著者

Shingo Fukuma Tatsuyoshi Ikenoue Yukari Yamada Yoshiyuki Saito Joseph Green Takeo Nakayama Shunichi Fukuhara

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.7, pp.410-416, 2021-07-05 (Released:2021-07-05)

参考文献数

39

被引用文献数

3

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Background: Breaches of ethics undermine the practice of medicine. In Japan, two major scandals involving clinical research and drug marketing occurred after the publication of clinical trials. To study the effects of those scandals, we evaluated changes in the use of first-generation angiotensin II receptor blockers (ARBs) after publication of relevant clinical trials and also after the subsequent scandals.Methods: We conducted a quasi-experimental design of an interrupted time series analysis (ITSA) on nationwide monthly drug-market data covering 12 years (2005 to 2017) in Japan. The main outcome was the use of first-generation ARBs (valsartan, candesartan, and losartan). The two exposures were the publication of ARB-related clinical-trial results (October 2006) and subsequent ARB-related scandals involving research and marketing (February 2013). A generalized estimating equation model was fitted for ITSA with a log link, Poisson distribution, robust variance estimators, and seasonality adjustment.Results: The publication of clinical trials was associated with 12% increase in the use of first-generation ARBs in Japan, and the subsequent ARB-related scandals was associated with 19% decrease. The decrease in the use of first-generation ARBs after the scandals was greater than the increase in their use after the publication of clinical-trial results. The net effect of the two exposures was a 9% decrease in the use of first-generation ARBs.Conclusions: The scandals were associated with decrease in the use of first-generation ARBs, and that decrease was greater than the increase associated with the publication of “successful” clinical trials, making the net effect not zero but negative.

著者

Akiko Tamakoshi Kotaro Ozasa Yoshihisa Fujino Koji Suzuki Kiyomi Sakata Mitsuru Mori Shogo Kikuchi Hiroyasu Iso

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20120161, (Released:2013-04-13)

参考文献数

4

被引用文献数

85 111

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The Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) was established in the late 1980s to evaluate the risk impact of lifestyle factors and levels of serum components on human health. During the 20-year follow-up period, the results of the study have been published in almost 200 original articles in peer-reviewed English-language journals. However, continued follow-up of the study subjects became difficult because of the retirements of principal researchers, city mergers throughout Japan in the year 2000, and reduced funding. Thus, we decided to terminate the JACC Study follow-up at the end of 2009. As a final point of interest, we reviewed the population registry information of survivors. A total of 207 (0.19%) subjects were ineligible, leaving 110 585 eligible participants (46 395 men and 64 190 women). Moreover, errors in coding date of birth and sex were found in 356 (0.32%) and 59 (0.05%) cases, respectively, during routine follow-up and final review. Although such errors were unexpected, their impact is believed to be negligible because of the small numbers relative to the large total study population. Here, we describe the final cohort profile at the end of the JACC Study along with selected characteristics of the participants and their status at the final follow-up. Although follow-up of the JACC Study participants is finished, we will continue to analyze and publish study results.

著者

Takaki Kobayashi Yukako Tani Shiho Kino Takeo Fujiwara Katsunori Kondo Ichiro Kawachi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200427, (Released:2021-02-06)

参考文献数

53

被引用文献数

7

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Background: Engagement in leisure activities among older people is associated with a lower risk of mortality. However, no studies have been conducted focusing on the difference of associations with mortality risk among multiple types of leisure activities.Methods: We examined prospectively the association of engagement in leisure activities with all-cause mortality in a cohort of older Japanese adults. The Japan Gerontological Evaluation Study included 48,216 participants aged 65 years or older. During a mean follow-up period of 5.6 years, we observed 5,575 deaths (11.6%). We investigated the total number of leisure activities, as well as combinations of 25 different leisure activities with Cox proportional hazards models, adjusting for potential confounding factors.Results: We found a linear relationship between the total number of leisure activities and mortality hazard (adjusted hazard ratio, 0.93; 95% CI, 0.92–0.95). Furthermore, engagement in leisure activities involving physical activity, as well as group-based interactions, showed the strongest associations with lowered mortality. By contrast, engagement in cultural leisure activities and solitary leisure activities were not associated with all-cause mortality.Conclusions: Although we cannot rule out residual confounding, our findings suggest that encouraging engagement in physically-active group-based leisure activities may promote longevity in older adults.

