著者
Shota Hamada Hideto Takahashi Nobuo Sakata Boyoung Jeon Takahiro Mori Katsuya Iijima Satoru Yoshie Tatsuro Ishizaki Nanako Tamiya
出版者
Japan Epidemiological Association
雑誌
Journal of Epidemiology (ISSN:09175040)
巻号頁・発行日
pp.JE20180055, (Released:2018-09-22)
参考文献数
29
被引用文献数
4

Background: This study aimed to determine whether there are disparities in healthcare services utilization according to household income among people aged 75 years or older in Japan.Methods: We used data on medical and long-term care (LTC) insurance claims and on LTC insurance premiums and needs levels for people aged 75 years or older in a suburban city. Data on people receiving public welfare were not available. Participants were categorized according to household income level using LTC insurance premiums data. The associations of low income with physician visit frequency, length of hospital stay (LOS), and medical and LTC expenditures were evaluated and adjusted for the five-year age group and LTC needs level.Results: The study analyzed 12,852 men and 18,020 women, among which 13.3% and 41.5% were respectively categorized as low income. Participants with low income for both genders were more likely to be functionally dependent. In the adjusted analyses, lower income was associated with fewer physician visits (incidence rate ratio: 0.90 (95% confidence interval 0.87-0.92) for men and 0.97 (0.95-0.99) for women), longer LOS (1.98 (1.54-2.56) and 1.42 (1.20-1.67)), and higher total expenditures (1.09 (1.01-1.18) and 1.09 (1.05-1.14)).Conclusions: This study suggests older people with lower income had fewer consultations with physicians but an increased use of inpatient services. The income categorization used in this study may be an appropriate proxy of socioeconomic status.
著者
Daijun Kirigaya Takeo Nakayama Tatsuro Ishizaki Shunya Ikeda Toshihiko Satoh
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
vol.50, no.22, pp.2793-2800, 2011 (Released:2011-11-15)
参考文献数
31
被引用文献数
13 22

Objective The aim of this study was to evaluate the adherence of guidelines for the management and treatment of glucocorticoid-induced osteoporosis, and to investigate whether it is associated with factors such as age, gender, glucocorticoid dose, physician specialty, and size of facility. Methods This was a cross-sectional study utilizing administrative data from a database of health insurance claims (2004-2007); 2,368 patients who received glucocorticoid treatment for≥90 days were extracted. The guideline adherence was determined by evaluations based on glucocorticoid prescription dose, prescription of anti-osteoporosis drugs, and whether or not bone mineral density was measured. Results Overall proportion of guideline adherence was 23.3%. In cases in which the equivalent dose of prednisolone was<5 mg/d and≥5 mg/d, the adherence was 8.3% and 30.5% respectively. Factors correlating with low adherence included young age, male gender, and lower glucocorticoid doses. Surgery and otolaryngology specialties had lower adherence than internal medicine. Smaller clinical facilities had lower adherence than larger facilities. Conclusion The adherence of guidelines for the management and treatment of glucocorticoid-induced osteoporosis is still low, and improvements in treatment quality can be expected through education of patient groups and medical care providers with large deviations from the guidelines.
著者
Tatsuro Ishizaki Taketo Furuna Yuko Yoshida Hajime Iwasa Hiroyuki Shimada Hideyo Yoshida Shu Kumagai Takao Suzuki
出版者
日本疫学会
雑誌
Journal of Epidemiology (ISSN:09175040)
巻号頁・発行日
vol.21, no.3, pp.176-183, 2011-05-05 (Released:2011-05-05)
参考文献数
33
被引用文献数
11 20

Background: Few studies have examined whether declines over time in hand-grip strength (HGS) and fast walking speed (FWS) differ by sex and age among non-Western community-dwelling older adults. This study aimed to quantify changes in HGS and FWS over the 6-year period from 1994 to 2000 and examine whether these changes differed by sex and baseline age among older individuals in a Japanese community.Methods: We conducted a community-based prospective cohort study. The participants were 513 nondisabled men and women aged 67 to 91 years at the 1994 survey. Independent variables regarding time since baseline, in addition to various time-dependent and time-independent covariates, were obtained in 1994, 1996, 1998, and 2000. The outcome variables were HGS and FWS assessed at each survey. All data on independent and dependent variables that were collected at each survey were simultaneously analyzed using a linear mixed-effects model.Results: The linear mixed-effects model revealed significant declines in both HGS (−0.70 kg/year, P < 0.001) and FWS (−0.027 m/sec/year, P < 0.001) among nondisabled older participants who had analyzable data in any survey during the 6-year period. Sex was significantly associated with the rate of decline in HGS (P < 0.001), but not FWS (P = 0.211).Conclusions: In this analysis of nondisabled older Japanese, a mixed-effects model confirmed a significant effect of aging on declines in HGS and FWS and showed that men had a significantly steeper decline in HGS than did women during a 6-year period.