著者

Tomohiro Shinozaki Etsuji Suzuki

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200226, (Released:2020-07-18)

参考文献数

84

被引用文献数

20

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Epidemiologists are increasingly encountering complex longitudinal data, in which exposures and their confounders vary during follow-up. When a prior exposure affects the confounders of the subsequent exposures, estimating the effects of the time-varying exposures requires special statistical techniques, possibly with structural (i.e., counterfactual) models for targeted effects, even if all confounders are accurately measured. Among the methods used to estimate such effects, which can be cast as a marginal structural model in a straightforward way, one popular approach is inverse probability weighting. Despite the seemingly intuitive theory and easy-to-implement software, misunderstandings (or “pitfalls”) remain. For example, one may mistakenly equate marginal structural models with inverse probability weighting, failing to distinguish a marginal structural model encoding the causal parameters of interest from a nuisance model for exposure probability, and thereby failing to separate the problems of variable selection and model specification for these distinct models. Assuming the causal parameters of interest are identified given the study design and measurements, we provide a step-by-step illustration of generalized computation of standardization (called the g-formula) and inverse probability weighting, as well as the specification of marginal structural models, particularly for time-varying exposures. We use a novel hypothetical example, which allows us access to typically hidden potential outcomes. This illustration provides steppingstones (or “tips”) to understand more concretely the estimation of the effects of complex time-varying exposures.

著者

Keisuke Kuwahara Toru Honda Tohru Nakagawa Shuichiro Yamamoto Takeshi Hayashi Tetsuya Mizoue

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.28, no.2, pp.94-98, 2018-02-05 (Released:2018-02-05)

参考文献数

24

被引用文献数

6 11

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Background: Data on the effect of physical activity intensity on depression is scarce. We investigated the prospective association between intensity of leisure-time exercise and risk of depressive symptoms among Japanese workers.Methods: The participants were 29,052 employees (24,653 men and 4,399 women) aged 20 to 64 years without psychiatric disease including depressive symptoms at health checkup in 2006–2007 and were followed up until 2014–2015. Details of leisure-time exercise were ascertained via a questionnaire. Depressive states were assessed using a 13-item questionnaire. Multivariable-adjusted hazard ratio of depressive symptoms was estimated using Cox regression analysis.Results: During a mean follow-up of 5.8 years with 168,203 person-years, 6,847 workers developed depressive symptoms. Compared with workers who engaged in no exercise during leisure-time (0 MET-hours per week), hazard ratios (95% confidence intervals) associated with >0 to <7.5, 7.5 to <15.0, and ≥15.0 MET-hours of leisure-time exercise were 0.88 (0.82–0.94), 0.85 (0.76–0.94), and 0.78 (0.68–0.88) among workers who engaged in moderate-intensity exercise alone; 0.93 (0.82–1.06), 0.82 (0.68–0.98), and 0.83 (0.71–0.98) among workers who engaged in vigorous-intensity exercise alone; and 0.96 (0.80–1.15), 0.80 (0.67–0.95), and 0.76 (0.66–0.87) among workers who engaged in both moderate- and vigorous-intensity exercise with adjustment for age, sex, lifestyles, work-related and socioeconomic factors, and body mass index. Additional adjustment for baseline depression score attenuated the inverse association, especially among those who engaged in moderate-intensity exercise alone.Conclusions: The results suggest that vigorous-intensity exercise alone or vigorous-intensity combined with moderate-intensity exercise would prevent depressive symptoms among Japanese workers.

著者

Wakaba Fukushima Megumi Hara Yuri Kitamura Masahiko Shibata Yoshikazu Ugawa Koichi Hirata Akira Oka Shinya Miyamoto Susumu Kusunoki Satoshi Kuwabara Shuji Hashimoto Tomotaka Sobue

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.32, no.1, pp.34-43, 2022-01-05 (Released:2022-01-05)