著者

Noriko Fujiwara Naoki Shimada Masanori Nojima Keisuke Ariyoshi Norie Sawada Motoki Iwasaki Shoichiro Tsugane

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20210087, (Released:2021-07-03)

参考文献数

18

被引用文献数

3

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BackgroundThe place of death and related factor such as diseases, symptoms, family burden, and cost has been examined, but social background and lifestyle were not considered in most studies. Here, we assessed factors that are associated with the place of death using the largest cohort study in Japan.MethodsA total of 17,546 deaths from the cohort study were assessed. The study database was created from the Japan Public Health Center-based Prospective Study (JPHC Study) in which demographic data were collected by Japanese Vital Statistics. Adjusted odds ratios for home death were calculated by logistic regression.ResultsMultivariate analysis adjusted for various factors showed that unmarried status (OR 2.4, 95%CI:2.0-2.9), unemployed male (OR 1.3, 95%CI: 1.1-1.5), and high drinking level (OR 1.3, 95%CI:1.1-1.6) were associated with home death. Regarding the cause of death, cardiovascular disease (OR 3.3, 95%CI:2.9-3.8), cerebrovascular disease (OR 1.9, 95%CI:1.6-2.2) and external factors (OR 4.1, 95%CI:3.5-4.8) were significantly associated with home death, compared with cancer. The risk of death at home was significantly higher in unmarried status stratified by cause of death (OR: cardiovascular 3.2, 95%CI:2.2-4.7 / cerebrovascular 5.0, 95%CI:2.8-8.9 / respiratory 3.4, 95%CI:1.6-7.6/ external 2.3, 95%CI:1.4-3.7), but for cancer, the risk of death at home tended to be higher in married status.ConclusionsThis study indicated that various factors are associated with home death using the largest cohort study in Japan. There is a high possibility of home deaths in people with fewer social connections and in those with diseases leading to sudden death.

著者

Sangjeong Ahn Gi Jeong Kim Sung-Im Do Kyungeun Kim Hyunjoo Lee In-Gu Do Dong-Hoon Kim Seoung Wan Chae Seungho Ryu Jin Hee Sohn

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200142, (Released:2021-02-02)

参考文献数

57

被引用文献数

1

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Background: Inflammation is emerging as a potential mechanism of cervical carcinogenesis. However, few studies have investigated the association between host inflammatory status and the natural course of cervical precursor lesion. The aim of this study was to assess the probability of LSIL regression, associated with an inflammatory biomarker, high-sensitivity C-reactive protein (hs-CRP).Methods: In a longitudinal cohort study, female participants were examined annually or biannually using cervical cytology between 2006 and 2015. Incident LSIL cases were included in the analysis, with regression defined as at least one consecutive normal cytologic result. A total of 520 women aged 22–64 years were followed up for LSIL regression. The multivariable-adjusted hazard ratios (HRs) for LSIL regression were estimated using a parametric proportional hazards model.Results: During 827.5 person-years of follow-up, 486 out of 520 subjects (93.5%) showed LSIL regression. After adjusting several important potential confounders, a higher quartile of hs-CRP levels was significantly associated with a lower rate of regression (for quartile 4 vs quartile 1, inverse HR 1.33; 95% CI, 1.04–1.69; P for trend = 0.028).Conclusions: The low rate of spontaneous regression recorded in women with higher hs-CRP lends support to the role of the perturbated host inflammatory status in cervical carcinogenesis, and suggests that hs-CRP level could help monitor LSIL.

