From: Health Statuses of People in Poverty Receiving Public Assistance in Japan: A Scoping Review
| Authors | Year | Study design | Setting/participants | Data | Reference group | N (public assistance (PA)/non-PA) |
Outcome | Findings |
|---|---|---|---|---|---|---|---|---|
| Noda T, et al. (13) | 2001 | Prospective cohort study | Patients with alcoholism attending to an abstinence self-help group | Medical records and a follow-up interview with each patient or their family | Nonrecipients | 306 (83/214), 9 had no information on receiving PA | Stable abstinence from alcohol and mortality | Non-PA recipients have more preferable odds of stable abstinence from alcohol (OR: 7.2, 95% CI: 1.8-28.4) and lower mortality (HR: 0.5, 95% CI: 0.4-0.8) than PA recipients |
| Kobayashi O, et al. (14) | 2008 | Case-control study | Single center/patients diagnosed with methamphetamine use disorder (aged 19-60 years) | Medical records | Nonrecipients | 101 (26/75) | 3-month treatment retention | The treatment retention group had a significantly larger proportion of patients receiving PA (38% vs. 17%). Those who received PA were twice as likely to remain in treatment as those without, although the p-value was statistically borderline (adjusted OR: 2.38, 95% CI: 0.92-6.16, p = 0.074) |
| Wada T, et al. (15) | 2009 | Retrospective cohort study | Patients with lateral epicondylitis treated with arthroscopic surgery (aged 42-71 years) | Medical records and a self-administered questionnaire survey | Nonrecipients | 18 (4/14) | Disability of the Arm, Shoulder, and Hand score | PA was found to be a potential predictor of a poorer outcome after arthroscopic surgery for lateral epicondylitis (median score: 36.5 vs. 2.2, p = 0.03) |
| Kamimura A, et al. (16) | 2013 | Retrospective cohort study | Data were collected through semistructured, in-person interviews with women who had experienced any type of intimate partner violence (IPV) in their lives (aged 24-80 years) | Interview survey | Nonrecipients | 3,403 person-years of 101 respondents, including 154 person-years of the recipients | Intimate partner violence-specific healthcare-seeking behavior | Receiving PA was associated with IPV-specific healthcare-seeking behavior (coef.: 1.08, SE: 0.48) |
| Uchimura K, et al. (17) | 2015 | Retrospective cohort study | Newly registered tuberculosis (TB) patients aged 15-59 years in Japan | Nationally representative registry data | Other insurance | 9,097 (711/uninsured: 321, insured: 8,065) | Tuberculosis death | The association between PA and death from tuberculosis disappeared in the multivariate model. However, the association remained among the uninsured (aHR [95% CI]: 1.08 [0.78-1.51] and 1.48 [1.02-2.15], for PA and uninsured, respectively). PA, particularly if limited to casual workers and unemployed persons, may contribute to the improvement of survival rates (from the Kaplan-Meier curve results) |
| Takenaka Y, et al. (18) | 2016 | Retrospective cohort study | Single center/newly diagnosed and histologically confirmed patients with head and neck squamous cell carcinoma (HNSCC), median age 76 years (range 28-92) | Medical records | Other insurance | 407 (72/335) | Mortality | The clinical stage distribution was not significantly different between the PA groups and other insurances (OR: 1.36, 95% CI: 0.78-2.39, for stages III and IV). The 5-year overall survival, cumulative incidence of HNSCC death, and cumulative incidence of other death rates were 63.3% and 59.1%, 27.0% and 31.8%, and 10.3% and 9.7% for the PA and other insurance groups, respectively. The adjusted subdistribution HR for the association between PA and HNSCC death was 0.73 (95% CI: 0.44-1.21) |
| Funakoshi M, et al. (19) | 2017 | Cross-sectional study | Multicenter/young adult patients (aged 20-40 years) with type 2 diabetes (T2DM) | Medical records and a self-administered questionnaire survey | Other insurance | 672 (64/608) | Diabetic complication | PA recipients have a higher odds ratio of having diabetes complications after adjusting for general risk factors (an OR of 2.19 (1.20-3.95) for retinopathy and an OR of 2.60 (1.16-5.50) for nephropathy |
