著者

Masayuki Endo Taisuke Jo Takaaki Konishi Ryosuke Kumazawa Hiroki Matsui Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1115-22, (Released:2023-05-24)

参考文献数

32

被引用文献数

1

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Objective Recommendations on the timing of Legionella urinary antigen tests for community-acquired pneumonia patients differ among guidelines in Japan, the United States, and European nations. We therefore evaluated the association between the timing of urinary antigen tests and in-hospital mortality in patients with Legionella pneumonia. Methods We conducted a retrospective cohort study using the Diagnosis Procedure Combination database, a nationwide database of acute care inpatients in Japan. Patients who underwent Legionella urinary antigen tests on the day of admission formed the tested group. Patients who were tested on day 2 of admission or later or were unexamined formed the control group. We performed a propensity score matching analysis to compare in-hospital mortality, length of hospital stay and duration of antibiotics use between the two groups. Results Of the 9,254 eligible patients, 6,933 were included in the tested group. One-to-one propensity score matching generated 1,945 pairs. The tested group had a significantly lower 30-day in-hospital mortality than the control group (5.7 vs. 7.7%; odds ratio, 0.72; 95% confidence intervals, 0.55-0.95; p=0.020). The tested group also showed a significantly shorter length of stay and duration of antibiotics use than the control group. Conclusions Urine antigen testing upon admission was associated with better outcomes in patients with Legionella pneumonia. Urine antigen tests upon admission may be recommended for all patients with severe community-acquired pneumonia.

著者

Hiroyuki Ohbe Yusuke Sasabuchi Ryosuke Kumazawa Hiroki Matsui Hideo Yasunaga

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.32, no.12, pp.535-542, 2022-12-05 (Released:2022-12-05)

参考文献数

31

被引用文献数

14

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Background: Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning.Methods: We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies.Results: Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively.Conclusion: Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.

著者

Yohei Hashimoto Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.4, no.4, pp.101-109, 2022 (Released:2022-10-03)

参考文献数

35

被引用文献数

4

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Propensity score analysis has been widely used in observational studies to make a causal inference. This study introduces three assumptions for causal inferences—conditional exchangeability, positivity, and consistency—and five steps for propensity score (PS) analysis—1) construct appropriate PS models, 2) check overlap in PS, 3) apply appropriate weighting (inverse probability of treatment weighting, standardized mortality ratio weighting, matching weights, and overlap weights) or matching methods according to the target of inference, 4) check the balance of covariates, and 5) estimate the effect of exposure appropriately. Finally, the advantages of PS analyses over conventional multivariable regression are discussed.

著者

Hayato Yamana Sachiko Ono Nobuaki Michihata Taisuke Jo Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.60, no.21, pp.3401-3408, 2021-11-01 (Released:2021-11-01)

参考文献数

29

被引用文献数

4

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Objective Maoto is a traditional Japanese Kampo formula used to treat influenza. However, clinical evidence for maoto has been limited to small-scale studies of its effect in alleviating symptoms. The present study evaluated whether or not the addition of maoto to a neuraminidase inhibitor was associated with a reduction in hospitalization following influenza. Methods Using the JMDC Claims Database, we identified outpatients <60 years old who were diagnosed with influenza by an antigen test from September 2013 to August 2018. One-to-five propensity score matching was conducted between patients who received maoto in addition to a neuraminidase inhibitor and those who received a neuraminidase inhibitor alone. Hospitalization within seven days of the influenza diagnosis was compared in the matched groups using the Mantel-Haenszel test. Results We identified 1.79 million cases of influenza from the database in the 5-year study period. Maoto was prescribed for 3.9% of the 1.67 million cases receiving a neuraminidase inhibitor. In the 64,613 propensity score-matched groups of patients, the 7-day hospitalization rate was 0.116% (n=75) for patients with maoto and 0.122% (n=394) for patients without maoto. The difference between these treatment groups was nonsignificant (common odds ratio, 0.95; 95% confidence interval, 0.74 to 1.22; p=0.695). Conclusion The addition of maoto to a neuraminidase inhibitor was not associated with a decrease in hospitalization among nonelderly patients with influenza. Further research is necessary to clarify the indication and efficacy of maoto.