著者

Masako Shimoda Kayo Kaneko Takeshi Nakagawa Naoko Kawano Rei Otsuka Atsuhiko Ota Hisao Naito Masaaki Matsunaga Naohiro Ichino Hiroya Yamada Chifa Chiang Yoshihisa Hirakawa Koji Tamakoshi Atsuko Aoyama Hiroshi Yatsuya

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20210128, (Released:2021-05-22)

参考文献数

33

被引用文献数

2

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Background: There is limited evidence regarding the relationship between Diabetes mellitus (DM) in middle age and mild cognitive impairment after a follow-up. Therefore, we investigated the relationship between fasting blood glucose (FBG) levels in middle age and cognitive function (assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J) in later life, following over 15 years of follow-up in the Aichi Workers’ Cohort Study in Japan.Methods: Participants were 253 former local government employees aged 60–79 years in 2018 who participated in a baseline survey conducted in 2002. Using baseline FBG levels and self-reported history, participants were classified into the normal, impaired fasting glucose (IFG) and, and DM groups. Total MoCA-J score ranges from 0 to 30, and cognitive impairment was defined as MoCA-J score ≤25 in this study. A general linear model was used to estimate the mean MoCA-J scores in the FBG groups, adjusted for age, sex, educational year, smoking status, alcohol consumption, physical activity, body mass index, systolic blood pressure, total cholesterol, and estimated glomerular filtration rate.Results: The mean MoCA-J score in the total population was 25.0, and the prevalence of MoCA-J score ≤25 was 49.0%. Multivariable-adjusted total MoCA-J scores were 25.2, 24.8, and 23.4 in the normal, IFG, and DM groups, respectively. The odds ratio of MoCA-J score ≤25 in the DM group was 3.29.Conclusions: FBG level in middle age was negatively associated with total MoCA-J scores assessed later in life, independent of confounding variables.

著者

Shunsuke Murata Misa Takegami Daisuke Onozuka Yuriko Nakaoku Akihito Hagihara Kunihiro Nishimura

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.6, pp.361-368, 2021-06-05 (Released:2021-06-05)

参考文献数

19

被引用文献数

5

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Background: Dementia-related missing and subsequent deaths are becoming serious problems with increases in people with dementia. However, there are no sufficient studies investigating the incidence rate, the mortality rate, and their risk factors.Methods: An ecological study aggregated at the Japanese prefectural level was conducted. Dementia-related missing persons cases and deaths in 2018 were extracted from the statistics of the National Police Agency in Japan. We extracted variables about older adults’ characteristics, care, and safety as candidate variables considered to be relevant to dementia-related missing persons cases and deaths. Associations of the candidate variables with the incidence and mortality rates were analyzed using the generalized linear model (family: quasi-poisson, link: log) adjusted for confounding factors (proportion of older adults and gross prefectural product).Results: The incidence rate and mortality rate per 100,000 person-year was 21.72 and 0.652 in Japan, respectively. One facility increase in the number of nursing care facilities for older adults per 100,000 persons aged 65-years-old or more was associated with a 7.9% (95% confidence interval [CI], 3.3–12.4%) decrease in the incidence rate. One increase in the number of public health nurses per 100,000 persons was associated with a 3.2% (95% CI, 1.6–4.9%) decrease in the incidence rate. A ten percent increase in the proportion of people who live in an urban area was associated with a 20.3% (95% CI, 8.7–33.2%) increase in the incidence rate and a 12.9% (95% CI, 5.6–19.8%) decrease in the mortality rate.Conclusions: Identified associated factors may be useful for managing or predicting dementia-related missing persons cases and associated deaths.

著者

Yuuki Tsuchihashi Yuzo Arima Takuri Takahashi Kazuhiko Kanou Yusuke Kobayashi Tomimasa Sunagawa Motoi Suzuki

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200519, (Released:2021-05-29)

参考文献数

40

被引用文献数

6

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BackgroundNotifications of novel coronavirus infections increased in early 2020 in Japan. We described characteristics of novel coronavirus infection cases and analyzed risk factors for severe outcomes.MethodsCases were persons with laboratory-confirmed novel coronavirus infection reported under national surveillance between January and March 2020. Clinical characteristics were described, and factors associated with severe outcomes (intensive care unit [ICU] admission, invasive ventilation/death) were analyzed using Poisson regression.ResultsAmong the 516 cases analyzed, median age was 60 years (range: 1–97 years) and 285 (55%) were male. Common symptoms/signs were fever (375/475, 79%), cough (353/465, 76%), and pneumonia (245/387, 63%). Ten (2%) cases died. Of the 348 cases with data, 50 (14%) required invasive ventilation. Adjusted for each other, male gender and 1-year increase in age were associated with ICU admission (risk ratio (RR) 4.18; 95% confidence interval (CI), 1.69–10.32 and RR 1.05; 95%CI, 1.03–1.08, respectively) and invasive ventilation/death (RR 2.79; 95%CI, 1.49–5.21 and RR 1.06; 95%CI, 1.04–1.08). Diabetes, dyslipidemia, hyperuricemia, and lung diseases were also associated with severe outcomes. Of the 80 cases asymptomatic at hospitalization, 40 developed symptoms and five of them >70 years of age required invasive ventilation.ConclusionsThe early stage of the novel coronavirus epidemic in Japan disproportionately affected the elderly. Older age, male gender, and underlying conditions were associated with severe outcomes. Notably, some elderly case-patients who were asymptomatic at diagnosis and promptly hospitalized still went on to develop severe disease, indicating the importance of careful monitoring of certain populations.

