Journal of Epidemiology最新文献

Background: The interaction and substitution effects of physical activity (PA) and sitting time (ST) living in non-western countries have not been well investigated. This study aimed to examine the association of moderate-to-vigorous physical activity (MVPA) and ST with disability and mortality in older adults.

Methods: This prospective study analyzed data from 10,164 adults over 65 who participated in the Kyoto-Kameoka study in Japan. We evaluated MVPA and ST using the validated International Physical Activity Questionnaire-Short Form. Participants were categorized into four groups based on their levels of MVPA (150 min/week) and ST (300 min/day): low MVPA/high ST, low MVPA/low ST, high MVPA/high ST, and high MVPA/low ST. Outcomes were gathered between July 30, 2011, and November 30, 2016.

Results: Over a median follow-up of 5.3 years (45,461 person-years), 2,273 disability cases were documented. The low MVPA/high ST groups were associated with higher disability risk than those in the high MVPA/low ST groups (hazard ratios [HRs], 1.52; 95% confidence interval [CI], 1.31-1.75), and the interaction between MVPA and ST accounted for 48.5% of the relative excess risk of disability in the low MVPA/high ST group (p for interaction = 0.006). Replacing daily 10 min of ST with 10 min of MVPA was associated with a reduced risk of disability (HR, 0.980; 95% CI, 0.971-0.989) and all-cause mortality (HR, 0.975; 95% CI, 0.962-0.988).

Conclusions: These findings indicate that even a small substitution of ST with MVPA could help lower both the risk of disability and mortality.

Background: Poor dietary habits are a significant changeable factor contributing to negative health effects; however, the connection between variations in dietary diversity over time and mortality remains uncertain. This study aimed to evaluate the association between longitudinal changes in the dietary diversity score (DDS) and mortality in Japanese adults.

Methods: This prospective study included 20,863 adults (13,144 women, 7,719 men) aged 40-79 years from the Japan Collaborative Cohort Study. The DDS was evaluated twice, once at baseline and again 5 years later, using a validated food frequency questionnaire that assessed 33 food items. Participants were classified into four groups based on mean DDS: baseline low DDS/5 years later low DDS (n=7,866; Low/Low group), baseline low DDS/5 years later high DDS (n=2,951; Low/High group), baseline high DDS/5 years later low DDS (n=3,000; High/Low group), and baseline high DDS/5 years later high DDS (n=7,046; High/High group). Survival data were collected until 2009, and hazard ratios (HRs) for mortality were calculated using a Cox proportional hazards model.

Results: During a median follow-up of 14.8 years (256,277 person-years), 2,995 deaths were documented. After adjusting for confounders, participants in the High/High group had a lower HR for mortality from all causes (HR:0.82; 95% confidence interval [CI]:0.74-0.91) and cardiovascular disease (HR:0.81; 95% CI:0.67-0.98) than those in the Low/Low group. Similar associations were observed with dairy, soy, and vegetables/fruits, but they were validated exclusively in women.

Conclusions: This study showed that maintaining a higher DDS may be associated with lower mortality in women.

Background: Amidst the global coronavirus disease 2019 (COVID-19) pandemic, Japan has faced a significant public health challenge, evident from the significant increase in mortality rates since 2021. This study described the variations in all-cause and cause-specific changes in mortality up to 2022 in Japan.

Methods: This study used official Vital Statistics from the Ministry of Health, Labour and Welfare (MHLW) to assess the impact of the pandemic on mortality trends. An analysis of all-cause and cause-specific age-standardized mortality rates (ASMRs) from 1995 to 2022 was conducted, employing the 2015 Japan Standard Population. Sex- and cause-specific ASMRs for a particular year were compared with those from the preceding year to assess annual changes.

