Social determinants affecting the use of complementary and alternative medicine in Japan: An analysis using the conceptual framework of social determinants of health

• Published in: PloS one Vol. 13; no. 7; p. e0200578
• Main Authors: Misawa, Jimpei, Ichikawa, Rie, Shibuya, Akiko, Maeda, Yukihiro, Hishiki, Teruyoshi, Kondo, Yoshiaki
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16-07-2018; Public Library of Science (PLoS)
• Subjects: Adult; Alternative medicine; Analysis; Anxiety; Complementary Therapies; Control systems; Delivery of Health Care; Demographic variables; Demographics; Dependent variables; Evaluation; Female; Health care; Health services; Health Services Research; Health Status; Humans; Independent variables; Indicators; Japan; Linear analysis; Male; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; People and Places; Physical Sciences; Research and Analysis Methods; Sex Factors; Social aspects; Social classes; Social interactions; Social Sciences; Social status; Socioeconomic Factors; Statistical models; Surveys; Surveys and Questionnaires; Variables; Japan; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0200578

This study aims to use the conceptual framework of social determinants of health (SDH) to elucidate the social determinants that affect the use of complementary and alternative medicine (CAM) from the perspectives of both intermediary and structural determinants. Data were derived from a survey mailed to 1,500 randomly selected residents (20-69 years old; May-July 2009) of Sendai city in Japan. A generalized linear model was used in the analysis, with CAM use over the past one month as the dependent variable, SDH structural and intermediary determinants as independent variables, and demographic characteristics, indicators of health status, and the evaluation of health or healthcare systems as control variables. The prevalence of CAM usage was 62.1%. The generalized linear model showed that middle subjective social status (OR = 1.47; 95% CI: 1.04-2.07) as structural determinants was significantly associated with CAM usage. Adding the intermediary determinants, the same effect was observed. When demographic characteristics, indicators of health status, and the evaluation of health or healthcare systems were introduced as control variables, the associations of the structural determinants disappeared, revealing that hope (OR = 1.25; 95%CI: 1.04-1.50) as intermediary determinants was associated with the use of CAM. Female sex (OR = 1.47; 95% CI: 1.02-2.12) and health anxiety (OR = 1.68; 95% CI: 1.20-2.34) were associated with CAM usage. We found that intermediary rather than structural determinants were associated with CAM usage. Hope as an intermediary determinant was particularly associated with CAM usage.