参考文献数

50

被引用文献数

8

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Background: Since June 2013, Japan has suspended proactive recommendation of human papillomavirus (HPV) vaccination due to self-reported diverse symptoms, including pain and motor dysfunction, as possible serious adverse events following immunization. Although these symptoms may be seen in adolescents without HPV vaccination, their frequency, taking into account disease severity, has not been examined.Methods: A two-stage, descriptive, nationwide epidemiological survey was conducted in 2016, with a 6-month target period from July 1 to December 31, 2015, to estimate the prevalence and incidence of diverse symptoms among Japanese adolescents without HPV vaccination. Participants were 11,037 medical departments in hospitals selected nationwide by stratified random sampling. Eligible patients had to satisfy four criteria: (1) aged 12–18 years upon visiting hospital; (2) having at least one of four symptoms/disorders (pain or sensory dysfunction, motor dysfunction, autonomic dysfunction, or cognitive impairment); (3) symptoms/disorders persisting for at least 3 months; and (4) both criteria (2) and (3) influence attendance at school or work. We then extracted data of patients with diverse symptoms similar to those after HPV vaccination while considering opinions of doctors in charge.Results: Estimated 6-month period prevalence of diverse symptoms among girls aged 12–18 years without HPV vaccination was 20.2 per 100,000. Annual incidence was estimated to be 7.3 per 100,000.Conclusion: Adolescent Japanese girls without HPV vaccination also visited hospitals with diverse symptoms similar to those following HPV vaccination. Our findings predict the medical demands for coincident diverse symptoms, which are temporally associated with but not caused by HPV vaccination of Japanese adolescents.

著者

Satoshi Seino Yu Nofuji Yuri Yokoyama Takumi Abe Mariko Nishi Mari Yamashita Miki Narita Toshiki Hata Shoji Shinkai Akihiko Kitamura Yoshinori Fujiwara

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20210392, (Released:2021-12-18)

参考文献数

47

被引用文献数

10

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Background: This 3.6-year prospective study examined combined impacts of physical activity, dietary variety, and social interaction on incident disability and estimated population-attributable fraction for disability reduction in older adults.Methods: Participants were 7,822 initially non-disabled residents (3,966 men and 3,856 women) aged 65–84 years of Ota City, Tokyo, Japan. Sufficiency of moderate-to-vigorous-intensity physical activity (MVPA) ≥150 min/week, dietary variety score (DVS) ≥3 (median), and social interaction (face-to-face and/or non-face-to-face) ≥1 time/week was assessed using self-administered questionnaires. Disability incidence was prospectively identified using the long-term care insurance system’s nationally unified database.Results: During a follow-up of 3.6 years, 1,046 (13.4%) individuals had disabilities. Independent multivariate-hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA, DVS, and social interaction sufficiency for incident disability were 0.68 (95% CI, 0.59–0.78), 0.87 (95% CI, 0.77–0.99), and 0.90 (95% CI, 0.79–1.03), respectively. Incident disability HRs gradually reduced with increased frequency of satisfying these behaviors (any one: HR 0.82; 95% CI, 0.65–1.03; any two: HR 0.65; 95% CI, 0.52–0.82; and all three behaviors: HR 0.54; 95% CI, 0.43–0.69), in an inverse dose-response manner (P < 0.001 for trend). Population-attributable fraction for disability reduction in satisfying any one, any two, and all three behaviors were 4.0% (95% CI, −0.2 to 7.9%), 9.6% (95% CI, 4.8–14.1%), and 16.0% (95% CI, 8.7–22.8%), respectively.Conclusion: Combining physical activity, dietary variety, and social interaction substantially enhances the impacts on preventing disability among older adults, with evidence of an inverse dose-response manner. Improving insufficient behavior elements through individual habits and preexisting social group activities may be effective in preventing disability in the community.

著者

Tami Saito Tuula Oksanen Kokoro Shirai Takeo Fujiwara Jaana Pentti Jussi Vahtera

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20190061, (Released:2019-09-07)

