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

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.本研究旨在借助健康社会决定因素（social determinants of health, SDH）的概念框架，从中介决定因素与结构决定因素双重视角，阐明影响补充与替代医学（complementary and alternative medicine, CAM）使用行为的社会决定因素。研究数据源自2009年5月至7月间，向日本仙台市1500名随机抽取的20至69岁居民邮寄的调查问卷。分析采用广义线性模型，以过去一个月内的CAM使用情况作为因变量，以健康社会决定因素的结构与中介决定因素作为自变量，并将人口统计学特征、健康状况指标、健康或医疗体系评价作为控制变量。CAM使用率达62.1%。广义线性模型分析结果显示，作为结构决定因素的中等主观社会地位（优势比（odds ratio, OR）=1.47；95%置信区间（confidence interval, CI）:1.04–2.07）与CAM使用行为存在显著关联。加入中介决定因素后，仍观测到相同效应。当引入人口统计学特征、健康状况指标及健康或医疗体系评价作为控制变量后，结构决定因素的关联消失，而作为中介决定因素的希望感（OR=1.25；95%CI:1.04–1.50）与CAM使用行为存在关联。女性性别（OR=1.47；95%CI:1.02–2.12）与健康焦虑（OR=1.68；95%CI:1.20–2.34）均与CAM使用行为相关。本研究发现，相较于结构决定因素，中介决定因素与CAM使用行为的关联更为显著，其中作为中介决定因素的希望感与CAM使用行为的关联尤为突出。