著者

Moemi Shimamura Yusuke Matsuyama Ayako Morita Takeo Fujiwara

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200366, (Released:2021-04-10)

参考文献数

34

被引用文献数

3

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Background: Procrastination is associated with stress and unhealthy behaviors. The oral condition reflects the long-term history of an individual’s stress exposure and oral health behaviors; however, empirical studies on the association of procrastination in childhood with remaining teeth in older age are limited. We investigated the association of procrastination in childhood with the number of remaining teeth among community-dwelling older Japanese adults.Methods: In total, 1616 community-dwelling senior residents of Wakuya City (Miyagi Prefecture, Japan) who were enrolled in the National Health Plan & the Medical Care System for the Elderly completed a self-administered questionnaire on the number of teeth. Procrastination was measured using a single binary question about timing of holiday homework completion in childhood. The number of remaining teeth was assessed via a questionnaire with response options of ≥20, 10–19, 1–9, and 0 teeth. Ordered logistic regression models with potential confounders (sex, age, maternal education, childhood socioeconomic status (SES), childhood maltreatment, conscientiousness trait) and mediators (adulthood SES, smoking history, alcohol use history) were estimated.Results: Forty-six percent of participants reported a higher tendency to procrastinate in childhood. The proportions of participants with ≥20, 10–19, 1–9, and 0 teeth were 39.6, 22.7, 24.0, and 13.7%, respectively. After adjusting for all covariates, a higher tendency to procrastinate in childhood was significantly associated with having fewer remaining teeth (odds ratio = 1.28; 95% confidence interval = 1.05–1.57).Conclusion: A higher tendency to procrastinate in childhood was associated with having fewer remaining teeth in later life.

著者

Yudai Tamada Kenji Takeuchi Chikae Yamaguchi Masashige Saito Tetsuya Ohira Kokoro Shirai Katsunori Kondo

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.5, pp.301-307, 2021-05-05 (Released:2021-05-05)

参考文献数

34

被引用文献数

19

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Background: While laughter is broadly recognized as a good medicine, a potential preventive effect of laughter on disability and death is still being debated. Accordingly, we investigated the association between the frequency of laughter and onset of functional disability and all-cause mortality among the older adults in Japan.Methods: The data for a 3-year follow-up cohort including 14,233 individuals (50.3% men) aged ≥65 years who could independently perform the activities of daily living and participated in the Japan Gerontological Evaluation Study were analyzed. The participants were classified into four categories according to their frequency of laughter (almost every day, 1–5 days/week, 1–3 days/month, and never or almost never). We estimated the risks of functional disability and all-cause mortality in each category using a Cox proportional hazards model.Results: During follow-up, 605 (4.3%) individuals developed functional disability, identified by new certification for the requirement of Long-Term Care Insurance, and 659 (4.6%) deaths were noted. After adjusting for the potential confounders, the multivariate-adjusted hazard ratio of functional disability increased with a decrease in the frequency of laughter (P for trend = 0.04). The risk of functional disability was 1.42 times higher for individuals who laughed never or almost never than for those who laughed almost every day. No such association was observed with the risk of all-cause mortality (P for trend = 0.39).Conclusions: Low frequency of laughter is associated with increased risks of functional disability. Laughter may be an early predictor of functional disability later on in life.

