著者

Haruka Sato Eri Eguchi Narumi Funakubo Hironori Nakano Hironori Imano Tetsuya Ohira

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220161, (Released:2022-12-10)

参考文献数

46

---

Background: The 2011 Great East Japan Earthquake has resulted in a nuclear accident, forcing residents of the surrounding areas to evacuate. To determine any association between excessive drinking and hypertension in the setting of disaster, we assessed whether the proportion of excessive drinkers increased and if post-disaster excessive drinking was a risk factor for hypertension.Methods: This retrospective study assessed data from the Japanese National Database. Cumulative population data for Fukushima Prefecture (3,497,576 people) were analyzed by categorizing residents into four areas—evacuation, coastal, central, and mountainous—to calculate the proportion of excessive, heavy (equivalent to binge drinking) and at-risk drinkers for 2008–2017. The hazard ratios (HRs) for the incidence of hypertension for 2012–2017 were examined in association with changes in drinking status pre- and post-disaster, which included 136,404 people who received specific health checkups pre-disaster (2008–2010) and post-disaster (2011–2012).Results: The proportion of excessive drinkers among women increased after the disaster in all areas examined. The association between excessive drinking and the incidence of hypertension was determined among men and women in all areas; it was stronger among women in evacuated areas, with the sex- and age-adjusted HRs for the incidence of hypertension of 1.41 for pre-disaster excessive drinking, 2.34 for post-disaster excessive drinking, and 3.98 for pre- and post-disaster excessive drinking, compared with not excessive drinking pre- and post-disaster.Conclusions: Excessive drinking post-disaster may be associated with an increased risk of hypertension among men and women, especially among women in the evacuation areas.

著者

Eun-San Kim Jiyoon Yeo Yongjoo Kim In-Hyuk Ha

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220171, (Released:2022-11-12)

参考文献数

44

---

Background: In 2016, two consecutive moderate magnitude earthquakes occurred in Ulsan, South Korea. Therefore, we aimed to investigate the impact of earthquakes on the mental health of residents in Ulsan.Method: We used data from the 2015–2017 Korean Health Insurance Review & Assessment Service National Patient Sample. We conducted an interrupted time series analysis using location-based controls. Changes in the number of antidepressants, benzodiazepines, and zolpidem prescriptions in Ulsan were compared to controls. Overall changes in weekly prescriptions one year after the first earthquake, compared to a non-earthquake scenario, were estimated.Results: In antidepressant prescriptions, the increase in trend after an earthquake was significantly higher than controls. However, the changes in benzodiazepines and zolpidem were not significant. Overall, the impact of the earthquake on weekly antidepressant prescriptions at one year was estimated as a 1.32 (95% CI: 1.18 - 1.56) rate ratio compared to the non-earthquake scenario. This corresponded to a 1,989.7 (95% CI: 1,202.1 to 3,063.0) increase in the number of prescriptions. Among subgroups, the increase was highest among males aged 20–39 years.Conclusion: The moderate earthquake in Ulsan was associated with an increase in antidepressant prescriptions. The increase in the male group aged 20–39 was the highest. The impact may vary according to the context of the population.

著者

Yumi Matsushita Tetsuji Yokoyama Kayoko Hayakawa Nobuaki Matsunaga Hiroshi Ohtsu Sho Saito Mari Terada Setsuko Suzuki Shinichiro Morioka Satoshi Kutsuna Shinya Tsuzuki Hisao Hara Akio Kimura Norio Ohmagari

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220056, (Released:2022-07-16)