Results: Among men, the annual all-cause ASMR per 100,000 people increased from 1,356.3 in 2021 to 1,437.8 in 2022 (6.0% increase). Among women, the annual all-cause ASMR increased from 722.1 in 2021 to 785.8 in 2022 (6.5% increase). Compared with the period 2020 to 2021, COVID-19 (+29.1 per 100,000 people for men and +13.4 per 100,000 people for women), senility (+14.1 per 100,000 people for men and +12.5 per 100,000 people for women), heart disease, malignant neoplasms (for women) and "other causes not classified as major causes" substantially contributed to the increase in all-cause ASMR from 2021 to 2022.

Conclusion: Further long-term monitoring from 2023 onwards is necessary, especially for conditions like senility, cardiovascular disease, and cancer, which may have long-term effects due to changes in healthcare settings, even though the strong countermeasures against COVID-19 were lifted in 2023.

Background: The health statuses of closely connected individuals are interdependent. Little is known about mortality risk associated with partner's cancer diagnosis and cause-specific mortality risk associated with partner's death.

Methods: Relative risks for all-cause and cause-specific mortality following a partner's cancer diagnosis or death compared to the period when the partner is cancer-free and alive were investigated in the population-based prospective cohort study that enrolled 140,420 people at the age between 40-69 years in 1990-1994.

Results: 55,050 participants (27,665 men and 27,385 women) who were identified as married couples were followed-up for 1,073,746.1 (518,368.5 in men and 555,377.6 in women) person-years, during which 9,816 deaths were observed (7,217 in men and 2,599 in women). After a partner's cancer diagnosis, the mortality rate ratio (MRR) of all-cause mortality was not increased among both men and women, while an increase of externally-caused MRR was observed. The suicide MRR significantly increased among men (MRR 2.90; 95% confidence interval, 1.70-4.93), and it persisted for more than 5 years. After a partner's death, the MRRs of all-cause, cardiovascular disease (CVD), respiratory disease (RD), and externally-caused mortality significantly increased only among men. Stratified analysis by smoking status among men showed significantly increased MRRs of CVD and RD mortality among former/current smokers, but not among never-smokers.

Conclusion: Partner's cancer diagnosis did not increase all-cause mortality risk, but increased externally-caused mortality risk, especially suicide among men. The impact of partner's death on mortality risk differed by the mortality causes and sex, and smoking affected some of cause-specific mortality risk.

Background: This study aimed to validate self-reported medical conditions in the Taiwan Biobank (TWBB), in which participants were inquired about 30 disease conditions, by comparing them with claims records from Taiwan's National Health Insurance (NHI) claims database.

Methods: We identified 30 clinical diagnoses using International Classification of Diseases - Clinical Modification codes from ambulatory and hospital claims within the NHI claims database, matching diseases included in the TWBB. The concordance between self-reports and claims records was evaluated using tetrachoric correlation to assess the correlation between binary variables.

Results: A total of 131,834 participants aged 30-70 years with data from the TWBB and NHI records were included. Concordance analysis revealed tetrachoric correlations ranged from 0.420 (chronic obstructive pulmonary disease) to 0.970 (multiple sclerosis). However, several disorders exhibited lower tetrachoric correlations. The concordance was higher among those with higher education attainment, and lower among married individuals.

Conclusion: The concordance between self-reports in the TWBB and NHI claims records varied across clinical diagnoses, showing inconsistencies depending on participant characteristics. These findings underscore the need for further investigation, especially when these variables are crucial to research objectives. Integrating complementary databases, such as clinical diagnoses, prescription records, and medical procedures, can enhance accuracy through customized algorithms based on disease categories and participant characteristics and optimize sensitivity or positive predictive values to align with specific research objectives.

Background: Advancements in cancer care have improved survivorship, potentially leading to changes in mortality causes. This study aimed to investigate the causes of death among cancer survivors, specially focusing on non-cancer-related mortality.

Methods: This nationwide population-based cohort study analyzed the causes of death based on the time since cancer diagnosis using data from the National Cancer Registry in Japan between January 2016 and December 2019. Non-cancer-related deaths were identified, and mortality risks associated with non-cancer diseases were compared to those of the Japanese general population using standardized mortality ratios (SMRs) with 95% confidence intervals (CIs). The follow-up period was up to 4 years after cancer diagnosis.