著者

Takahisa Ohta Junzo Nagashima Wataru Fukuda Hiroyuki Sasai Naokata Ishii

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200581, (Released:2021-04-10)

参考文献数

39

被引用文献数

1

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BackgroundKnee extensor muscle strength and cardiorespiratory fitness (CRF) are major components of physical fitness. Because the interactive association of knee extensor muscle strength and CRF with bone health remains unclear, we aimed to investigate such association in Japanese adults.MethodsAltogether, 8,829 Japanese adults (3,731 men and 5,098 women) aged ≥45 years completed the maximum voluntary knee extension test, submaximal exercise test, medical examination, and a questionnaire on lifestyle habits. Using an osteo-sono assessment index, low bone stiffness tendency was defined as 80% under the young-adults mean. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) were calculated after confounder adjustment.ResultsOverall, 542 men (14.5%) and 978 women (19.2%) had low bone stiffness tendency. We observed an inverse association between muscle strength and low bone stiffness tendency after adjustment for CRF in both sexes (p for linear trend < 0.001). Compared with the lowest CRF, the multivariable ORs (95% CI) for low bone stiffness tendency in the highest CRF were 0.47 (0.36, 0.62) for men and 1.05 (0.82, 1.35) for post-menopausal women (p < 0.001 and p = 0.704, respectively). No interactive association between muscle strength and CRF for low bone stiffness tendency existed in both sexes and irrespective of menopausal status.ConclusionKnee extensor muscle strength and CRF were associated additively, not synergistically, with bone health. Maintaining high levels of both physical fitness components may improve musculoskeletal health in the cohort. The relationship between physical fitness and bone status should be longitudinally investigated in the future.

著者

Tatsuhiko Anzai Keisuke Fukui Tsubasa Ito Yuri Ito Kunihiko Takahashi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.2, pp.152-156, 2021-02-05 (Released:2021-02-05)

参考文献数

34

被引用文献数

26

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Background: Suicide amidst the coronavirus disease (COVID-19) pandemic is an important issue. In Japan, the number of suicides in April 2020 decreased by nearly 20% from that in 2019. To assess the impact of an infectious disease pandemic, excess mortality is often discussed. Our main purpose was evaluating excess mortality from suicide in Japan during the early pandemic period.Methods: We used data on suicides collected by the National Police Agency of Japan until June 2020. We estimated excess mortality during the early pandemic period (March–June 2020) using a time-series model of the number of suicides before the pandemic. A quasi-Poisson model was employed for the estimation. We evaluated excess mortalities by the categories of age and sex, and by prefecture.Results: No significant excess mortality was observed throughout the early pandemic; instead, a downward trend in the number of suicides for both sexes was noted. For males, negative values of excess mortalities below the lower bound of the 95% prediction interval were observed in April and May. All numbers of females during the period were included in the interval, and the excess mortalities in June were positive and higher than those in April and May. In Tokyo, the number of suicides was below the lower bound throughout the period.Conclusion: Our results suggest that various changes, such as communication, and social conditions amid the early COVID-19 pandemic induced a decrease in suicides in Japan. However, continuous monitoring is needed to evaluate the long-term effects of the pandemic on suicides.

著者

Hiroyuki Kikuchi Masaki Machida Itaru Nakamura Reiko Saito Yuko Odagiri Takako Kojima Hidehiro Watanabe Keisuke Fukui Shigeru Inoue

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.30, no.11, pp.522-528, 2020-11-05 (Released:2020-11-05)

参考文献数

28

被引用文献数

3 86

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Background: This longitudinal study aimed to examine the changes in psychological distress of the general public from the early to community-transmission phases of the COVID-19 pandemic and to investigate the factors related to these changes.Methods: An internet-based survey of 2,400 Japanese people was conducted in two phases: early phase (baseline survey: February 25–27, 2020) and community-transmission phase (follow-up survey: April 1–6, 2020). The presence of severe psychological distress (SPD) was measured using the Kessler’s Six-scale Psychological Distress Scale. The difference of SPD percentages between the two phases was examined. Mixed-effects ordinal logistic regression analysis was performed to assess the factors associated with the change of SPD status between the two phases.Results: Surveys for both phases had 2,078 valid respondents (49.3% men; average age, 50.3 years). In the two surveys, individuals with SPD were 9.3% and 11.3%, respectively, demonstrating a significant increase between the two phases (P = 0.005). Significantly higher likelihood to develop SPD were observed among those in lower (ie, 18,600–37,200 United States dollars [USD], odds ratio [OR] 1.95; 95% confidence interval [CI], 1.10–3.46) and the lowest income category (ie, <18,600 USD, OR 2.12; 95% CI, 1.16–3.86). Furthermore, those with respiratory diseases were more likely to develop SPD (OR 2.56; 95% CI, 1.51–4.34).Conclusions: From the early to community-transmission phases of COVID-19, psychological distress increased among the Japanese. Recommendations include implementing mental health measures together with protective measures against COVID-19 infection, prioritizing low-income people and those with underlying diseases.

