Trends in self-reported current diabetes care use, socioeconomic inequalities, and associated factors in Japan: evidence from the Comprehensive Survey of Living Conditions (1986-2022).

INTRODUCTION

Long-term trends in diabetes care use and socioeconomic inequalities are not well described in Japan.  RESEARCH DESIGN AND

METHODS

We analyzed nationally representative data from the Comprehensive Survey of Living Conditions (1986-2022). Diabetes care use was defined as self-reported current medical facility attendance for diabetes. Age-standardized prevalence was calculated as the proportion of adults currently receiving outpatient diabetes care; undiagnosed cases and diagnosed individuals not currently in treatment were therefore not captured. In the 2022 survey, a survey-weighted Poisson regression model was used to estimate prevalence ratios (PRs) of factors associated with current diabetes care use, including educational level and occupational class.

RESULTS

Age-standardized self-reported current diabetes care use increased from 1986 to 2022, rising from 2.2% to 8.3% in men and from 1.7% to 4.4% in women, with a significant widening of the sex inequalities over the study period. Educational differences were evident, particularly among working-age adults. In 2022, compared with the high-education group, PRs were 1.17 (95% CI 1.13 to 1.22) for the middle-education group and 1.22 (95% CI 1.13 to 1.32) for the low-education group for both sexes. Occupational differences were more modest. Compared with upper non-manual workers, lower non-manual workers had a lower PR=0.92 (95% CI 0.86 to 0.98), while non-employed individuals had a higher PR=1.10 (95% CI 1.01 to 1.21); manual workers, self-employed individuals, and farmers did not differ significantly from the reference group. Older age, men, hypertension, depression, and current smoking were also associated with higher current diabetes care use.

CONCLUSIONS

Self-reported diabetes care use increased from 1986 to 2022 in Japan, with lower educational level associated with higher current diabetes care use, particularly among working-age adults. These findings help inform continued monitoring of socioeconomic inequalities in diabetes care.