参考文献数

27

---

Background: Prioritization for novel coronavirus disease 2019 (COVID-19)-related health policies usually considers age and certain other characteristics, but sex is rarely included, despite the higher risk of severe disease in men. The aim of this study was to compare the impact of sex and age on the severity of COVID-19 by estimating the age difference in years for which the risk for men versus women is the same.Methods: We analyzed 23,414 Japanese COVID-19 inpatients aged 20–89 years (13,360 men and 10,054 women). We graded the severity of COVID-19 (0 to 5) according to the most intensive treatment required during hospitalization. The risk of grade 2/3/4/5 (non-invasive positive pressure ventilation/invasive mechanical ventilation/extracorporeal membrane oxygenation/death), grade 3/4/5, and separately grade 5 was analyzed using a multiple logistic regression model.Results: The odds ratio (OR) of grades 2/3/4/5, 3/4/5 (primary outcome), and 5 for men relative to women was 2.76 (95% CI, 2.44–3.12), 2.78 (95% CI, 2.42–3.19), and 2.60 (95% CI, 2.23–3.03), respectively, after adjustment for age and date of admission. These risks for men were equivalent to those for women 14.1 (95% CI, 12.3–15.8), 11.2 (95% CI, 9.7–12.8), and 7.5 (95% CI, 6.3–8.7) years older, respectively.Conclusion: The risks of worse COVID-19 prognosis (grades 3/4/5) in men were equivalent to those of women 11.2 years older. Reanalyzing data extracted from four previous studies also revealed a large impact of sex difference on the severity of COVID-19. We should pay more attention to sex differences to predict the risk of COVID-19 severity and to formulate public health policy accordingly.

著者

Zhaoqing Lyu Tomoko Fujitani Kouji H. Harada

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220151, (Released:2022-07-30)

参考文献数

6

著者

Masaaki Yamada Michikazu Sekine Takashi Tatsuse Yukiko Asaka

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.10, pp.537-544, 2021-10-05 (Released:2021-10-05)

参考文献数

32

被引用文献数

3 7

---

Background: Little is known about pathological Internet use (PIU) and online risky behaviors among elementary school children. We aimed to investigate the prevalence and factors associated with PIU and online risky behaviors.Methods: A school-based cross-sectional study was conducted in Toyama, Japan in 2018. The study included 13,413 children in the 4th–6th grades (mean, 10.5 years old) from 110 elementary schools (61.1% of elementary schools in Toyama). We assessed PIU using Young’s Diagnostic Questionnaire (YDQ) and risky behaviors. Poisson regression analysis was conducted.Results: Totally, 13,092 children returned questionnaires (response rate 97.6%). The prevalence of PIU was 4.2% and that of each risky behavior was as follows: 21.6% for spending money online, 6.6% for uploading personal movies, 5.2% for interpersonal issues, and 2.4% for having met strangers. PIU was significantly associated with boys (prevalence ratio [PR] 1.26; 95% confidence interval [CI], 1.04–1.52), skipping breakfast (PR 1.43; 95% CI, 1.14–1.79), Internet time (for 2∼3 h, PR 3.49; 95% CI, 2.63–4.65; for 3∼4 h, PR 4.45; 95% CI, 3.27–6.06; and for ≥4 h, PR 8.25; 95% CI, 6.45–10.55), physical inactivity (PR 2.63; 95% CI, 2.00–3.47), late bedtime (PR 1.86; 95% CI, 1.45–2.39 for ≥11 p.m.), no rules at home (PR 1.22; 95% CI, 1.01–1.46), no child-parent interaction (PR 1.37; 95% CI, 1.06–1.77), and no close friends in real life (PR 1.69; 95% CI, 1.30–2.19).Conclusions: PIU and risky behaviors were not rare among the elementary school children. Besides unhealthy lifestyles, social and family environments were associated with PIU. Having child-parent interaction and helping children develop close friendships in real life are effective deterrents to PIU.