参考文献数

36

被引用文献数

3

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Background: While marriage and education help maintain older adults’ health, their joint association with mortality remains unclear. This cross-national study examined the combined effect of marriage and education on the mortality of older Japanese and Finnish adults.Methods: Data on 22,415 Japanese and 11,993 Finnish adults, aged 65–74 years, were obtained from the Japan Gerontological Evaluation Study of 2010–2012 and the Finnish Public Sector Study of 2008–2009 and 2012–2013. We followed up on respondents’ survival status for 5 years using public records. Marital status, educational level, and other variables in both datasets were harmonized.Results: The Cox proportional hazards model showed that unmarried men had a higher mortality risk than married men in both countries (hazard ratio [HR] 1.47; 95% confidence interval [CI], 1.21–1.79 for Japanese and HR 1.94; 95% CI, 1.29–2.91 for Finnish); no such difference was observed in women. The highest mortality risk was observed in unmarried men with tertiary education in both Japan (HR 1.85; 95% CI, 1.21–2.83) and Finland (HR 2.21; 95% CI, 1.26–3.89), when adjusted for baseline age, health-related behaviors, and illnesses.Conclusions: Our findings showed similarity in the combined effect of marriage and education between Japan and Finland, differing from observations in countries with more apparent socioeconomic health disparities. Further studies should examine the reasons for the excessive mortality risk in highly educated, unmarried men in both countries and consider whether selection bias led to underestimation of the true risk in unmarried older adults with lower education.

著者

Silvano GALLUS Alessandra LUGO Xiaoqiu LIU Panagiotis BEHRAKIS Roberto BOFFI Cristina BOSETTI Giulia CARRERAS Liliane CHATENOUD Luke CLANCY Xavier CONTINENTE Ruaraidh DOBSON Tobias EFFERTZ Filippos T. FILIPPIDIS Marcela FU Gergana GESHANOVA Giuseppe GORINI Sheila KEOGAN Hristo IVANOV Maria-José LOPEZ Angel LOPEZ-NICOLAS José PRECIOSO Krzysztof PRZEWOZNIAK Cornel RADU-LOGHIN Ario RUPRECHT Sean SEMPLE Joan B SORIANO Polina STARCHENKO Marta TRAPERO-BERTRAN Olena TIGOVA Anna S TZORTZI Constantine VARDAVAS Vergina K VYZIKIDOU Paolo COLOMBO Esteve FERNANDEZ the TackSHS Project Investigators

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20190344, (Released:2020-04-04)

参考文献数

35

被引用文献数

51

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Background: Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries.Methods: Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017-2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of 11,902 participants.Results: Overall 25.9% of participants were current smokers (31.0% among men and 21.2% among women, p<0.001), while 16.5% were former smokers. Smoking prevalence ranged from 18.9% in Italy to 37.0% in Bulgaria. It decreased with increasing age (compared to <45, multivariable odds ratio, OR, for ≥65 years was 0.31; 95% confidence interval, CI: 0.27-0.36), level of education (OR for low vs. high was 1.32; 95% CI: 1.17-1.48) and self-rated household economic level (OR for low vs. high was 2.05; 95% CI: 1.74-2.42). The same patterns were found in both sexes.Conclusions: These smoking prevalence estimates represent the most up-to-date evidence in Europe. From them it can be derived that there are more than 112 million current smokers in the EU-28. Lower socio-economic status is a major determinant of smoking habit in both sexes.

著者

Tatsuya Takahashi Minouk Schoemaker Klaus Trott Steven Simon Keisei Fujimori Noriaki Nakashima Akira Fukao Hiroshi Saito

出版者

日本疫学会

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.13, no.2, pp.99-107, 2003 (Released:2007-11-30)

参考文献数

23

被引用文献数

18 42

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The US nuclear weapons testing program in the Pacific conducted between 1946 and 1958 resulted in radiation exposure in the Marshall Islands. The potentially widespread radiation exposure from radioiodines of fallout has raised concerns about the risk of thyroid cancer in the Marshallese population. The most serious exposures and its health hazards resulted from the hydrogen-thermonuclear bomb test, the Castle BRAVO, on March 1, 1954. Between 1993 and 1997, we screened 3, 709 Marshallese for thyroid disease who were born before the BRAVO test. It was 60% of the entire population at risk and who were still alive at the time of our examinations. We diagnosed 30 thyroid cancers and found 27 other study participants who had been operated for thyroid cancer before our screening in this group. Fifty-seven Marshallese born before 1954 (1.5%) had thyroid cancer or had been operated for thyroid cancer. Nearly all (92%) of these cancers were papillary carcinoma. We derived estimates of individual thyroid dose proxy from the BRAVO test in 1954 on the basis of published age-specific doses estimated on Utirik atoll and 137Cs deposition levels on the atolls where the participants came from. There was suggestive evidence that the prevalence of thyroid cancer increased with category of estimated dose to the thyroid. J Epidemiol2003;13:99-107.

