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Background <p>Universal health coverage in Japan aims to ensure equal access to medical care regardless of socioeconomic status. However, disparities in healthcare utilization may persist. We investigated the association between equivalent household income and self-reported inability to access necessary healthcare.</p> Methods <p>We analyzed data from the Japan <i>COVID-19 and Society</i> Internet Survey (JACSIS) in September 2022. We assessed two outcomes: (1) having unmanaged comorbidities, and (2) foregoing medical care due to cost. The primary exposure was equivalent household income quintiles. Weighted multivariable logistic regression models were developed using inverse probability weighting, adjusting for age, sex, socioeconomic status, and health-related conditions.</p> Results <p>We analyzed 28,617 participants (mean [SD] age, 48.1 [17.2] years; 48.9% male), 20% of whom were in the lowest income quintile (&lt;2 million JPY). Lower income was consistently associated with both unmanaged comorbidities and foregoing medical care due to cost. Compared with the highest income quintile (≥5.5 million JPY), the adjusted odds ratios (AORs) for unmanaged comorbidities were 1.40 (95% confidence intervals [CI], 1.19–1.65) in the lowest quintile, 1.25 (95% CI, 1.06–1.48) in the second, and 1.17 (95% CI, 1.00–1.36) in the third. For foregoing care due to cost, the associations were more pronounced, with AORs of 3.68 (95% CI, 2.68–5.04), 2.08 (95% CI, 1.44–2.99), and 1.72 (95% CI, 1.25–2.37), respectively.</p> Conclusion <p>Despite the universal health coverage system in Japan, socioeconomic disparities in healthcare access remain evident. These findings highlight the need for targeted policy interventions to address inequities in medical access among socioeconomically vulnerable groups.</p>

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Socioeconomic disparities in healthcare access under universal health coverage: a nationwide survey in Japan

  • 期刊论文

  • 发表日期：

    2026年3月16日

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  • Hiroshi Ito,
  • Shuichi Okaya,
  • Yingfang Zheng,
  • Nobutake Shimojo,
  • Takahiro Tabuchi

摘要

Background

Universal health coverage in Japan aims to ensure equal access to medical care regardless of socioeconomic status. However, disparities in healthcare utilization may persist. We investigated the association between equivalent household income and self-reported inability to access necessary healthcare.

Methods

We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS) in September 2022. We assessed two outcomes: (1) having unmanaged comorbidities, and (2) foregoing medical care due to cost. The primary exposure was equivalent household income quintiles. Weighted multivariable logistic regression models were developed using inverse probability weighting, adjusting for age, sex, socioeconomic status, and health-related conditions.

Results

We analyzed 28,617 participants (mean [SD] age, 48.1 [17.2] years; 48.9% male), 20% of whom were in the lowest income quintile (<2 million JPY). Lower income was consistently associated with both unmanaged comorbidities and foregoing medical care due to cost. Compared with the highest income quintile (≥5.5 million JPY), the adjusted odds ratios (AORs) for unmanaged comorbidities were 1.40 (95% confidence intervals [CI], 1.19–1.65) in the lowest quintile, 1.25 (95% CI, 1.06–1.48) in the second, and 1.17 (95% CI, 1.00–1.36) in the third. For foregoing care due to cost, the associations were more pronounced, with AORs of 3.68 (95% CI, 2.68–5.04), 2.08 (95% CI, 1.44–2.99), and 1.72 (95% CI, 1.25–2.37), respectively.

Conclusion

Despite the universal health coverage system in Japan, socioeconomic disparities in healthcare access remain evident. These findings highlight the need for targeted policy interventions to address inequities in medical access among socioeconomically vulnerable groups.