著者

Yu-Tai Liu Yung Liao Ming-Chun Hsueh Hsin-Yen Yen Jong-Hwan Park Jae Hyeok Chang

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220105, (Released:2022-10-29)

参考文献数

35

---

Background: The impact of meeting leisure time physical activity (LTPA) recommendations and household physical activity (HPA) on all-cause mortality in the Taiwanese population is unclear. We aimed to investigate the relationship between sufficient LTPA and all-cause mortality in middle-aged and older Taiwanese adults and the role of HPA in those with insufficient LTPA.Methods: This nationwide prospective cohort study included 4,960 participants aged ≥50 years from the Taiwan Longitudinal Study in Aging (TLSA) survey. Physical activity patterns were assessed in 2003 and then followed up until 2015 for mortality through the National Death Registration Record. Cox proportional hazards regression was conducted to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality.Results: Of the 4,960 participants, 1712 died of all-cause mortality. Compared to those who had insufficient LTPA, participants who engaged in sufficient LTPA showed a significantly lower risk of all-cause mortality (HR=0.84, 95% CI, 0.73-0.97). For those with insufficient LTPA, HPA also had a significantly reduced risk of all-cause mortality (HR=0.85, 95% CI, 0.75-0.96) among general population. Similar associations were observed in subsequent sensitivity analyses. The subgroup analysis showed that the relationship between HPA and reduced mortality risk was only found in the women with insufficient LTPA group.Conclusion: This study confirmed that sufficient LTPA is associated with a lower risk of all-cause mortality. If sufficient LTPA cannot be performed, additional HPA is related to lower mortality.

著者

Naomi Matsumoto Junya Shimizu Yuji Yokoyama Hirokazu Tsukahara Takashi Yorifuji

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220265, (Released:2022-10-29)

参考文献数

6

被引用文献数

2

著者

Noriko Kaneko Yoshikazu Nishino Yuri Ito Tomoki Nakaya Seiki Kanemura

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220066, (Released:2022-07-16)

参考文献数

35

被引用文献数

1

---

Background: Previous studies have shown that socioeconomic factors are associated with cancer incidence and stage at diagnosis; however, relevant findings in Japan are limited. We examined the association between socioeconomic status and cancer incidence, stage at diagnosis, and detection status by screening, as assessed by the areal deprivation index (ADI), using population-based cancer registry data.Methods: A total of 79,816 cases including stomach, colorectal, lung, female breast, and cervical cancer diagnosed in Miyagi Prefecture between 2005 and 2010 were analyzed. After calculating the ADI at the place of residence in each case, we examined the association between quintiles of ADI and age-adjusted incidence rates of all stages and advanced stages by sex and site using Poisson regression analysis. The association between the ADI and the proportion of screen-detected cancers was also examined using logistic regression analysis.Results: The age-adjusted incidence rates of all sites and lung cancer in men and lung cancer and cervical cancer in women tended to increase significantly in areas with a higher ADI. The age-adjusted incidence rates of advanced-stage cancers were significantly higher for all sites and lung cancer in both sexes, and stomach and colorectal cancer in men. The proportion of screen-detected cancer tended to be significantly lower in areas with a higher ADI for stomach and colorectal cancer in men.Conclusion: Our results indicate that socioeconomic disparities may affect cancer incidence and early diagnosis in Japan. These results suggest the importance of cancer control measures targeting people with low socioeconomic status in Japan.

著者

Yoshihide Kinjo Valerie Beral Suminori Akiba Tim Key Shoichi Mizuno Paul Appleby Naohito Yamaguchi Shaw Watanabe Richard Doll

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.9, no.4, pp.268-274, 1999 (Released:2007-11-30)