著者

Mikio Nakajima Yohei Okada Tomohiro Sonoo Tadahiro Goto

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220147, (Released:2022-07-16)

参考文献数

15

被引用文献数

14

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Background: The Japan Coma Scale (JCS) is the most frequently adopted method for evaluating level of consciousness in Japan. However, no validated method for converting the JCS to Glasgow Coma Scale (GCS) exists. The aims of the present study were to develop and validate a method to convert the JCS to GCS.Methods: This is a multicenter retrospective cohort study involving three emergency departments (EDs) in Japan. We included all adult patients who visited the ED between 2017 and 2020. The participating facilities were divided into two cohorts—one cohort to develop a table to convert the JCS to GCS (development cohort), and the other cohort to validate the conversion table (validation cohort). The conversion table of the JCS to GCS was developed based on the median values of the GCS. The outcome was the concordance rate between the JCS and GCS.Results: We identified 8,194 eligible patients. The development cohort included 7,373 patients and the validation cohort included 821 patients. In the validation cohort, the absolute and relative concordance rates were 80.3% (95% confidence interval, 77.4–82.9%) and 93.2% (95% confidence interval, 91.2–94.8%), respectively.Conclusions: This study developed and validated a novel method for converting the JCS to GCS. Assuming the offset by a single category between the JCS and GCS is acceptable, the concordance rate was over 90% in the general adult patient population visiting the ED. The conversion method may assist researchers to convert JCS into GCS, which is more commonly recognized among global audiences.

著者

Kazuki Ide Philip Hawke Takeo Nakayama

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20230030, (Released:2023-04-08)

参考文献数

9

被引用文献数

8

著者

Kei Hayashi Ichiro Kawachi Tetsuya Ohira Katsunori Kondo Kokoro Shirai Naoki Kondo

出版者

日本疫学会

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.26, no.10, pp.546-552, 2016-10-05 (Released:2016-10-05)

参考文献数

32

被引用文献数

41

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Background: We sought to evaluate the associations between frequency of daily laughter with heart disease and stroke among community-dwelling older Japanese women and men.Methods: We analyzed cross-sectional data in 20 934 individuals (10 206 men and 10 728 women) aged 65 years or older, who participated in the Japan Gerontological Evaluation Study in 2013. In the mail-in survey, participants provided information on daily frequency of laughter, as well as body mass index, demographic and lifestyle factors, and diagnoses of cardiovascular disease, hyperlipidemia, hypertension, and depression.Results: Even after adjustment for hyperlipidemia, hypertension, depression, body mass index, and other risk factors, the prevalence of heart diseases among those who never or almost never laughed was 1.21 (95% CI, −1.03–1.41) times higher than those who reported laughing every day. The adjusted prevalence ratio for stroke was 1.60 (95% CI, 1.24–2.06).Conclusions: Daily frequency of laughter is associated with lower prevalence of cardiovascular diseases. The association could not be explained by confounding factors, such as depressive symptoms.

著者

Zhongyu Ren Cong Huang Haruki Momma Yufei Cui Kaijun Niu Shota Sugiyama Masakazu Nanno Ryoichi Nagatomi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20170029, (Released:2018-04-21)

