Journal of Epidemiology最新文献

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.

Background: While evidence from Western countries links low-to-moderate alcohol consumption to a lower risk of type 2 diabetes mellitus (T2D), findings have been inconsistent in Asia. Since T2D in Asia involves both insulin resistance and deficient insulin secretion, both of which are differently affected by alcohol, we prospectively examined whether the association differs according to body mass index (BMI) categories among the Japanese.

Methods: Participants were 31,524 health checkup examinees (26,819 males and 4,705 females aged 20-64 years) who were free from diabetes at baseline. Self-reported data on alcohol use were used to estimate the average daily alcohol consumption at the baseline. Incident diabetes was identified at annual checkups during the follow-up period. A Cox proportional hazards model was used to estimate hazard ratios and 95% confidence intervals.

Results: During a median follow-up of 12.0 years, 3,527 male and 287 female participants developed T2D. The association between alcohol consumption and T2D risk differed markedly by BMI in both sexes. Among males, low- and moderate-level alcohol consumption was associated with a lower T2D risk in individuals with BMI ≥25.0 kg/m², whereas consumption at a level of 2 go/day (approximately 46 g ethanol) was linked to an increased T2D risk in those with BMI ≤22.0 kg/m². In females, similar patterns were observed, although confidence intervals were broad due to smaller sample size.

Conclusions: In Japan, low-to-moderate alcohol consumption may lower T2D risk in those with excess body weight, while high alcohol consumption may increase T2D risk in those with lower BMI.

Background: The decline in measles vaccination coverage is a global concern. In Japan, coverage of the first dose of measles vaccine, which had exceeded the target of 95.0% since fiscal year (FY) 2010, fell to 93.5% in FY 2021. Vaccination coverage increased to 95.4% in FY 2022 but varied by municipality. Few studies have focused on regional disparities in measles vaccination coverage. This study aimed to clarify the regional disparities in measles vaccination coverage by municipality in Japan and their associated factors.

Methods: In this ecological study, the measles vaccination coverage in FY 2022; population density; area deprivation index (ADI; an indicator of socioeconomic status); proportion of foreign nationals, single-father households, single-mother households, and mothers aged ≥30 years; and number of medical facilities, pediatricians, and non-pediatric medical doctors in 1,698 municipalities were extracted from Japanese government statistics. Negative binomial regression was performed with the number of children vaccinated against measles as the dependent variable, number of children eligible for measles vaccination as the offset term, and other factors as independent variables.

Results: Vaccination coverage was less than 95.0% in 54.3% of municipalities. Vaccination coverage was significantly positively associated with population density and negatively associated with the proportion of single-father households, mothers aged ≥30 years, and the ADI (incidence rate ratios: 1.004, 0.976, 0.999, and 0.970, respectively).

Conclusion: This study showed regional disparities in measles vaccination coverage in Japan. Single-father households, age of mothers, and socioeconomic status may be key factors when municipalities consider strategies to improve vaccination coverage.

Background: A recent systematic review showed Japan's mortality from chronic obstructive pulmonary disease (COPD) is the lowest among 204 countries, despite notably higher smoking rates in men in Japan than in the United States. This study aims to compare (1) trends in smoking rates, (2) trends in COPD mortality, and (3) the spirometry-based COPD prevalence in the general adult population between Japan and the United States.

Methods: Age- and sex-specific smoking rates from the 1980s through 2010s and COPD mortality from 1999 through 2019 were obtained from national surveys and official statistics (International Classification of Diseases-10^th codes J40-44), respectively. A systematic review and meta-analysis was performed to estimate COPD prevalence in Japan, while the National Health and Nutrition Examination Survey 2007-2012 was used for the United States. A fixed ratio of 0.7 of forced expiratory volume in the first second of forced vital capacity was used to define COPD.

Results: Over the past 4 decades, men in Japan consistently had 20-30% higher smoking rates than their United States counterparts. From 1999-2019, age-adjusted COPD mortality in men in Japan was only a third of the United States, whereas that in women was less than a tenth in 2019. Synthesizing data from 11 studies, involving 89,955 participants, Japan's COPD prevalence was more than 10% lower than in the United States in almost all age groups for both sexes.

Conclusion: This study showed markedly lower rates of COPD in Japan than in the United States. Investigating factors contributing to the paradoxical observations could lead to advancing COPD risk reduction strategies.

Background: The lockdowns imposed by the government during coronavirus disease 2019 (COVID-19) pandemic have had a significant impact on the Italian population habits.

Methods: LOckdown and lifeSTyles in Italy and in Tuscany studies collected data on a representative sample of the Italian adult population in 2020 (n = 6,003) followed up through 2023 via four additional surveys (3,000 ≤ n ≤ 6,600) through an online self-administered questionnaire. The Alcohol Use Disorders Identification Test-Concise was used to identify at-risk drinkers. Considering the cohort of individuals who took part to the first and at least one other wave (n = 5,378), a multilevel logistic model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of being at-risk drinkers.