| Kawahara YY, et al. (20) | 2017 | Retrospective cohort study | Single center/patients admitted to the emergency room and then had an episode of self-harm | Medical records | Nonrecipients | 405 (54/351) | Repetition of short-term self-harm (<1 month and <6 months) | Living on PA was associated with repetition of self-harm within 6 months (multivariable HR: 3.126 [1.699-5.754]). |
| Nakanishi M, et al. (21) | 2017 | Panel data | National Patient Survey | Nationally representative survey data | Nonrecipients | 13,014 (1,112/11,902) | Deliberate self-harm | The proportion of patients receiving PA was higher in those who had engaged in deliberate self-harm (8.5%) than in the general population |
| Yuda M. (22) | 2018 | Cross-sectional study | - The Fact-Finding Survey on Medical Assistance (Iryo-Fujo Jittai Chosa). - The Survey of Medical Care Activities in Public Health Insurance (Syakai Iryo Shinryo-Koui Betsu Chosa) |
Nationally representative sets of individual-level claims data | Other insurance | 299,520 (18,693/280,827) | Inpatient care elasticity | The medical expenditure is significantly higher for medical assistance patients than for other medical health insurance patients, with an arc elasticity of approximately 0.20 |
| Izumi K, et al. (23) | 2019 | Panel data | One municipality/patients with culture-positive TB notified with genotype data of Mycobacterium tuberculosis | Registry data | Nonrecipients | 1,025 (304/720), 1 had no information on receiving PA | Clustered cases | Receiving PA (adjusted OR: 1.81, 95% CI: 1.15-2.84) at the time of tuberculosis diagnosis was associated with genotype clustering |
| Cho T, et al. (24) | 2020 | Retrospective cohort study | Single center/women who underwent Chlamydia trachomatis testing during a singleton pregnancy and delivered after the 22nd week of gestation (control group: randomly selected individuals from among patients with negative results) | Medical records | Nonrecipients | 2,233 (74/2,159) | Preterm birth | The Chlamydia-positive group had a higher rate of PA coverage than the control group (12.4% vs. 2.1%) |
| Ikeda K, et al. (65) | 2020 | Case-control study | Single center/patients who visited the Emergency Department (ED), aged ≥20 years | Medical records | Other insurance | 340 (27/313) | Frequent ED use | The receipt of PA significantly increased the OR for frequent visits even after adjusting for sex, age, and potential confounding factors (OR: 3.89, 95％ CI: 1.62-9.35) |
| Kaneko M, et al. (25) | 2020 | Cross-sectional study | Multicenter/patients who presented to the EDs | Medical records | Nonrecipients | 20,388 (110/20,257), 21 had no information on receiving PA | Frequent ED use | Receiving PA (adjusted OR: 7.19, 95% CI: 2.87-18.07) had an association with frequent ED visits |
| Osawa I, et al. (26) | 2020 | Cross-sectional study | Single center/ED patients (age ≥ 18 years) | Medical records | Nonrecipients | 556 (37/519) | Hospitalization rates | Frequent ED users tended to receive PA more than nonfrequent ED users (8.9% vs. 4.7%). The risk for hospitalization was not associated with frequent ED use (adjusted OR: 1.21, 95% CI, 0.74-1.96) |
| Yoshikawa R, et al. (27) | 2020 | Panel data | Japanese tuberculosis surveillance data | Registry data | Other insurance | 88,351 (7,148/81,203) | Patient delay (the time from the onset of symptoms to the initial doctor visit): short, moderate, and long delay | Receiving PA was specifically a risk factor for moderate and long delays (adjusted OR [95% CI]: 1.19 [1.09-1.31] and 1.36 [1.16-1.60] for moderate and long delays, respectively) |
| Kaneko M, et al. (28) | 2021 | Prospective cohort study | Multicenter/patients who had started receiving regular physician-led health care at home or at nursing homes, aged ≥65 years | Survey data, administered by physicians | Nonrecipients | 825 (115/710) | All-cause mortality | A multivariate Cox proportional-hazards model showed that nonreceipt of PA was associated with mortality, indicating that patients who received PA were less likely to die, adjusted HR: 0.61 (0.41-0.90) with multiple imputation (complete case analysis, n = 663: 0.65 [0.42-1.01]) |