参考文献数

29

被引用文献数

46 58

---

Cerebrovascular disease was a leading cause of death from 1955 to 1980 in Japan. The mortality rate from this disease has decreased sharply in recent decades. This downward trend seems to correspond to the dietary habits of Japanese. Data from a large prospective cohort study were analyzed to examine the association between dietary habits and cerebrovascular disease mortality in Japan. The subjects for this analysis were 223, 170 men and women aged 40 to 69 at baseline in December 1965. There were 6, 168 deaths in men and 4, 862 deaths in women due to cerebrovascular disease (ICD7: 330-334) during the follow-up period from January 1966 to December 1981. Rate ratio (RR) and 95% confidence interval (95%Cl) adjusted for sex, attained age, follow-up period, prefecture, cigarette smoking, alcohol drinking and occupation was used for comparison. In this study, the risk of mortality from cerebrovascular disease was inversely associated with dairy milk, meat and fish consumption. Therefore the joint effect of dairy milk, meat and fish (DMF) as animal fat and protein was of interest. In the binary analysis, DMF (D, M, F) means the combination of dairy milk (1-3 times/week or more), meat (1-3 times/week or more) and fish (4 times/week or more). Thus DMF (d, m, f) was the reference group having dairy milk (less than 1 time/week), meat (less than 1 time/week) and fish (less than 4 times/week). For the disease, the RR of DMF (D, M, F) was 0.68 with 95%CI of 0.63 to 0.74, relative to the reference group. Furthermore the joint effect of DMF was more strongly associated with cerebral haemorrhage (ICD7: 331, DMF (D, M, F); RR: 0.63, 95%Cl: 0.55-0.70) than with cerebral embolism and thrombosis (ICD7: 332, DMF (D, M, F); RR: 0.79, 95%Cl: 0.70- 0.89). These findings suggest that the increasing intake of animal fat and/or protein may have played a key role in reducing cerebrovascular disease in Japan. J Epidemiol, 1999 ; 9 : 268-274.

著者

Soichiro Saeki

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220166, (Released:2022-06-18)

参考文献数

4

被引用文献数

2

著者

Soichiro Saeki

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220141, (Released:2022-06-18)

参考文献数

6

被引用文献数

8

著者

Takashi Yoshioka Yohei Maeda

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.30, no.8, pp.372-373, 2020-08-05 (Released:2020-08-05)

参考文献数

7

被引用文献数

11 28

著者

Masaru Sakurai Junji Kobayashi Yasuo Takeda Shin-Ya Nagasawa Junichi Yamakawa Junji Moriya Hiroshi Mabuchi Hideaki Nakagawa

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.26, no.8, pp.440-446, 2016-08-05 (Released:2016-08-05)

参考文献数

31

被引用文献数

14 20

---

Aims: The present study aimed to investigate relationships among abdominal obesity, metabolic abnormalities, and the prevalence of chronic kidney disease (CKD) in relatively lean Japanese men and women.Participants and methods: The participants included 8133 men and 15 934 women between 40 and 75 years of age recruited from the government health check-up center in Kanazawa City, Japan. The prevalence of abdominal obesity, high blood pressure, dyslipidemia, and high fasting plasma glucose levels were assessed according to the Japanese criteria for metabolic syndrome. The estimated glomerular filtration rate (eGFR) was calculated using the modified Modification of Diet in Renal Disease equation for the Japanese population, and participants with an eGFR <60 mL/min/1.73 m2 and/or proteinuria were diagnosed with CKD.Results: Overall, 23% of males and 14% of females met criteria for CKD. Having more numerous complicated metabolic abnormalities was significantly associated with a higher odds ratio (OR) of CKD for men and women, irrespective of abdominal obesity. However, there was a sex difference in the OR of CKD for obese participants without metabolic abnormalities, such that abdominal obesity without metabolic abnormalities was significantly associated with a higher OR for men (multivariate-adjusted OR 1.63; 95% confidence interval [CI], 1.16–2.28) but not for women (OR 1.01; 95% CI, 0.71–1.44).Conclusions: The present findings demonstrated that obesity without metabolic abnormalities was associated with a higher risk of CKD in men but not women in a relatively lean Japanese population.