Results: The prevalence of at-risk drinkers was 26.4% before, 23.4% during the first lockdown, and stabilized around 30.0% thereafter. Being at-risk alcohol consumers decreased with decreasing economic status (P for trend <0.001), was less frequent among middle-aged compared to younger (OR 0.73; 95% CI, 0.60-0.89) and among divorced/separated (OR 0.77; 95% CI, 0.60-0.99) or single (OR 0.75; 95% CI, 0.64-0.89) compared to married individuals. It was more frequent among individuals with anxiety or depressive symptoms (OR 1.24; 95% CI, 1.12-1.37), those using psychotropic drugs (OR 1.99; 95% CI, 1.69-2.35) and users of conventional and/or alternative nicotine products (OR 3.67; 95% CI, 3.00-4.48).

Conclusion: The long-term trends in alcohol consumption after the COVID-19 pandemic are unfavorable in Italy. The results point to an increased vulnerability for at-risk alcohol consumption among younger individuals, women with higher economic status, and married individuals. At-risk drinking is strongly related to mental health symptoms and nicotine consumption.

Introduction: This study aimed to determine the association between cumulative maternal physical activity level and their children's physical activity in early childhood. We also compared the influence of each maternal physical activity on children's physical activity in early childhood.

Methods: We analyzed the data from 1,067 Japanese mother-child pairs. Maternal physical activity was assessed using the International Physical Activity Questionnaire. Cumulative physical activity level in mothers was computed based on the categories (low, moderate, and high) of physical activity from five time points (pre-pregnancy, during pregnancy, 1.5, 3.5, and 5.5 years postpartum). Children's physical activity level was measured at age 5.5 years using the WHO Health Behaviour School-aged Children questionnaire and defined as engaging in physical activity for at least 60 minutes per day for more than 5 days. Logistic regression analysis was used to determine the association between maternal and children's physical activity levels.

Results: The results showed the positive association between cumulative maternal physical activity and children's physical activity level (P for trend < 0.001). Furthermore, maternal physical activity during pregnancy (P for trend = 0.031) and 5.5 years postpartum (P for trend < 0.001) was positively associated with children's physical activity.

Conclusion: A positive association was observed between the cumulative maternal physical activity level and the physical activity level of their children at 5.5 years of age. Furthermore, maternal physical activity during pregnancy and at 5.5 years postpartum were positively associated with the level of children's physical activity.

BackgroundStudies have shown that informal caregiving is associated with an increased risk of cardiovascular diseases. However, there is limited evidence on the mechanisms involved. To fill this knowledge gap, we investigated the association of informal caregiving with changes in health-related behaviors.MethodsWe analyzed a nationally representative sample aged 50-59 years as of 2005 using fifteen waves of the Longitudinal Survey of Middle-Aged and Older Adults, conducted between 2005-2019. We investigated the association between the change in informal caregiving status and the change in health-related behaviors, including (1) heavy drinking, (2) smoking, (3) no exercise habits, and (4) no attendance at annual health checkups. We used multivariable logistic regression models with correlated random effects, adjusting for individual-level time-invariant characteristics.ResultsAmong 268,165 observations from 30,530 participants (median age 55 [interquartile range 52-57] at baseline; 51.6% women), 32,164 (12.0%) observations from 10,224 individuals provided informal care. After adjusting for potential confounders, informal caregiving was associated with higher probabilities of deteriorating health-related behaviors, including heavy drinking (adjusted odds ratio [aOR] 1.16; 95% confidence interval [CI] 1.03-1.32; adjusted p=0.032) and no exercise habits (aOR 1.09; 95%CI 1.04-1.15; adjusted p<0.001). We observed similar patterns for smoking (aOR 1.12; 95%CI 1.001-1.26; adjusted p=0.053) and no attendance at health checkups (aOR 1.05; 95%CI 0.999-1.10; adjusted p=0.053).ConclusionThis study showed that the transition into informal caregiving was associated with deteriorating cardiovascular-related health behaviors in Japan. These findings highlighted the importance of continued efforts to prevent the deterioration of caregivers' health-related behaviors.

Background: We launched the Wako Cohort Study in 2023 to identify individual and socio-environmental factors related to the extension of healthy life expectancy and the reduction of health disparities among community-dwelling adults and to develop health promotion and care prevention strategies. This study profile aims to describe the study design and participants' profile at baseline.

Methods: The Wako Cohort Study is a prospective study of community-dwelling adults aged ≥ 40 years living in Wako City, Saitama Prefecture, Japan. The Wako Cohort Study consists of two surveys: a mail-in survey for persons aged ≥ 40 years and a face-to-face assessment (on-site survey) for those aged ≥ 65 years. The survey items were designed considering the following points: 1) life course perspective (transition from middle to old age in the life course), 2) health indifference, and 3) employment in older age.

Results: A total of 8,824 individuals participated in the mail-in survey (2,395 persons aged 40-64 years and 6,429 aged ≥ 65 years). Of those aged ≥ 65 years who returned the mail survey, 1,004 participated in the subsequent on-site survey. Men aged ≥ 65 years tended to have higher health interests than those aged 40-64 years; however, this was not true for women. In the mail-in survey, 30.4 % of those aged ≥ 65 years were employed.

Conclusions: The Wako Cohort Study is expected to provide new insights into the development of strategies to extend healthy life expectancy and reduce health disparities in Japan.