| Koyama Y, et al. (29) | 2021 | Cross-sectional study | One municipality/a survey was administered to caregivers of all 6-7-year-old children attending public elementary schools | Social survey data (self-questionnaire) | Low-income (LI) households without PA | 6,920 (PA(+)/LI(+): 191, PA(−)/LI(+): 452, PA(−)/LI(+): 6,277) | Child mental health assessed using the Strength and Difficulties Questionnaire (SDQ) and child resilience assessed using the Children’s Resilient Coping Scale (CRCS) |
The SDQ and CRCS scores were not significantly different between recipients or nonrecipients of PA. However, the mental health outcomes were worse in PA recipients across all scores, particularly emotional symptoms and prosocial behavior. Children in households receiving PA had a higher risk of school refusal than those in households not receiving PA; children living in PA household were four times more likely to refuse to go to school than children living in LI households without PA (OR: 4.00, 95% CI: 0.85-18.84, p = 0.080) |
| Watanabe S, et al. (30) | 2021 | Retrospective cohort study | Single center/patients with ST-segment elevation myocardial infarction | Medical records | Nonrecipients | 525 (67/458) | Clinical features | The prevalence of smoking was higher in the PA group than in the non-PA group (91.0 vs. 81.1%, p = 0.02). The high-density lipoprotein cholesterol level in the PA group was lower than that in the non-PA group (43.2 ± 9.9 mg/dL vs. 47.1± 12.8 mg/dL, p = 0.005). Ventricular arrhythmia on admission was significantly more frequent in the PA group than in the non-PA group (11.9 vs. 4.8%, p = 0.02). The left ventricular ejection fraction in the PA group was lower than that in the non-PA group (in the acute phase 46.6％ ± 10.7 vs. 53.3± 8.6, p = 0.001; in the chronic phase 48.7% ± 10.1 vs. 55.3 ± 9.4, p = 0.008) |
| Fujito H, et al. (31) | 2022 | Retrospective cohort study | Single center/patients who were admitted for acute heart failure (HF) and were discharged or transferred to another hospital, followed up for 1 year | Medical records | Other insurance | 771 (87/684) | Cardiac events (death from cardiovascular disease (CVD) or readmission) after discharge | The PA group was significantly younger and had a higher incidence of diabetes, smoking, and ischemic and hypertensive heart disease as well as lower estimated glomerular filtration rate than the non-PA group (all P < 0.05). Patients with acute HF covered by PA received the same quality of medical care, including invasive therapy, as those not covered by PA After adjusting for covariates, PA was independently associated with 1-year cardiac event rate (HR: 2.15, 95% CI: 1.42-3.26) |
| Kaneko M, et al. (32) | 2022 | Cross-sectional study | One municipality/older adults aged 75 years or older who visited medical facilities at least four times a year | Claims data | Nonrecipients | 413,600 (14,243/399,357) | Care fragmentation (Fragmentation of Care Index (FCI)) | Multivariable analysis revealed that patients receiving PA had a lower FCI than those not receiving PA, with a coefficient of 0.137 (This can be explained by the fact that people receiving PA need to report to the local government the name of the medical institution where they would like to visit.) |
| Kino S, et al. (33) | 2022 | Cross-sectional study | 39 municipalities/older community-dwelling recipients | Social survey data (self-questionnaire) | Nonrecipients | 93,280 (1,093/92,187) | Depressive symptoms (Geriatrics Depression Scale GDS) | The older PA recipients have a higher prevalence of depressive symptoms (PR 1.57 [95% CI: 1.47-1.67]) than nonrecipients |
| Kino S, et al. (66) | 2022 | Cross-sectional study | 39 municipalities/older community-dwelling recipients | Social survey data (self-questionnaire) | Nonrecipients | 16,135 (202/15,933) | Suicidal ideation and attempts | PA recipients had a higher prevalence of lifetime suicidal ideation (PR: 1.47, 95% CI: 1.02-2.13) and a higher prevalence of attempted suicide (PR: 1.91, 95% CI: 1.20-3.04) than nonrecipients |
| Nakayama T, et al. (34) | 2022 | Case-control study | Single center/patients who initiated maintenance dialysis (median age (IQR) 70 (59-79) years) | Medical records | Nonrecipients | 355 (13/342) | Peritoneal dialysis (PD) selection | Multivariate analysis revealed that PA (OR: 0.70; 95% CI: 0.08-6.09, p = 0.74) was not significantly associated with PD selection |