著者

Toshiyuki Ojima

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.4, no.3, pp.121-128, 1994 (Released:2007-11-30)

参考文献数

12

被引用文献数

2 2

---

To refer to municipal governments employing public health nurses (PHNs), the relationship between the number of PHNs and accomplishment in health care programs was observed. Data regarding accomplishment in health care programs were obtained by a nationwide questionnaire survey sent to all of the municipal governments (cities, towns, and villages). Of the 3, 268 governments, 2, 800 ones or 86% responded the survey. Population sizes and standardized mortality ratios for major causes of death of municipalities were obtained from the Wide-area Information-exchange System for Health and welfare administration (WISH). Results were as follows : The correlation coefficient between the ratios of PHNs and participation rates to stomach cancer examination was 0.63. The correlations were significant and strong in the program achievement of the following ; tracking of non-examinees, registration of stroke patients, activities of local community organizations, participation rates to basic health examination, stomach cancer examination, cervical cancer examination, health education, health counseling, and rehabilitation programs. The results suggest that the number of PHNs in a municipality is one of the important factors to obtain effective achievement of health care programs. Using regression models the author estimated that 1.96-2.72 PHNs per 10, 000 population are required to achieve the target participation rates organized by the Japanese Government. J Epidemioi, 1994; 4 : 121-128.

著者

Hirokazu Tanaka Johan P. Mackenbach Yasuki Kobayashi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20210106, (Released:2021-10-09)

参考文献数

28

被引用文献数

4

---

Background: We aimed to develop census-linked longitudinal mortality data for Japan and assess its validity as a new resource for estimating socioeconomic inequalities in health.Methods: Using deterministic linkage, we identified, from national censuses for 2000 and 2010 and national death records, persons and deceased persons who had unique personal identifiers (generated using sex, birth year/month, address, and marital status). For the period 2010–2015, 1 537 337 Japanese men and women aged 30–79 years (1.9% in national census) were extracted to represent the sample population. This population was weighted to adjust for confounding factors. We estimated age-standardized mortality rates (ASMRs) by education level and occupational class. The slope index of inequality (SII) and relative index inequality (RII) by educational level were calculated as inequality measures.Results: The reweighted sample population’s mortality rates were somewhat higher than those of the complete registry, especially in younger age-groups and for external causes. All-cause ASMRs (per 100 000 person-years) for individuals aged 40–79 years with high, middle, and low education levels were 1078 (95% confidence interval: 1051–1105), 1299 (1279–1320), and 1670 (1634–1707) for men, and 561 (536–587), 601 (589–613), and 777 (745–808) for women, respectively, during 2010–2015. SII and RII by educational level increased among both sexes between 2000–2005 and 2010–2015, which indicates mortality inequalities increased.Conclusions: The developed census-linked longitudinal mortality data provide new estimates of socioeconomic inequalities in Japan that can be triangulated with estimates obtained with other methods.

著者

Wang Chao Jiang Heng Zhu Yi Guo Yingying Gan Yong Tian Qingfeng Lou Yiling Cao Shiyi Lu Zuxun

出版者

日本疫学会

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

2021

被引用文献数

2

---

<p><b>Background:</b> Increasing number of studies has suggested the time to first cigarette after waking (TTFC) have significant positive effect on respiratory diseases. However, few of them are focused on Chinese population. This study aims to estimate the impact of TTFC on the prevalence of chronic respiratory diseases (CRD) in Chinese elderly and explore the association in different sub-populations.</p><p><b>Methods:</b> Cross-sectional data of demographic characteristics, living environment, smoking-related variables, and CRD were drawn from the Chinese Longitudinal Healthy Longevity Survey in 2018. Multivariate stepwise logistic regression analyses were conducted to examine the association of the TTFC with the prevalence of CRD.</p><p><b>Results:</b> This study includes 13208 subjects aged 52 years and older, with a mean age of 85.3 years. Of them, 3779 participants are ex- or current smokers (44.9% had the TTFC ≤30 minutes, 55.1% >30 minutes) and 1503 have suffered from CRD. Compared with non-smokers, participants with TTFC ≤30 minutes seemed to have higher prevalence of CRD (OR 1.97; 95% CI, 1.65-2.35) than those with TTFC >30 minutes (OR 1.70; 95% CI, 1.44-2.00), although the difference was statistically insignificant (<i>P_interaction</i>=0.12). Compared with TTFC >30 minutes, TTFC ≤30 minutes could drive a higher prevalence of CRD among female participants, those aged 90 years and older, urban residents, and those ex-smokers (<i>P_interaction</i><0.05).</p><p><b>Conclusions:</b> Shorter TTFC relates to higher prevalences of CRD in Chinese older females, those aged 90 years and older, urban residents, and ex-smokers. Delaying TTFC might particially reduce its detrimental impact on respiratory disease in these specific subpopulations.</p>