Results: A total of 3,990,661 patients (45.8% women) were included in the analysis, yielding 6,237,269 person-years of follow-up. Of these, 1,001,857 (25.1%) patients died during the study period. Cancer-related and non-cancer-related causes accounted for 86.6% and 13.4% of deaths, respectively. The proportion of non-cancer-related deaths increased from 10.2% at 6 months to 31.6% at 4 years after cancer diagnosis. Heart disease (21.8%), cerebrovascular disease (9.8%), and pneumonia (9.1%) were the leading cause of non-cancer-related deaths: the SMRs for these diseases were 2.69 (95% CI, 2.66-2.72), 2.07 (95% CI, 2.03-2.10), and 2.41 (95% CI, 2.36-2.45), respectively. The SMR for suicide was 1.81 (95% CI, 1.74-1.89); however, it lost significance in males and females 2 and 2.5 years after cancer diagnosis, respectively.

Conclusion: The proportion of non-cancer-related deaths among cancer patients has increased over time, emphasizing the need to manage cancer and its comorbidities carefully.

Background: The burden of cancer in India has been rising, yet testing for early detection remains low. This study explored inequalities in the uptake of breast cancer (BC) examination and cervical cancer (CC) among Indian women, focusing on socioeconomic, regional, and educational differences.

Methods: Data from the 2019-21 National Family Health Survey (n = 353,518) were used to assess the uptake of BC examination and CC testing. Inequalities were quantified using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). SII measured absolute inequality, while RII and RCI assessed relative inequality between disadvantaged and advantaged groups.

Results: The ever uptake of tests for early detection of BC and CC were low at 9 and 20 per 1,000 women, respectively. Higher uptake was observed among women from the richest households compared to the poorest (SII: 1.1 for BC and 1.8 for CC). The magnitude of relative socioeconomic inequalities was more pronounced in rural areas (RCI: 22.5 for BC and 21.3 for CC) compared to urban areas. Similarly, higher-educated women were 4.84 times (RII: 4.84) and 2.12 times (RII: 2.12) more likely to undergo BC examination and CC testing, respectively, compared to non-educated women. The Northeastern region exhibited greater socioeconomic inequality, while the Western region showed more education-based inequality.

Conclusion: The lower uptake of BC examination and CC testing and the marked inequalities underscore the need for targeted interventions to improve access and utilization of testing services, especially among lower-educated women, and those in rural areas.

BackgroundEvidence of post-COVID-19 condition (PCC) in the Alpha- and Delta-variant dominant waves is limited.MethodsIn a nationwide multicentre cohort study in collaboration with 20 hospitals, we collected data using self-administered questionnaires and electronic medical records of participants aged 20 or more diagnosed with COVID-19, hospitalized between Apr 1 2021 and Sept 30 2021, and discharged alive. Descriptive statistics were analyzed for PCC and mental health (HADS anxiety and depression scores), comparing Alpa and Delta-dominant waves.ResultsWe analyzed 1,040 patients (median age, 57 [IQR 49-66] years; men, 66.2%). Of the respondents, 45.4% had at least one PCC symptom one year after infection. The common symptoms included dyspnea (20.7%), fatigue/malaise (17.6%), muscle weakness (15.4%), decrease in concentration (13.4%), and sleep disorder (13.3%), followed by brain fog (8.4%). Among patients with PCC, 14.0% had anxiety (HADS-Anxiety ≥11), and 18.6% had depression (HADS-Depression ≥11), with four times higher proportions than those without PCC; only small variations by age, sex, and waves were observed. Associated factors for PCC were age 40 years or over, women, severity of COVID-19 during hospitalization, ex-smokers who quit smoking before COVID-19 infection and being infected during the Delta-variant dominant wave.ConclusionThe study described the prevalence of PCC, associated factors, and mental health of COVID-19 survivors hospitalized during the Alpha and Delta-variant dominant waves in Japan. Further follow-up will be conducted to examine the longer-term impact of COVID-19 on PCC, complications, daily life, and socioeconomic status.