Shuko Takahashi1, Soong-Nang Jang2, Shiho Kino3, Ichiro Kawachi3. 1. Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1210A, Boston, MA, 02115, USA; International Health, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Division of Medical Education, Iwate Medical University, 2-1-1, Nishitokuta, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan. 2. Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu Seoul 06709, South Korea; Department of Social and Behavioral Sciences, Harvard. T.H. Chan School of Public Health, 401 Park Drive, Boston, MA, 02215, USA. Electronic address: jang@cau.ac.kr. 3. Department of Social and Behavioral Sciences, Harvard. T.H. Chan School of Public Health, 401 Park Drive, Boston, MA, 02215, USA.
Abstract
BACKGROUND: Japan and South Korea represent "outliers" among rich nations with regard to having achieved high life expectancy but also ranking near the bottom on United Nations indices of gender equality. In the present study, we compared gender inequalities in self-rated health (SRH) across the life course captured in nationally representative surveys from South Korea and Japan. Our comparative analysis focused on the following questions, (1) Do Japan and South Korea exhibit similar patterns of gender inequalities in health as found in western settings (e.g. the "gender paradox" whereby women enjoy longer life expectancy, but worseself-rated health compared to men)? (2) Can gender differences in educational attainment and income account for gender differences in health in Japan & Korea? (3) Do gender inequalities in self-rated health differ over the life-course in Japan compared to South Korea? METHODS: Cross-sectional data were drawn from nationally representative surveys in South Korea and Japan. We analyzed data for 239,076 participants aged 20 years or older (226,105 in South Korea and 12,971 in Japan). We evaluated the gender gap in poor SRH between two countries using logistic regression models controlling for covariates sequentially. RESULTS: (1) The absolute female/male gap in prevalence of poor SRH was much narrower in Japan compared to South Korea; (2) the prevalence ratios of poor SRH (women relative to men) were significantly higher in South Korea than in Japan after retirement age; (3) but the difference in the prevalence ratios of poor SRH by gender between two countries largely disappeared after adjusting for educational attainment & comorbidity. CONCLUSIONS: Each country needs to analyze their specific situations to understand what determines their population health status. In addition, there must exist other reasons for the"gender paradox" - i.e. why Japan & Korea have managed to achieve high longevity without gender equality.
BACKGROUND: Japan and South Korea represent "outliers" among rich nations with regard to having achieved high life expectancy but also ranking near the bottom on United Nations indices of gender equality. In the present study, we compared gender inequalities in self-rated health (SRH) across the life course captured in nationally representative surveys from South Korea and Japan. Our comparative analysis focused on the following questions, (1) Do Japan and South Korea exhibit similar patterns of gender inequalities in health as found in western settings (e.g. the "gender paradox" whereby women enjoy longer life expectancy, but worseself-rated health compared to men)? (2) Can gender differences in educational attainment and income account for gender differences in health in Japan & Korea? (3) Do gender inequalities in self-rated health differ over the life-course in Japan compared to South Korea? METHODS: Cross-sectional data were drawn from nationally representative surveys in South Korea and Japan. We analyzed data for 239,076 participants aged 20 years or older (226,105 in South Korea and 12,971 in Japan). We evaluated the gender gap in poor SRH between two countries using logistic regression models controlling for covariates sequentially. RESULTS: (1) The absolute female/male gap in prevalence of poor SRH was much narrower in Japan compared to South Korea; (2) the prevalence ratios of poor SRH (women relative to men) were significantly higher in South Korea than in Japan after retirement age; (3) but the difference in the prevalence ratios of poor SRH by gender between two countries largely disappeared after adjusting for educational attainment & comorbidity. CONCLUSIONS: Each country needs to analyze their specific situations to understand what determines their population health status. In addition, there must exist other reasons for the"gender paradox" - i.e. why Japan & Korea have managed to achieve high longevity without gender equality.