著者
Ayaka Igarashi Jun Aida Toshimi Sairenchi Toru Tsuboya Kemmyo Sugiyama Shihoko Koyama Yusuke Matsuyama Yukihiro Sato Ken Osaka Hitoshi Ota
出版者
Japan Epidemiological Association
雑誌
Journal of Epidemiology (ISSN:09175040)
巻号頁・発行日
pp.JE20170330, (Released:2018-05-31)
参考文献数
20

Background: Annually, more than 1.2 million deaths due to road traffic accidents occur worldwide. Although previous studies have examined the association between cigarette smoking and injury death, the mortality outcome often included non-traffic accident-related deaths. This study aimed to examine the association between cigarette smoking and traffic accident death.Methods: We conducted a prospective cohort study using data from the Ibaraki Prefectural Health Study conducted between 1993 and 2013. The cohort included 97,078 adults (33,138 men and 63,940 women) living in Ibaraki Prefecture, who were aged 40–79 years at an annual health checkup in 1993. We divided participants into four smoking status groups: non-smokers, ex-smokers and current smokers who smoked <20 and ≥20 cigarettes per day. Hazard ratios (HRs) of traffic accident death were calculated using a Cox proportional hazards model.Results: During 20 years of follow-up, average person-year of follow-up were 16.8 and 18.2 in men and women, respectively. Among men, after adjusting for age and alcohol intake, compared to non-smokers, HRs for traffic accident death among current smokers of <20 cigarettes/day and ≥20 cigarettes/day were 1.32 (95% confidence interval (CI), 0.79–2.20) and 1.54 (95% CI, 0.99–2.39), respectively. In contrast, among women, we found no association between smoking status and traffic accident deaths.Conclusion: In this prospective cohort study, we found a positive association, though marginally significant, between smoking and traffic accident death among men in Japan. Among women, because smaller number of death among smokers, adequate estimation could not be obtained.
著者
Yusuke Matsuyama Toru Tsuboya Shun-ichiro Bessho Jun Aida Ken Osaka
出版者
Tohoku University Medical Press
雑誌
The Tohoku Journal of Experimental Medicine (ISSN:00408727)
巻号頁・発行日
vol.244, no.2, pp.163-173, 2018 (Released:2018-03-01)
参考文献数
29

Healthcare utilization after natural disasters remains understudied. In general, people in Japan pay 10%-30% of total amount of costs, according to their health insurance plan. A policy exempting survivors from copayments was introduced after the Great East Japan Earthquake in March 2011, which had a magnitude of 9.0 on the Richter scale and followed by devastating tsunamis. Among the disaster-affected areas, Miyagi prefecture experienced the largest number of deaths and the greatest extent of damage. However, the exemption was suspended in Miyagi prefecture from April, 2013, because of the huge governmental financial burden due to the immensity of damage from the disaster. Subsequently, in April 2014, the exemption was re-introduced, with smaller coverage. We, therefore, evaluated the influence of this policy change on monthly healthcare utilization in Miyagi prefecture between April 2008 and June 2015. We also evaluated the association between the proportion of people exempted from copayment in each municipality and the difference in healthcare utilization before and after the suspension using multivariable linear regression. Healthcare utilization in Miyagi increased immediately after the institution of the exemption policy and it peaked after one year. In March 2013, just before the suspension, a rapid increment in healthcare utilization was observed, suggesting that the copayment may be a barrier for people in the disaster-affected area to access to healthcare. The exemption policy did help the survivors to use healthcare utilization in Miyagi. After devastating natural disasters, policymakers should guarantee that all survivors can utilize healthcare services on demand.
著者
Yusuke Matsuyama Jun Aida Toru Tsuboya Shihoko Koyama Yukihiro Sato Atsushi Hozawa Ken Osaka
出版者
日本疫学会
雑誌
Journal of Epidemiology (ISSN:09175040)
巻号頁・発行日
pp.JE20160184, (Released:2017-10-28)
参考文献数
44

Background: Secondhand smoke (SHS) causes many deaths. Inequalities in SHS have been reported in several countries; however, the evidence in Asian countries is scarce. We aimed to investigate the association between socioeconomic status (SES) and SHS at home and the workplace/school among non-smoking Japanese adults.Methods: Cross-sectional data from the Miyagi Prefectural Health Survey 2014 were analyzed. Self-reported questionnaires were randomly distributed to residents ≥20 years of age and 2,443 (92.8%) responded. The data of the 1,738 and 1,003 respondents were included to the analyses for SHS in the past month at home and at the workplace/school, respectively. Ordered logistic regression models considering possible confounders, including knowledge of the adverse health effects of tobacco, were applied.Results: The prevalence of SHS at home and the workplace/school was 19.0% and 39.0%, respectively. Compared with ≥13 years of education, odds ratios (ORs) and 95% confidence intervals (CIs) for SHS at home were 1.94 (95% CI, 1.42–2.64) for 10–12 years and 3.00 (95% CI, 1.95–4.60) for ≤9 years; those for SHS at the workplace/school were 1.80 (95% CI, 1.36–2.39) and 3.82 (95% CI, 2.29–6.36), respectively. Knowledge of the adverse health effects of tobacco was significantly associated with lower SHS at home (OR 0.95; 95% CI, 0.91–0.98) but it was not associated with SHS at the workplace/school (OR 1.02; 95% CI, 0.98–1.06).Conclusions: Social inequalities in SHS existed among Japanese non-smoking adults. Knowledge about tobacco was negatively associated with SHS at home but not at workplace/school.