参考文献数

31

被引用文献数

5

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Background: There is scarce epidemiological evidence regarding the relationships of the consumption of different types of vegetables or fruits with change in skeletal muscle strength. We prospectively examined the relationships among Japanese adults, using handgrip strength to assess skeletal muscle strength.Methods: A 3-year study was carried out with 259 Japanese adults who were 22–68 years of age. The frequency of consumption of different types of vegetables or fruits were obtained using a validated self-administered dietary history questionnaire. Handgrip strength was measured with a handheld digital Smedley dynamometer.Results: After adjustment for confounding factors, the mean change in handgrip strength in participants stratified according to the level of tomato and tomato product consumption at baseline were −3.2 (95% confidence interval [CI], −4.0 to −2.3) for <1 time/week, −2.7 (95% CI, −3.6 to −1.8) for 1 time/week, −1.6 (95% CI, −2.5 to −0.8) for 2–3 times/week, and −1.7 (95% CI, −2.8 to −0.7) for ≥4 times/week, (P for trend = 0.022). However, the significant relationships of consumption of other types of vegetables and different types of fruits with change in handgrip strength were not observed.Conclusion: Higher consumption of tomato and tomato product at baseline was significantly associated with reduced decline in handgrip strength among Japanese adults over a 3-year follow-up period. This study suggests that consumption of tomato and tomato product could be protective against the decline in skeletal muscle strength associated with aging.

著者

Noriko Cable

出版者

日本疫学会

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20140045, (Released:2014-07-12)

参考文献数

40

被引用文献数

3 26

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The application of the life course approach to social epidemiology has helped epidemiologists theoretically examine social gradients in population health. Longitudinal data with rich contextual information collected repeatedly and advanced statistical approaches have made this challenging task easier. This review paper provides an overview of the life course approach in epidemiology, its research application, and future challenges. In summary, a systematic approach to methods, including theoretically guided measurement of socioeconomic position, would assist researchers in gathering evidence for reducing social gradients in health, and collaboration across individual disciplines will make this task achievable.

著者

Soichiro Saeki Misa Kusumoto

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220244, (Released:2022-10-15)

参考文献数

9

被引用文献数

2

著者

Naho Morisaki Taku Obara Aurelie Piedvache Sumitaka Kobayashi Chihiro Miyashita Tomoko Nishimura Mami Ishikuro Fumihiro Sata Reiko Horikawa Chisato Mori Hirohito Metoki Kenji J Tsuchiya Shinichi Kuriyama Reiko Kishi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220076, (Released:2022-08-06)

参考文献数

35

被引用文献数

7

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Background: Recent literature suggest the effect of maternal smoking on risk of hypertensive disorders in pregnancy (HDP) and preeclampsia may differ by ethnicity, however studies on Asians are limited.Methods: We investigated the association between maternal smoking and HDP and preeclampsia, by using a common analysis protocol to analyze the association in six birth cohorts participating in a Japanese consortium of birth cohorts (JBiCC). Results were compared with published results from cohorts not included in this consortium, and where possible produced a meta-analysis including these studies.Results: Meta-analysis of four cohort studies including 28,219 participants produced an odds ratio (OR) of 1.24 (95% confidence interval (CI) 0.88-1.87) for effect of smoking beyond early pregnancy compared to women who did not smoke during pregnancy. These results combined with those from the Japan Environment and Children’s Study (JECS) yielded an OR of 1.19 (95%CI 1.00-1.43, p=0.056). Meta-analysis results for categories of smoking volume were insignificant, but when combined with JECS yielded an OR of 0.86 (95%CI 0.65-1.12) for smoking 1-4 cigarettes, 1.25 (95%CI 0.98-1.60) for smoking 5-9 cigarettes, and 1.27 (95%CI 1.04-1.54) for smoking 10 or more cigarettes per day. All effects were insignificant for preeclampsia.Conclusion: Our results suggest the protective effect of smoking longer, smoking more on HDP and preeclampsia repeatedly observed among Europeans and North Americans likely do not hold for the Japanese.

著者

Silvano Gallus Cristina Bosetti Giuseppe Gorini Chiara Stival Roberto Boffi Alessandra Lugo Giulia Carreras Chiara Veronese Claudia Santucci Roberta Pacifici Biagio Tinghino Vincenzo Zagà Patrizia Russo Maria Sofia Cattaruzza the COSMO-IT Investigators

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220321, (Released:2023-02-25)