| Nishimoto Y, et al. (35) | 2022 | Retrospective cohort study | Multicenter/patient with acute HF (AHF) and patients who were hospitalized because of AHF for the first time | Registry data | Nonrecipients | 3,728 (218/3,510) | Cumulative 1-year incidences of all causes of death, HF, and hospitalizations after discharge | The adjusted risk for HF hospitalization beyond 180 days was significant in those with PA (HR: 1.56, 95% CI: 1.07-2.29, p = 0.02) |
| Sengoku T, et al. (36) | 2022 | Cross-sectional study | People residing in Japan during the years 2015-2017 | National Database (NDB) and Medical Assistance Claims data | Nonrecipients | The total numbers of recipients in Japan during 2015, 2016, and 2017 were 2,161,442, 2,148,282, and 2,130,482, respectively | Type 2 diabetes prevalence | The mean crude prevalence and age-standardized prevalence of diabetes (inpatients and outpatients) among 47 prefectures were 7.8% in recipients and 3.9% in public health insurance enrollees. In the city-level analysis, the odds ratio for the prevalence of T2D by region ranged from 0.31 to 1.51 |
| Wakata S, et al. (37) | 2022 | Repeated cross-sectional study | Patients in a single center clinic | Clinic medical records | Nonrecipients | 374 (68/306) | The Health-Related Quality of Life by SF-12 score, with three components: physical health component summary (PCS), mental health component summary (MCS), and role-social component summary (RCS) |
The PA recipients had lower PCS and RCS scores than those not receiving any welfare benefit (PCS Beta: −8.24, 95% CI: −10.43 to −6.05; RCS Beta: −7.87, 95% CI: 11.88 to −3.85). A decline in the MCS score was observed more in PA recipients than in those not receiving any welfare benefits during the COVID-19 pandemic (Beta: −4.27, 95% CI: −6.67 to −1.82) |
| Yuda M. (38) | 2022 | Cross-sectional study | - The Fact-finding Survey on Medical Assistance for PA patients - the Survey of Medical Care Activities in Public Health Insurance for the universal public health insurance patients |
Nationally representative sets of individual-level claims data | Other insurance | 1,698,857 (261,546/1,437,311) | Outpatient care utilization | PA assignment increases monthly healthcare expenditure by approximately 20% and the monthly number of doctor visits by approximately 25%. When imposing a copayment on PA beneficiaries, monthly healthcare expenditure significantly decreases by approximately 25.0% and the number of visits by approximately 30%. The estimated price elasticity based on these results is extremely small, approximately −0.02, indicating that the level of copayment rate has a negligible effect on the intensive margin of outpatient healthcare utilization |
| Lu Y, et al. (39) | 2023 | Prospective cohort study | 19 municipalities/people aged ≥65 years who were not certified as requiring long-term care | Social survey data (self-questionnaire) | Nonrecipients | 73,262 (Not available) | Functional disability over 5 years | In the ridge regression model, the characteristic of households receiving PA was an important predictor of functional disability |
| Miyake H, et al. (40) | 2023 | Cross-sectional study | Single center/patients with rheumatoid arthritis | Survey data, administered by healthcare providers to the patients or their representatives | Nonrecipients | 991 (17/974) | Polypharmacy and excessive polypharmacy | Excessive polypharmacy, defined as regularly taking 10 or more orally administered medications, was associated with the presence of PA (OR: 3.80, 95% CI: 1.23-11.72). |
| Miyake H, et al. (41) | 2023 | Cross-sectional study | Single center/patients with systemic lupus erythematosus (SLE) | Survey data, administered by healthcare providers to the patients or their representatives | Nonrecipients | 261 (8/253) | Polypharmacy and excessive polypharmacy | Excessive polypharmacy was associated with the presence of PA (multivariable OR: 18.9, 95% CI: 3.30-102.65) |
