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ファイル
言語
英語
属性
RESEARCH ARTICLE
著者
奥山 健太 Center for Community-based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan
内容記述(抄録等)
Although primary care access is known to be an important factor when seeking care, its effect on individual health risk has not been evaluated by an appropriate spatial measure. This study examined whether geographic accessibility to primary care assessed by a sophisticated form of spatial measure is associated with a risk of hypertension and its treatment status among Japanese people in rural areas, where primary care is not yet established as specialization. We used an enhanced two-step floating catchment area method to calculate the neighborhood residential unit-level primary and secondary care accessibility for 52,029 subjects who participated in the 2015 annual health checkup held at 15 cities in Shimane Prefecture. Their hypertension level and treatment status were examined crosssectionally with their neighborhood primary care and secondary care accessibility (computed with two separate distance-decay weight: slow and quick) by multivariable logistic regression controlling for demographics and neighborhood income level. The findings showed that greater geographic accessibility to primary care was associated with a decreased risk of hypertension in both slow and quick distance-decay weight, odds ratio (OR) = 0.989 (95% Confidence Interval (CI) = 0.984, 0.994), OR = 0.989 (95%CI = 0.984, 0.993), respectively. On the other hand, better secondary care accessibility was associated with an increased risk of hypertension and untreated hypertension; however, the effect of secondary care was mitigated by the effect of primary care accessibility in both slow and quick distance-decay model, hypertension: OR = 0.974 (95% CI = 0.957, 0.991), OR = 0.981 (95%CI = 0.970, 0.991), untreated hypertension: OR = 0.970 (95%CI = 0.944, 0.996), OR = 0.975 (95%CI = 0.959, 0.991), respectively.
In addition, the results revealed that young and fit people were at a higher risk of untreated hypertension, which is a unique finding in the context of the Japanese healthcare system. Our findings indicate the importance of primary care even in Japan, where it is not yet established, and also emphasize the need for a culturally specific perspective in health equity.
掲載誌名
PLOS ONE
14
3
開始ページ
e0213098
発行日
2019-3-4
DOI
出版者
PLOS
資料タイプ
学術雑誌論文
ファイル形式
PDF
著者版/出版社版
出版社版
業績ID
e35317
部局
医学部