参考文献数

24

被引用文献数

5

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Background. Despite the robust evidence of an excess risk of COVID-19 severity and mortality in ever smokers, the debate on the role of current and ex-smokers on COVID-19 progression remains open. Limited or no data are available on the link between electronic-cigarette (e-cigarette), heated tobacco product (HTP) and second-hand-smoke (SHS) exposure and COVID-19 progression. To fill this knowledge gap, we undertook the COvid19 and SMOking in ITaly (COSMO-IT) study.Methods. A multi-centre longitudinal study was conducted in 2020-2021 in 24 Italian hospitals on a total of 1820 laboratory-confirmed COVID-19 patients. We estimated multivariable odds ratios (OR) and 95% confidence intervals (CI), to quantify the association between smoking-related behaviours (i.e., smoking status, e-cigarette and HTP use, and SHS exposure) and COVID-19 severity (composite outcome: intubation, intensive care unit admission and death), and mortality.Results. Compared to never smokers, current smokers had an increased risk of COVID-19 mortality (OR=2.17; 95% CI=1.06-4.41). E-cigarette use was non-significantly associated to an increased risk of COVID-19 severity (OR=1.60; 95% CI=0.96-2.67). An increased risk of mortality was observed for exposure to SHS among non-smokers (OR=1.67; 95% CI=1.04-2.68), the risk being particularly evident for exposures of ≥6 hours/day (OR=1.99; 95% CI=1.15-3.44).Conclusions. This multicentric study from Italy shows a dismal COVID-19 progression in current smokers and, for the first time, in SHS exposed non-smokers. These data represent an additional reason to strengthen and enforce effective tobacco control measures and to support smokers in quitting.

著者

Susumu Yagome Takehiro Sugiyama Kosuke Inoue Ataru Igarashi Ryotaro Bouchi Mitsuru Ohsugi Kohjiro Ueki Atsushi Goto

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220032, (Released:2022-06-11)

参考文献数

25

被引用文献数

11

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Background: Regular visits with healthcare professionals are important for preventing serious complications in patients with diabetes. The purpose of this retrospective cohort study was to clarify whether there was any suppression of physician visits among patients with diabetes during the spread of the novel coronavirus 2019 (COVID-19) in Japan and to assess whether telemedicine contributed to continued visits.Methods: We used the JMDC Claims database, which contains the monthly claims reported from July 2018 to May 2020 and included 4,595 (type 1) and 123,686 (type 2) patients with diabetes. Using a difference-in-differences analysis, we estimated the changes in the monthly numbers of physician visits or telemedicine per 100 patients in April and May 2020 compared with the same months in 2019.Results: For patients with type 1 diabetes, the estimates for total overall physician visits were −2.53 (95% confidence interval [CI], −4.63 to 0.44) in April and −8.80 (95% CI, −10.85 to −6.74) in May; those for telemedicine visits were 0.71 (95% CI, 0.47–0.96) in April and 0.54 (95% CI, 0.32–0.76) in May. For patients with type 2 diabetes, the estimates for overall physician visits were −2.50 (95% CI, −2.95 to −2.04) in April and −3.74 (95% CI, −4.16 to −3.32) in May; those for telemedicine visits were 1.13 (95% CI, 1.07–1.20) in April and 0.73 (95% CI, 0.68–0.78) in May.Conclusion: The COVID-19 pandemic was associated with suppression of physician visits and a slight increase in the utilization of telemedicine among patients with diabetes during April and May 2020.

著者

Shinichi Kuriyama Naoki Nakaya Kaori Ohmori-Matsuda Taichi Shimazu Nobutaka Kikuchi Masako Kakizaki Toshimasa Sone Fumi Sato Masato Nagai Yumi Sugawara Yasutake Tomata Munira Akhter Mizuka Higashiguchi Naru Fukuchi Hideko Takahashi Atsushi Hozawa Ichiro Tsuji

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.20, no.3, pp.253-258, 2010-05-05 (Released:2010-05-05)