| Miyake H, et al. (42) | 2023 | Cross-sectional study | Single center/patients with rheumatoid arthritis | Survey data, administered by healthcare providers to the patients or their representatives | Nonrecipients | 991 (17/974) | Vaccination | Influenza vaccine: PA was significantly associated with nonvaccination |
| Nakamura Y, et al. (43) | 2023 | Case-control study | Single center/those who visited the Department of Psychiatry and Neurology | Medical records | Never received PA | 536 (87/449) | Medical visit behavior as a proxy for medication adherence | History of PA receipt was associated with higher nonattendance (OR: 2.04, 95% CI: 1.22-3.43, p = 0.007) |
| Kino S, et al. (44) | 2024 | Cross-sectional study | 60 municipalities/older community-dwelling recipients | Social survey data (self-questionnaire) | Nonrecipients | 16,366 (229/16,137) | Dental visits | In the fully adjusted model, PA recipients were 24% less likely to have dental visits for any reason (prevalence ratio [95% CI], 0.76 [0.64-0.90]), 23% less likely for treatment (0.77 [0.65-0.92]), and 21% less likely for prevention [0.79 (0.65-0.95]) |
| Kushibuchi M, et al. (67) | 2024 | Retrospective cohort study | Single center/patients diagnosed with alcoholic liver cirrhosis | Medical records | Nonrecipients | 244 (62/182) | All-cause mortality | The overall mortality rates were 48.4% and 31.9% for PA and non-PA recipients, respectively (p = 0.002). In the Cox regression model adjusted for age, ALBI score, HCV infection, and presence or absence of a designated key family contact, the hazard ratio for PA status was 1.75 (95% CI: 1.03-2.98, p = 0.039) |
From: Health Statuses of People in Poverty Receiving Public Assistance in Japan: A Scoping Review
| Authors | Year | Design | Settings/participants | Data | N | Outcome | Findings |
|---|---|---|---|---|---|---|---|
| Okumura Y, et al. (45) | 2019 | Cross-sectional study | All PA recipients hospitalized in psychiatric hospitals | National database | 46,559 | Age-sex-standardized claim ratio of the psychiatric admission | There is a geographical (prefectural) variation in the number and total medical cost of psychiatric admissions among recipients. There is a positive correlation between recipients’ psychiatric admission, the number of prefectural psychiatric beds per 100,000 population, and the prefectural proportion of the population receiving PA |
| Nishioka D, et al. (46) | 2020 | Retrospective cohort study | Adult recipients in two municipalities in Japan (>=20 years old) | Municipal database | 6,016 | Frequent outpatient attendance | Recipients living alone had an incidence of 1.58 (95% CI: 1.05-2.39) compared with those not living alone. Recipients visiting private institutions had an incidence of 1.74 (95% CI: 1.20-2.52) compared with those visiting medical corporations |
| Isozaki A, et al. (47) | 2021 | Cross-sectional study | Randomly sampled older recipients in Japan | Social survey data (self-questionnaire) | 1,280 | Health checkup behavior | The health behavior scale was developed, including two constructs (self-perception of personal power and practical skills for daily health), which correlates with recipients’ health checkup behavior |
| Nishioka D, et al.(48) | 2021 | Retrospective cohort study | Children in the household receiving PA in two municipalities in Japan (<=15 years old) | Municipal database | 573 | Children’s acute and chronic diseases | Among PA recipients, living in single parenthood is associated with a higher prevalence of the following: Asthma (IR: 1.62, 95% CI: 1.16-2.26) Allergic rhinitis (IR: 1.41, 95% CI: 1.07-1.86) Dermatitis and eczema (IR: 1.81, 95% CI: 1.21-2.7) Dental diseases (IR: 1.79, 95% CI: 1.33-2.42) An insignificant association was observed between single parenthood and children’s acute health conditions |
| Nishioka D, et al. (49) | 2021 | Retrospective cohort study | Adult recipients in two municipalities in Japan (>=20 years old) | Municipal database | 2,698 younger adults (20-64 years old) and 3,019 older adults (>65 years old) | 1-year cumulative incidence of diabetes diagnosis | Among younger (20-64 years old) men, the incidence of diabetes diagnosis was higher among those who were: Unemployed (IR: 1.28, 95% CI: 0.85-1.91) Living alone (IR: 1.48, 95% CI: 0.96-2.29). However, no significant association was observed among young women and older recipients |
