Table 2 Scoping review studies investigating urban-rural disparities in the quality of healthcare in Japan
Title | Year of publication | Language | Study design | Study setting: Level of care | Study setting: national/prefecture/city, town, village | Data source | Sample size |
|---|---|---|---|---|---|---|---|
A regional difference in care burden feelings of family caregivers with frail elderly using visiting nurse [30] | 2007 | Japanese | Cross-sectional | Home-visit nursing service | One prefecture | Questionnaire | 167 families |
Current situations and issues in respiratory medicine in Japan [31] | 2010 | English | Cross-sectional | Hospital | National | Questionnaire | 1251 hospitals |
Geographic distribution of radiologists and utilization of teleradiology in Japan: A longitudinal analysis based on national census data [32] | 2015 | English | Cross-sectional | Municipality | National | Questionnaire | 1811 municipalities |
Rural-urban disparity in emergency care for acute myocardial infarction in Japan [33] | 2018 | English | Prospective cohort | hospital | Prefecture | Registry | Rural: 1313 individuals、Metropolitan: 2,075 individuals |
Geographical distribution of family physicians in Japan: a nationwide cross-sectional study [34］ | 2019 | English | Cross-sectional | Prefecture | National | Database of academic society | 527 family physicians |
Geography of suicide in Japan: spatial patterning and rural-urban differences [35] | 2021 | English | Cross-sectional | Municipality | National | Suicide database | 240673 individuals |
Regional and facility disparities in androgen deprivation therapy for prostate cancer from a multi-institutional Japan-wide database [36] | 2021 | English | Prospective cohort | Hospital | National | Japan Study Group of Prostate Cancer (J-CaP) | 19162 individuals |
Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas [37] | 2021 | English | Retrospective cohort | Prefecture | National | The national database of hospital-based cancer registries | 5066 individuals |
Regional disparities in adherence to guidelines for the treatment of chronic heart failure [38] | 2021 | English | Prospective cohort | Hospital | Prefecture | Acute Decompensated Heart Failure Syndromes (ATTEND) | 387 individuals |
Urban-rural inequalities in care and outcomes of severe traumatic brain injury: A nationwide inpatient database analysis in Japan [39] | 2022 | English | Retrospective cohort | Hospital | National | Diagnosis Procedure Combination(DPC) | 48910 individuals |
Regional variation in national healthcare expenditure and health system performance in central cities and suburbs in Japan [40] | 2022 | English | Cross-sectional | Municipality | National | Open data | 23 urban municipalities and 27 rural municipalities |
Disparity of performance measure by door-to-balloon time between a rural and urban area for management of patients with ST-segment elevation myocardial infarction - insights from the Nationwide Japan Acute Myocardial Infarction Registry [41] | 2023 | English | Retrospective cohort | Hospital | National | The Japan Acute Myocardial Infarction Registry (JAMIR) | 17167 individuals |
The inter-prefectural regional disparity of healthcare resources and representative surgical procedures in orthopedics and general surgery: a nationwide study in Japan during 2015–2019 [42] | 2023 | English | Cross-sectional | Prefecture | National | Nippon Data Base (NDB) Open data | 47 prefectures |
Development and validation of a rurality index for healthcare research in Japan: a modified Delphi study [43] | 2023 | English | Cross-sectional | Municipality | National | Open data | 335 secondary medical areas and 1713 municipalities |
Primary care physicians working in rural areas provide a broader scope of practice: a cross‑sectional study [44] | 2024 | English | Cross-sectional | Primary care clinic and hospital | National | Questionnaire | 299 primary care physicians |
Title | Index or definition of rurality | Details of the index or definition of rurality: population size/density | Donabedian's model (structure, process, outcomes) | Study outcome | Covariates | Overview of results |
|---|---|---|---|---|---|---|
A regional difference in care burden feelings of family caregivers with frail elderly using visiting nurse [30] | Urban: ordinance, designated cityRural: depopulated area | Not applicable | Outcomes | Care burden of family caregivers | Caregiver's age Caregiver's gender Duration of care Welfare services used Certification for long-term care/support needs, Activities of daily living | No difference in care burden of family caregivers |
Current situations and issues in respiratory medicine in Japan [31] | Population size | Metropolitan areas (population ≥500000)Urban areas (200000 to 500000)Provincial areas (50000 to 200000)Rural areas (<50000) | Structure, process | Numbers of internists, respiratory physicians, respiratory specialistsScope of practice | Not applicable | Fewer respiratory specialists in rural areas than the Japanese average. Lower self-containment level (Scope of Practice) in rural areas than in urban areas. |
Geographic distribution of radiologists and utilization of teleradiology in Japan: A longitudinal analysis based on national census data [32] | Ordinance designated city/special ward/city/town | Not applicable | Structure | Numbers of radiologists, computed tomography and magnetic resonance imaging | Not applicable | Fewer radiologists in rural areas than in urban areas. |
Rural-urban disparity in emergency care for acute myocardial infarction in Japan [33] | Population size | Rural areas: prefecture with population <2 million | Process | Direct ambulance transport, onset-to-balloon time | Age, sex, mode of transport, hypertension, diabetes mellitus, dyslipidemia, current smoker, previous percutaneous coronary intervention, previous myocardial infarction, Killip classification at presentation, ST elevation myocardial infarction, multivessel disease and left anterior descending coronary artery lesion as the culprit | Less direct ambulance transportation in rural areas than in urban areas. Onset-to-balloon time in rural areas is longer than in urban areas. |
