-rated health as an outcome [ 7 – 11 ]. One study reported that occupational inequalities in self-rated health increased somewhat after the 1997 Asian financial crisis [ 7 ].…”

“…Furthermore, between 1986 and 2013, income-based inequalities in self-rated health have been negatively associated with unemployment during periods of high unemployment [ 10 ]. The associations between self-rated health and economic stagnation are still unclear because previous studies evidenced inconsistent associations not only in Japan [ 7 – 11 ] but worldwide [ 18 – 22 ].…”