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Socioeconomic status and improvement in functional ability among older adults in Japan: a longitudinal study

BMC Public Health. 2019;19(1):1-8 DOI 10.1186/s12889-019-6531-9


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Journal Title: BMC Public Health

ISSN: 1471-2458 (Online)

Publisher: BMC

LCC Subject Category: Medicine: Public aspects of medicine

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML



Airi Amemiya (Department of Health Education and Health Sociology, The University of Tokyo)

Naoki Kondo (Department of Health Education and Health Sociology, The University of Tokyo)

Junko Saito (Department of Health Education and Health Sociology, The University of Tokyo)

Masashige Saito (Faculty of Social Welfare, Nihon Fukushi University)

Daisuke Takagi (Department of Health and Social Behavior, The University of Tokyo)

Maho Haseda (Department of Health Education and Health Sociology, The University of Tokyo)

Yukako Tani (Department of Global Health Promotion, Tokyo Medical and Dental University)

Katsunori Kondo (Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University)


Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 18 weeks


Abstract | Full Text

Abstract Background Recovery from functionally disabled status is an important target of public health measures for older adults. This study aimed to examine socioeconomic inequalities in the improvement of functional ability among older adults stratified by the level of disability at baseline. Methods In the Japan Gerontological Evaluation Study, we conducted a mail survey of community-dwelling older adults (1937 men and 2212 women) who developed functional impairment during 2010–2014. The survey data were individually linked to the longitudinal records of changes in the levels of functional disability based on the Public Long-Term Care Insurance System. Results The mean (standard deviation) follow-up period was 316 (269) days. During follow-up, 811 participants (19.5%) showed improved functional ability. Among those with severe disabilities at baseline, men with 13 or more years of education were more likely to improve functional ability than men with 9 or fewer years of education (hazard ratio: 1.97, 95% confidence interval: 1.12–3.45). A similar association was observed among women (hazard ratio: 2.16, 95% confidence interval: 1.03–4.53). Neither income nor occupation was statistically associated with improved functional ability. Conclusions There are education-related inequalities in the improvement of functional ability, especially among older adults with severe disabilities. Health policy makers and practitioners should consider the educational background of individuals with reduced functionality in formulating strategies to improve their functional ability.