Geographical distribution of family physicians in Japan: a nationwide cross-sectional study [34] | Population densityOrdinance designated City/special ward/town | Municipalities divided into quintiles by population density | Structure | Number of family physicians per 100000 population | Not applicable | More family physicians in rural areas than any other specialists. |
Geography of suicide in Japan: spatial patterning and rural-urban differences [35] | Population density | Municipalities divided into deciles sorted by population density | Outcomes | Number of suicides | Single-person households Unmarried adultsUnemployment rateEducational attainment | Men aged 0–39 and 40–59 years: rural residents had a higher suicide risk than urban residents. |
Regional and facility disparities in androgen deprivation therapy for prostate cancer from a multi-institutional Japan-wide database [36] | Population density | Urban areas: prefectures with a population density >1000 persons/km2 | Outcomes | Cancer mortality All-cause mortality | Age, initial Prostate-Specific Antigen (PSA) value at pretreatmentGleason scoreClinical TNM-stageTherapeutic modality Regional area or facility type | Geographical regions (rural or urban) do not affect outcomes |
Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas [37] | Population size | Urban areas: a prefecture with >6 million population | Process, outcomes | Treatment strategy, mortality | Age, sex, first-line treatments | cStage I thoracic esophageal cancer mortality in rural areas is worse than in urban areas. |
Regional disparities in adherence to guidelines for the treatment of chronic heart failure [38] | Authors-defined rural and urban areas | Process | Treatment rates for heart failure with reduced ejection fraction (HFrEF) as recommended by guidelines | Not applicable | Treatment rates for HFrEF following guidelines were lower in rural areas than in urban areas. | |
Urban-rural inequalities in care and outcomes of severe traumatic brain injury: A nationwide inpatient database analysis in Japan [39] | Population size | Urban areas (population ≥50000)Rural areas (10000 to 50000) | Outcomes | In-hospital mortality | Age, sex, fiscal year, and season of admission, admission on weekends or at night, referral from other institutions, ambulance use, smoking history, body mass index, comorbidities, Charlson comorbidity index, Japan Coma Scale score at admission, details of head injury (diffuse axonal injury, acute epidural hemorrhage, acute subdural hemorrhage, traumatic subarachnoid hemorrhage, contusion, skull fracture, penetrating injury), and injury severity score | Mortality by brain traumatic injury in rural areas is greater than that in urban areas. |
Regional variation in national healthcare expenditure and health system performance in central cities and suburbs in Japan [40] | Population size | Metropolitan areas (population ≥500000)Suburb areas: three categories (100000 to 500000, 30000 to 100000, <30000) | Structure, process, outcomes | Total medical expenses of national healthcare experience: medical expenses of inpatients, medical expenses of outpatients, and consultation rates of inpatients and outpatients | Number of doctors, number of nurses, number of beds, income, number of people employed in primary industries, percentage of completely unemployed, percentage of population aged 65–74, number of household members, percentage of singles, percentage of households with own houses | The factors affecting medical care costs in suburban areas differ from those in metropolitan areas. |
Disparity of performance measure by door-to-balloon time between a rural and urban area for management of patients with ST-segment elevation myocardial infarction - Insights from the Nationwide Japan Acute Myocardial Infarction Registry [41] | Population density | Municipalities divided by the median of population density | Process, outcomes | In-hospital death, door-to-balloon time | Both in-hospital death and door-to-balloon time are worse in rural areas than in urban areas. | |
The inter-prefectural regional disparity of healthcare resources and representative surgical procedures in orthopedics and general surgery: a nationwide study in Japan during 2015–2019 [42] | Population size and density | Urban areas: large cities with a population >500000 and top seven prefectures with a high population density >1000 persons/km2. | Structure, process | Numbers of physicians and surgeries | Not applicable | Nonlarge cities had significantly more femur fracture surgeries, lower leg fracture surgeries, total knee arthroplasties, cholecystectomies, and hospitals than in large cities. Sparsely populated areas had significantly more femur fracture surgeries, lower leg fracture surgeries, total knee arthroplasties, cholecystectomies, orthopedic surgeon specialists, hospitals, and higher aging rates than densely populated areas. |
Development and validation of a rurality index for healthcare research in Japan: a modified Delphi study [43] | Rurality index for Japan | Structure, outcomes | Indices for physician distribution and average life expectancy | Not applicable | The indices for physician distribution and average life expectancy are negatively correlated with rurality. | |
Primary care physicians working in rural areas provide a broader scope of practice: a cross‑sectional study [44] | Rurality index for Japan | Process | Scope of practice | Sex, years of clinical experience, clinical setting (clinic or hospital), certification status, and experience of practice in rural areas | The scope of practice is broader in rural areas than in urban areas. |