| Nishioka D, et al. (50) | 2021 | Retrospective cohort study | Households receiving PA to rear children in five municipalities | Municipal database | 4,893 households | Households’ healthcare costs | Government savings through income reduction were counterbalanced by increased medical expenditure among child-rearing individuals in poverty (i.e., a 50 USD reduction in cash benefits may lead to a 248.6 USD increase in healthcare costs per household [95% CI: 25.4-471.7]) |
| Nishioka D, et al. (51) | 2021 | Retrospective cohort study | Adult recipients in two municipalities in Japan (>=20 years old) | Municipal database | 4,497 | Dental care access | Recipients who were younger (IR: 0.87 [by 10 years old], 95% CI: 0.84-0.91), women (IR: 1.22, 95% CI: 1.08-1.38), immigrants (IR: 1.53, 95% CI: 1.16-2.01), and with mental disabilities (IR: 1.30, 95% CI: 1.08-1.56) may have greater accessibility to dental care. Living alone and employment are potential predictors of dental care access. |
| Kino S, et al. (68) | 2022 | Retrospective cohort study | Older community-dwelling recipients | Social survey data (self-questionnaire) | 347 | Starting or leaving PA program | People with higher perceived mutual community help were 1.21 times (95% CI: 1.02-1.46) more likely to commence PA 3 years later than those who did not. PA recipients who felt community attachment to their resident community were 1.16 times more likely to give up PA 3 years later than those who did not (95% CI: 1.06-1.28). Similarly, those who had social roles were 1.15 times more likely to give up PA 3 years later than those who had not (95% CI: 1.01-1.30). |
| Kino S, et al. (52) | 2022 | Retrospective cohort study | Older community-dwelling recipients | Social survey data (self-questionnaire) | 335 | Changes in social relationships | Recipients who stopped receiving PA experienced an increase in the number of friends, frequency of meetings with friends, and participation in sports and hobby clubs. Conversely, the social relationships of nonrecipients in 2013 who started to receive PA in 2016 did not significantly change. |
| Nishioka D, et al. (53) | 2022 | Retrospective cohort study | Recipients in six municipalities in Japan | Municipal database | 15,739 | Frequent outpatient attendance (FOA) | Using CART analyses, the employed subpopulation with mental disabilities exhibited the highest risk of FOA (incidence proportion: 16.7%). Conventional regression analyses revealed that being unemployed was significantly associated with frequent outpatient attendance (IR: 1.71, 95% CI: 1.13-2.59). Living alone was also a predictor in regression analyses but not in CART analyses. |
| Imamatsu Y, et al. (54) | 2023 | Cross-sectional study | Randomly sampled older recipients in Japan | Social survey data (self-questionnaire) | 1,608 | Health behavior scale for older adults living alone and receiving PA (HBSO) | Recipients with higher Lubben social network scale scores have more preferable HBSO scores. A health checkup was also a predictor of a higher HBSO |
| Nishioka D, et al. (55) | 2023 | Retrospective cohort study | Adult recipients in two municipalities in Japan (>=20 years old) | Municipal database | 2,386 | Unscheduled asthma visits | Among working recipients, the IRs of unscheduled visits were higher among recipients cohabiting with adults (IR: 1.90, 95% CI: 1.00-3.59) and recipients cohabiting with children (IR: 2.35, 95% CI: 1.11-4.95) than among recipients living alone. Among the nonworking recipients, the IRs of unscheduled visits were lower among recipients living with family (IR: 0.74, 95% CI: 0.41-1.35) and those living with children (IR: 0.50, 95% CI: 0.20-1.23) than among recipients living alone |
| Ueno K, et al. (56) | 2023 | Cross-sectional study | Older recipients in two municipalities in Japan (>=65 years old) | Municipal database | 3,165 | Clustering older recipients using the soft clustering method | Employing a soft clustering technique can help identify meaningful segments among older recipients, which is useful in considering support measures for the recipients |
From: Health Statuses of People in Poverty Receiving Public Assistance in Japan: A Scoping Review