参考文献数

27

被引用文献数

38 62

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Background: Large-scale cohort studies conducted in Japan do not always include psychosocial factors as exposures. In addition, such studies sometimes fail to satisfactorily evaluate disability status as an outcome.Methods: This prospective cohort study comprised 49 603 (22 438 men and 27 165 women) community-dwelling adults aged 40 years or older who were included in the Residential Registry for Ohsaki City, Miyagi Prefecture, in northeastern Japan. The baseline survey, which included psychosocial factors, was conducted in December 2006. Follow-up of death, immigration, cause of death, cancer incidence, and long-term care insurance certification was started on 1 January 2007.Results: The response rate was 64.2%. In general, lifestyle-related conditions in the study population were similar to those of the general Japanese population; however, the proportion of male current smokers was higher in the cohort. The association between age and the proportion of those reporting psychological distress showed a clear U-shaped curve, with a nadir at age 60 to 69 years in both men and women, although more women were affected by such distress than men. The proportion of those who reported a lack of social support was highest among those aged 40 to 49 years. Most men and women surveyed did not participate in community activities. Among participants aged 65 years or older, 10.9% of participants were certified beneficiaries of the long-term care insurance system at baseline.Conclusions: The Ohsaki Cohort 2006 Study is a novel population-based prospective cohort study that focuses on psychosocial factors and long-term care insurance certification.

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

30

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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

Thi Tra Bui Minji Han Ngoc Minh Luu Thi Phuong Thao Tran Min Kyung Lim Jin-Kyoung Oh

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220175, (Released:2022-11-26)

参考文献数

41

被引用文献数

2

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BackgroundAlcohol drinking behaviors change temporally and can lead to changes in related cancer risks; previous studies have been unable to identify the association between the two using a single-measurement approach. Thus, this study aimed to investigate the association of drinking trajectories with the cancer risk in Korean men.MethodsA trajectory analysis using group-based trajectory modeling was performed on 2,839,332 men using data on alcohol drinking levels collected thrice during the Korean National Health Insurance Service’s general health screening program conducted between 2002 and 2007. Cox proportional hazards regression was performed to evaluate the associations between drinking trajectories and cancer incidence, after adjustments for age, income, body mass index, smoking status, physical activity, family history of cancer, and comorbidities.ResultsDuring 10.5 years of follow-up, 189,617 cancer cases were recorded. Six trajectories were determined: non-drinking, light, moderate, decreasing-heavy, increasing-heavy, and steady-heavy. Light-to-heavy alcohol consumption increased the risk for all cancers combined in a dose-dependent manner (adjusted hazards ratio, 95% confidence interval for trajectories = 1.03, 1.02-1.05; 1.06, 1.05-1.08; 1.19, 1.16-1.22; 1.23, 1.20-1.26; and 1.33, 1.29-1.38; respectively [p-trend <0.001]). Light-to-heavy alcohol consumption was linked to lip, oral cavity, pharyngeal, esophageal, colorectal, laryngeal, stomach, and gallbladder and biliary tract cancer risks, while heavy alcohol consumption was associated with hepatic, pancreatic, and lung cancer risks. An inverse association was observed for thyroid cancer. The cancer risks were lower for decreasing-heavy drinkers, compared to steady-heavy drinkers.ConclusionNo safe drinking limits were identified for cancer risks; reduction in heavy intake had protective effects.

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.JE20200025, (Released:2020-06-27)

参考文献数

34

被引用文献数

27

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Background: Japan is one of the world’s largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times.Method: We analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every three years (n ≈ 700,000 per year) in Japan, during 2001-2016. Age-standardized smoking prevalence was computed based on occupational class and educational level. We calculated smoking prevalence difference (PD) and ratio (PR) of (a) manual workers versus upper non-manual workers and (b) low versus high educational level. The slope index of inequality (SII) and relative index inequality (RII) by educational level were used as inequality measures.Results: Overall smoking prevalence (25-64 years) decreased from 56.0% to 38.4% among men and from 17.0% to 13.0% among women during 2001–2016. The PD between manual and upper non-manual workers (25-64 years) increased from 11.9% (95% confidence interval: 11.0-12.9) to 14.6% (13.5-15.6) during 2001–2016. In 2016, smoking prevalence (25-64 years) for low, middle, and highly educated individuals were 57.8%, 43.9%, and 27.8% for men, and 34.7%, 15.9%, and 5.6% for women, respectively. SII and RII by educational level increased among both sexes. Larger socioeconomic differences in smoking prevalence were observed in younger generations, which suggests that socioeconomic inequalities in smoking evolve in a cohort pattern.Conclusions: Socioeconomic inequalities in smoking widened between 2001 and 2016 in Japan, which indicates that health inequalities will continue to exist in near future.