著者

Yuiko Nagamine Takeo Fujiwara Yukako Tani Hiroshi Murayama Takahiro Tabuchi Katsunori Kondo Ichiro Kawachi

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.30, no.11, pp.497-502, 2020-11-05 (Released:2020-11-05)

参考文献数

36

被引用文献数

8

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Background: Socioeconomic mobility affects health throughout the life course. However, it is not known whether there are gender differences in the association between life-course subjective socioeconomic status (SSS) mobility and mortality at older ages.Methods: Participants were 16,690 community-dwelling adults aged 65–100 years in the Japan Gerontological Evaluation Study (JAGES). Baseline information including demographic characteristics, depression, and lifestyle factors were collected in 2010. Participants’ vital status was confirmed in 2013 via linkage to death records. We categorized life-course socioeconomic mobility into the following categories: ‘persistently high’, ‘downward mobility’, ‘upward mobility’, and ‘persistently low’. Cox proportional hazard modeling was used to estimate hazard ratios (HR) for all-cause mortality.Results: Mortality HRs for the ‘downward’ group were 1.37 (95% confidence interval [CI], 1.08–1.74) among men and 1.27 (95% CI, 0.94–1.71) among women in comparison with the ‘persistently high’ group. Compared to the ‘persistently low’ group, the HRs for the ‘upward’ group were 0.54 (95% CI, 0.35–0.83) among women and 0.91 (95% CI, 0.73–1.24) among men. Associations were not changed after adjusting for objective socioeconomic status but were attenuated by depression.Conclusions: ‘Downward’ mobility was associated with mortality among men, but not among women. Depression appeared to mediate the association. A protective effect of upward mobility was observed among women but not among men.

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

vol.29, no.10, pp.377-383, 2019-10-05 (Released:2019-10-05)

参考文献数

29

被引用文献数

8 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 5-year age groups and LTC needs level.Results: The study analyzed 12,852 men and 18,020 women, among which 13.3% and 41.5%, respectively, were 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 [IRR] 0.90; 95% confidence interval [CI], 0.87–0.92 for men and IRR 0.97; 95% CI, 0.95–0.99 for women), longer LOS (IRR 1.98; 95% CI, 1.54–2.56 and IRR 1.42; 95% CI, 1.20–1.67, respectively), and higher total expenditures (exp(β) 1.09; 95% CI, 1.01–1.18 and exp(β) 1.09; 95% CI, 1.05–1.14, respectively).Conclusions: This study suggests that 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

Gertraud Maskarinec Phyllis Raquinio Bruce S. Kristal Adrian A. Franke Steven D. Buchthal Thomas M. Ernst Kristine R. Monroe John A. Shepherd Yurii B. Shvetsov Loïc Le Marchand Unhee Lim

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200538, (Released:2021-02-27)

