Individual income, income distribution, and self rated health in Japan: cross sectional analysis of nationally representative sample

Objective To assess the effects on self rated health of individual income and income distribution in Japan. Design Cross sectional analysis. Data collected on household income, self rated health, and other sociodemographic characteristics at the individual level from comprehensive survey of the living conditions of people on health and welfare in a nationally representative sample from each prefecture, Setting Prefectures in Japan. Participants 80 899 people aged >15 years with full records in survey. Main outcome measures Dichotomous variable for self rated health of each respondent (0 if excellent very good or good; I if fair or poor). Results Inequality in income at die prefecture level measured by the Gini coefficient was comparable with that in other industrialised countries. Unadjusted odds ratios show a 14% increased risk (odds ratio 1.14, 95% confidence interval 1.02 to 1.27) in reporting poor or fair health for individuals living in prefectures with higher inequality in income. After adjustment, individual income was more strongly associated with self rated health than income inequality. Additional inclusion of regional effects showed that median income at the prefecture level was related to self rated health. Conclusions Individual income, probably relative to the median prefecture income, has a stronger association with self-rated health than income inequality at the prefecture level.