ArticleThe Lancet regional health. Western Pacific2026
Cross-level regional and socioeconomic inequalities in step counts: a descriptive epidemiological investigation of 1.5 million Japanese smartphone users.
Article in The Lancet regional health. Western Pacific, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Although regional inequalities in physical activity are recognised as a global concern, nationwide evidence from device-based measurements is limited. Given the multilevel nature of inequality, we quantified step count disparities across municipalities and examined cross-level interactions between individual-level socioeconomic status (SES) and walkability. Methods: We conducted municipality- and individual-level analyses using step count data from 1,542,536 smartphone users aged 20-64 years. We calculated municipality-level mean daily steps and Gini coefficients, and examined associations between mean daily steps, municipal walkability, and Gini coefficients. Linear mixed-effects models quantified cross-level interactions between individual SES (education, employment, and equivalised household income) and walkability (modelled as a continuous variable) on individual-level mean daily steps. Cross-level patterns were visualised across quintile-based walkability strata. Findings: Municipality-level mean daily steps varied substantially across the 951 municipalities, with a maximum difference of 3724 steps/day (ranging from 4026 to 7750 steps/day, nearly a 2-fold disparity). Municipalities with higher mean daily steps had greater walkability (r = 0.76) and more equal step-count distributions (Gini coefficient; r = -0.79, stronger than simulated mathematical correlations). Significant cross-level interactions on individual-level mean daily steps were evident, with patterns differing across SES domains: step-count differences across walkability strata were prominent for education and income (623-762 steps/day), whereas employment status showed substantial differences between employed and non-employed individuals, reaching 826-1514 steps/day in highly walkable areas. Interpretation: Substantial inequalities exist across and within municipalities, and individual-level disparities vary based on SES and walkability. Nationwide surveillance and cross-sectoral collaborations are needed to identify populations vulnerable to inactivity and implement targeted strategies. Funding: Japan Society for the Promotion of Science and Japan Science and Technology Agency.
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