Characteristics and hospitalizations among children on public assistance in Japan: A population-based cohort study

Abstract

BACKGROUND: Child poverty is a critical issue in Japan. While public assistance (seikatsu-hogo) alleviates financial barriers to healthcare, the multidimensional nature of poverty, including social and environmental factors, may still affect children's health. Although previous research has explored health disparities among adults receiving public assistance, little is known about the current conditions and healthcare needs of child recipients. This study aimed to describe the characteristics of children on public assistance and identify the incidence and predictors of hospitalization among them. METHODS: This retrospective cohort study included children receiving public assistance in six Japanese municipalities. We extracted data on children's age, sex, household composition, siblings, guardians' employment status, timing of public assistance receipt, nationality, and disability certificates as of April 2016 and observed them for 1 year. The primary outcome was all-cause hospitalization. Poisson regression analyses were performed to identify predictors of hospitalization. RESULTS: We analyzed data from 1990 children receiving public assistance. Overall, 4.6% were hospitalized during the observation period, with higher rates in younger children and those with disabilities. Hospitalization incidence was varied across households conditions and residing municipalities. CONCLUSIONS: Children on public assistance in Japan may face higher hospitalization risks, and the differences were observed across household conditions and residential areas. Further research using more detailed data should explore child poverty and health, including both recipients and non-recipients of public assistance.