参考文献数

39

被引用文献数

7

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Aims. As the proportion of visceral (VAT) to subcutaneous adipose tissue (SAT) may contribute to type 2 diabetes (T2D) development, we examined this relation in a cross-sectional design within the Multiethnic Cohort that includes Japanese Americans known to have high VAT. The aim was to understand how ectopic fat accumulation differs by glycemic status across ethnic groups with disparate rates of obesity, T2D, and propensity to accumulate VAT.Methods. In 2013-16, 1,746 participants aged 69.2 (2.7) years from five ethnic groups completed questionnaires, blood collections, and whole-body DXA and abdominal MRI scans. Participants with self-reported T2D and/or medication were classified as T2D, those with fasting glucose >125 and 100-125 mg/dL as undiagnosed cases (UT2D) and prediabetes (PT2D), respectively. Using linear regression, we estimated adjusted means of adiposity measures by T2D status.Results. Overall, 315 (18%) participants were classified as T2D, 158 (9%) as UT2D, 518 (30%) as PT2D, and 755 (43%) as normoglycemic (NG) with significant ethnic differences (p<0.0001). In fully adjusted models, VAT, VAT/SAT, and percent liver fat increased significantly from NG, PT2D, UT2D, to T2D (p<0.001). Across ethnic groups, the VAT/SAT ratio was lowest for NG participants and highest for T2D cases. Positive trends were observed in all groups except African Americans, with highest VAT/SAT in Japanese Americans.Conclusions. These findings indicate that VAT plays an important role in T2D etiology, in particular among Japanese Americans with high levels of ectopic adipose tissue, which drives the development of T2D to a greater degree than in other ethnic groups.

著者

Jess D. Curb Kazunori Kodama

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.6, no.4sup, pp.197-201, 1996 (Released:2007-11-30)

参考文献数

19

被引用文献数

8 9

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The NI-HON-SAN Study begun in 1965, and is a comparative study of cardiovascular disease and associated risk factors in Japanese living in Japan, Hawaii, and San Francisco. Early comparisons showed the prevalence of stroke to be the highest in Japan, intermediate in Hawaii, and the lowest in California. The trends for the prevalance of coronary heart disease in these three areas on the other hand were found to be completely opposite to those of stroke. Comparisons of risk factors demonstrated no difference in blood pressure levels, whereas the mean serum cholesterol level and body mass index were the lowest in Japan. A major difference in intake of total and saturated fats was noted between these three areas with the lowest values noted in Japan. The NI-HON-SAN Study demonstrated that a change to a Western life-style had a favorable effect in reducing stroke but conversely resulted in increase of coronary heart disease. The message to be noted is that an excessive change to a Western life-style should be avoided in developing countries, where rapid economic growth is taking place. J Epidemiol, 1996 ; 6 : S197-S201.

著者

Ryosuke Fujii Asahi Hishida Takeshi Nishiyama Masahiro Nakatochi Keitaro Matsuo Hidemi Ito Yuichiro Nishida Chisato Shimanoe Yasuyuki Nakamura Tanvir Chowdhury Turin Sadao Suzuki Miki Watanabe Rie Ibusuki Toshiro Takezaki Haruo Mikami Yohko Nakamura Hiroaki Ikezaki Masayuki Murata Kiyonori Kuriki Nagato Kuriyama Daisuke Matsui Kokichi Arisawa Sakurako Katsuura-Kamano Mineko Tsukamoto Takashi Tamura Yoko Kubo Takaaki Kondo Yukihide Momozawa Michiaki Kubo Kenji Takeuchi Kenji Wakai

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200540, (Released:2021-02-20)

参考文献数

38

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Background: Inflammation is thought to be a risk factor for kidney disease. However, discussion is controversial whether inflammatory status is either a cause or an outcome of chronic kidney disease. We aimed to investigate the causal relationship between high-sensitivity C-reactive protein (hs-CRP) and estimated glomerular filtration rate (eGFR) using mendelian randomization (MR) approaches.Methods: A total of 10,521 participants of the Japan Multi-institutional Collaborative Cohort Study was analyzed in this study. We used two-sample MR approaches (the inverse-variance weighted (IVW), the weighted median (WM), and the MR-Egger method) to estimate the effect of genetically determined hs-CRP on kidney function. We selected four and three hs-CRP associated single nucleotide polymorphisms (SNPs) as two instrumental variables (IV): IVCRP and IVAsian, based on SNPs previously identified in European and Asian populations. IVCRP and IVAsian explained 3.4% and 3.9% of the variation in hs-CRP, respectively.Results: Using the IVCRP, genetically determined hs-CRP was not significantly associated with eGFR in the IVW and the WM methods (estimate per 1 unit increase in ln(hs-CRP), 95%CI: 0.000, –0.019 to 0.020 and –0.003, –0.019 to 0.014). For IVAsian, we found similar results using the IVW and the WM methods (estimate, 95% CI: –0.005, –0.020 to 0.010 and –0.004, –0.020 to 0.012). The MR-Egger method also showed no causal relationships between hs-CRP and eGFR (IVCRP: –0.008, –0.058 to 0.042; IVAsian: 0.001, –0.036 to 0.036).Conclusions: Our two-sample MR analyses with different IVs did not support a causal effect of hs-CRP on eGFR.