著者

Soichiro Saeki Kaori Minamitani Isao Muraki Tomoko Shingaki Koji Nagura Ken Nakata Hiroyasu Iso

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20210288, (Released:2021-11-06)

参考文献数

7

被引用文献数

11

著者

Yuri Yaguchi-Tanaka Takahiro Tabuchi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.7, pp.417-425, 2021-07-05 (Released:2021-07-05)

参考文献数

34

被引用文献数

2 8

---

Background: Few longitudinal studies have examined the association between skipping breakfast and overweight/obesity in pre-elementary school children. Furthermore, this association may differ between boys and girls. The main objective of this study was to assess whether skipping breakfast in early childhood was associated with later incidence of overweight/obesity, with stratification by gender, using data on children aged 2.5 to 13 years old in The Longitudinal Survey of Newborns in the 21st century.Methods: We examined the associations between skipping breakfast at 2.5 years old and overweight/obesity at 2.5 (n = 34,649), 4.5 (n = 35,472), 7 (n = 31,266), 10 (n = 31,211), and 13 (n = 28,772) years old. To estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of overweight/obesity by each age (2.5, 4.5, 7, 10, and 13 years), a multivariate logistic regression was used adjusting for time-invariant and time-varying covariates.Results: At the age of 2.5 years, 11.0% of boys and 12.2% of girls were skipping breakfast. In fully adjusted models, skipping breakfast at 2.5 years old was not significantly associated with overweight/obesity at 2.5 and 4.5 years old, but was significantly associated with overweight/obesity at 7 and 10 years old, in both sexes. Skipping breakfast at 2.5 years old was significantly associated with overweight/obesity at 13 years old in boys (OR 1.38; 95% CI, 1.17–1.62), but not in girls (OR 1.21; 95% CI, 0.98–1.49).Conclusions: Skipping breakfast in early childhood increased overweight/obesity in later childhood, but there may be gender differences in the association.

著者

Masao Ichikawa Haruhiko Inada Ai Hori Takahiro Tabuchi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.7, pp.451-452, 2021-07-05 (Released:2021-07-05)

参考文献数

3

被引用文献数

2

著者

TOHYAMA Eiichi

出版者

日本疫学会

雑誌

Journal of epidemiology (ISSN:09175040)

巻号頁・発行日

vol.6, no.4, pp.184-191, 1996-12

参考文献数

46

被引用文献数

16

---

The Okinawa Islands located in the southern-most part of Japan were under U.S.administration from 1945 to 1972. During that time, fluoride was added to the drinking water supplies in most regions. The relationship between fluoride concentration in drinking water and uterine cancer mortality rate was studied in 20 municipalities of Okinawa and the data were analyzed using correlation and multivariate statistics. The main findings were as follows.<br>(1) A significant positive correlation was found between fluoride concentration in drinking water and uterine cancer mortality in 20 municipalities (r=0.626, p<0.005).<br>(2) Even after adjusting for the potential confounding variables, such as tap water diffusion rate, primary industry population ratio, income gap, stillbirth rate, divorce rate, this association was considerably significant.<br>(3) Furthermore, the time trends in the uterine cancer mortality rate appear to be related to changes in water fluoridation practices. <i>J Epidemiol</i>, 1996 ; 6 : 184-191.