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Effects of socioeconomic status on physical and mental health of hemodialysis patients in Japan: differences by age, period, and cohort

Authors Sugisawa H, Shimizu Y, Kumagai T, Sugisaki H, Ohira S, Shinoda T

Received 24 February 2016

Accepted for publication 11 May 2016

Published 11 July 2016 Volume 2016:9 Pages 171—182

DOI https://doi.org/10.2147/IJNRD.S107031

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Professor Pravin Singhal


Hidehiro Sugisawa,1 Yumiko Shimizu,2 Tamaki Kumagai,3 Hiroaki Sugisaki,4 Seiji Ohira,5 Toshio Shinoda6

1Graduate School of Gerontology, J.F. Oberlin University, Machida, 2Faculty of Nursing, The Jikei University School of Medicine, Chofu, 3School of Nursing, Osaka City University, Osaka, 4Hachioji Azumacho Clinic, Hachioji, 5Sapporo Kita Clinic, Sapporo, 6Kawakita General Hospital, Suginami, Japan

Study purpose: Whether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients.
Methods:
Data were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients’ association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors.
Results: Relative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or ­depressive symptoms.
Conclusion: The number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period.

Keywords: complications, depressive symptoms, cross classified random effects model, income status, raking adjustment

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