著者

Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.1, no.3, pp.76-79, 2019 (Released:2020-05-19)

参考文献数

12

被引用文献数

39 218

著者

Hayato Yamana Sachiko Ono Akira Okada Taisuke Jo Hideo Yasunaga

出版者

Japan Society for Occupational Health

雑誌

Journal of Occupational Health (ISSN:13419145)

巻号頁・発行日

vol.62, no.1, pp.e12183, 2020 (Released:2021-01-25)

参考文献数

17

被引用文献数

3

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Objectives: It is unclear whether mandatory health examination is effective for employees who are already being treated for chronic diseases. We focused on patients being treated for hypertension and evaluated the association between employer-based health examination attendance and diabetes treatment initiation.Methods: Using a database that stores health insurance claims and health examination results of subscribers enrolled in society-managed health insurance plans in Japan, we identified employees aged 40-59 years who were being treated for hypertension when starting diabetes treatment from April 2012 to December 2016. A case-crossover analysis was conducted using 90, 180, and 270 days prior to diabetes treatment initiation as reference points and 90 days after the mandatory health examination as the exposure period. We conducted a subgroup analysis by hemoglobin A1c (HbA1c) level and frequency of outpatient blood glucose testing before the mandatory health examination.Results: We identified 1464 individuals starting treatment for diabetes while on antihypertensive drugs. The overall odds ratio for starting diabetes treatment within 90 days of the health examination was 1.89 (95% confidence interval: 1.70-2.10). The subgroup analysis showed that this odds ratio increased as HbA1c level increased and as blood glucose testing frequency decreased.Conclusions: Among employees starting treatment for diabetes while being treated for hypertension, employer-based mandatory health examination attendance was associated with initiation of diabetes treatment. The health examinations may be functioning as a complement to screening in outpatient settings.

著者

Daisuke Shigemi Toshitaka Morishima Ayako Shibata Takahiro Tabuchi Hideo Yasunaga Isao Miyashiro

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.2, no.3, pp.75-83, 2020 (Released:2020-07-01)

参考文献数

28

被引用文献数

1

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BACKGROUNDUnlike the recommendations made in many other countries, Japanese guidelines equally recommend radical hysterectomy or concurrent chemoradiotherapy for treatment of stage IIB cervical carcinoma. The main study objective was to compare the overall mortality of hysterectomy versus concurrent chemoradiotherapy as primary treatment in patients with localized or regionally extended cervical cancer.METHODSUsing Diagnosis Procedure Combination database combined with population-based cancer registry data in Osaka Prefecture, Japan, we conducted a retrospective cohort study. All adult patients who had been diagnosed with cervical cancer, registered in the population-based cancer registry from January 1, 2010 to December 31, 2015 were included. To compare overall mortality between patients who received radical hysterectomy and concurrent chemoradiotherapy as primary treatment, we performed a Cox regression analysis of the original cohort, and Kaplan-Meier analysis with stabilized inverse probability of treatment weights using propensity score.RESULTSAmong 740 eligible patients, 564 patients were included in the hysterectomy group and 176 patients were included in the concurrent chemoradiotherapy group. Primary hysterectomy was not independently associated with overall mortality (adjusted HR 0.70, 95% CI 0.46–1.07) by the Cox regression analysis. The Kaplan-Meier analysis with stabilized inverse probability of treatment weights did not show a significant difference in overall mortality between the two groups (P = 0.096).CONCLUSIONSThis study indicates that primary treatment type (hysterectomy versus concurrent chemoradiotherapy) was not statistically associated with overall mortality among patients diagnosed with localized or regionally extended cervical cancer.

著者

Yuki Miyamoto Hiroyuki Ohbe Miho Ishimaru Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.59, no.15, pp.1789-1794, 2020-08-01 (Released:2020-08-01)

参考文献数

13

被引用文献数

5

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Objective Carbazochrome sodium sulfonate (CSS) has been routinely used to treat bleeding; however, no study has examined the effect of CSS for gastrointestinal bleeding. Therefore, we aimed to investigate the effect of CSS for colonic diverticular bleeding. Methods We performed a nationwide observational study using the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted for diverticular bleeding from July 2010 to March 2018. Patients who received CSS on the day of admission were defined as the CSS group, and those not receiving CSS were defined as the control group. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, total costs, and blood transfusion within 7 days of admission. Propensity score matching analyses were performed to compare outcomes between the two groups. Results A total of 59,965 patients met our eligibility criteria. Of these, 14,437 (24%) patients received CSS on the day of admission. One-to-one propensity score matching created 14,379 matched pairs. There was no significant difference in the in-hospital mortality between the CSS and control groups (0.6% vs. 0.5%, respectively; odds ratio: 0.96; 95% confidence interval: 0.72-1.29). The length of stay was longer in the CSS group than in the control group (11.4 vs. 11.0 days, respectively; difference: 0.44; 95% confidence interval: 0.14-0.73). There were no significant differences in the total costs or the proportion of patients receiving blood transfusion between the groups. Conclusions CSS may not reduce in-hospital mortality, length of stay, total costs, or the need for blood transfusion in patients with colonic diverticular bleeding.