| Authors | Year | Design | Settings/data | N | Outcome | Findings |
|---|---|---|---|---|---|---|
| Aihara H, et al. (57) | 2002 | Ecological study | Yearly Annual Report of Hygiene in Osaka | 5 areas in Osaka City | The Standardized Mortality Ratio (SMR) of suicide (standardization to the 1980 Japanese population) in each area in Osaka | Among young (<40 years old) and middle-aged (40-64 years old) men, the number of persons per household and the availability of PA were associated with a higher SMR of suicide Among middle-aged (40-64 years old) women, the suicide rate was associated with the number of PA recipients per 1,000 persons for the period between 1980 and 1999 A real difference in association between the number of persons per household, the PA, and SMR in suicide was observed in Osaka prefecture |
| Aihara H, et al. (58) | 2003 | Ecological study | Yearly vital statistics for Japan | 47 prefectures | The SMR of suicide (standardization to the 1980 Japanese population) in each prefecture | Multivariate regression analyses revealed that the male SMR of suicide was negatively associated with the number of persons per household and PA |
| Mishina H, et al. (59) | 2012 | Ecological study | Data from home visits in the area covered by Fushimi Health Center to 2,933 mothers who had given birth between December 1, 2008 and October 31, 2010 | 5 localities in Fushimi-ward in Kyoto City | The detection rate of postpartum depressive symptoms in mothers | The proportion of households receiving PA in the localities had a positive correlation with the detection rate of postpartum depressive symptoms (r = 0.90, P = 0.04) |
| Honjo K, et al. (60) | 2014 | A retrospective cohort study | Data from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study), followed up from 1990 to 2006 in 45 municipalities | 35 municipalities | All-cause death, cardiovascular death, cancer death, and death from injury, toxicosis, or external causes | Among men, the risk of death from cancer was significantly higher in the prefecture with a higher proportion of households receiving PA (coefficient 0.150 with SE 0.063 per unit increase) |
| Minagawa Y, et al. (61) | 2017 | Ecological study | Prefectural data from a Comprehensive Survey of Living Conditions (Kokumin Seikatsu Kiso Chosa) in 2010 | 47 prefectures | Prefecture-specific disability-free life expectancy (DFLE) at 65 years of age in 2010 | The percentage of older people receiving PA in prefecture was negatively associated with DFLE at 65 for women only (men: −0.01, not significant; women: −0.30, p < 0.001 per 1% point increase) |
| Okui T, et al. (62) | 2021 | Ecological study | Prefectural data was aggregated from individual data in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) data in the period of 2015-2018 | 47 prefectures | Standardized claim ratio (SCR) of the number of multidrug prescriptions (number of simultaneous prescriptions of seven or more internal medicines) by prefectures | The number of PA recipients per 1,000 persons was positively and significantly associated with the SCR (standardized partial regression coefficient = 0.244, p = 0.038) |
| Yoshikawa Y, et al. (63) | 2021 | Ecological study | The data on the cumulative number of cases with positive COVID-19 test results and deaths at the prefectural and national levels was provided by the Ministry of Health, Labour and Welfare of Japan | 47 prefectures | Rate ratios of COVID-19 incidence and mortality across prefectures | In prefectures with the most socioeconomic disadvantages, indicated by a greater proportion of the population receiving PA, there were higher incidence (RRs 2.45, 95% CI: 2.43-2.48) and mortality (RRs 2.02, 95% CI: 1.88-2.18) |
| Okui T, et al. (64) | 2022 | Ecological study | Prefectural data aggregated from individual data in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) data in the period of 2015-2018 | 47 prefectures | SCR of the amount of diazepam, equivalent dose prescriptions by prefectures | The number of PA recipients per capita was positively and significantly associated with the SCR (0.296, 95% CI: 0.0072-0.522) in hypnotics and (0.284, 95% CI: 0.096-0.476) in anxiolytics by a unit increase |