著者

Yukai Lu Yumi Sugawara Sanae Matsuyama Ichiro Tsuji

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200260, (Released:2020-12-26)

参考文献数

39

被引用文献数

4

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Background: Both weight loss and cognitive impairment are common in late-life, but it remains unknown whether weight change is associated with risk of incident dementia among elderly Japanese. Our study aimed to investigate the association between long-term weight change since midlife and risk of incident disabling dementia using a community-based cohort study of elderly Japanese.Methods: In 2006, we conducted a cohort study of 6,672 disability-free Japanese adults aged ≥65 years. In both 1994 and 2006, the participants reported their weight using a self-reported questionnaire. Based on weight obtained at these two time points, participants were classified into: stable weight (-1.4 – +1.4kg), weight gain (≥ +1.5kg), and weight loss of -2.4 – -1.5kg, -3.4 – -2.5 kg, -4.4 – -3.5kg, -5.4 – -4.5kg, and ≤-5.5kg. Incident disabling dementia was retrieved from the public Long-term Care Insurance database. Participants were followed-up for 5.7 years (between April 2007 and November 2012). Cox proportional hazards model was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident disabling dementia.Results: During 32,865 person-years of follow-up, 564 participants were ascertained as having incident disabling dementia. Compared with stable weight, the multivariable-adjusted HRs (95%CIs) were 0.97 (0.70, 1.34) for weight loss of -2.4 – -1.5kg, 0.98 (0.70, 1.38) for -3.4 – -2.5kg, 1.28 (0.91, 1.81) for -4.4 – -3.5kg,1.27 (0.92, 1.77) for -5.4 – -4.5kg, and 1.64 (1.29, 2.09) for ≤-5.5kg.Conclusion: Our study suggested that a ≤-3.5kg weight loss over 12 years might be associated with higher risk of incident disabling dementia among elderly Japanese.

著者

Satomi Ikeda Ai Ikeda Kazumasa Yamagishi Miyuki Hori Sachimi Kubo Mizuki Sata Chika Okada Mitsumasa Umesawa Tomoko Sankai Akihiko Kitamura Masahiko Kiyama Tetsuya Ohira Takeshi Tanigawa Hiroyasu Iso

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20190140, (Released:2020-02-22)

参考文献数

35

被引用文献数

6

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Background. The frequency of laughter has been associated with cardiovascular disease and related biomarkers, but no previous studies have examined association between laughter and changes in blood pressure levels. We therefore sought to identify temporal relationships between frequency of laughter in daily life and systolic and diastolic blood pressure changes in participants from 2010 to 2014.Methods. Participants were 554 men and 887 women aged 40-74 years who answered self-administered questionnaire quantifying frequency of laughter at baseline. We measured participant blood pressure levels twice using automated sphygmomanometers for each year from 2010 to 2014. The associations between laughter and changes in blood pressure over time were analyzed using linear mixed-effect models.Results. There was no significant difference in blood pressure according to frequency of laughter at baseline in either sex. Men with frequency of laughter 1 to 3 per month or almost never had significantly increased systolic and diastolic blood pressure levels over four-year period (time-dependent difference (95% CI): 0.96 mmHg (-0.2, 1.8); p=0.05). Changes in blood pressure associated with infrequent laughter (i.e., 1 to 3 per month or almost never) were evident in men without antihypertensive medication use over four years (0.82 mmHg (0.1, 1.5); p=0.02) and men who were current drinkers at baseline (1.29 mmHg (-0.1, 2.3); p=0.04). No significant difference was found between frequency of laughter and systolic (0.23mmHg (-1.0, 1.5); p=0.72) and diastolic (-0.07mmHg (-0.8, 0.7); p=0.86) blood pressure changes in women.Conclusions. Infrequent laughter was associated with long-term blood pressure increment among middle-aged men.