Journal of Epidemiology最新文献

Background: With global aging, especially in Asia, preventing pneumonia among seniors is vital. The necessity of introducing pneumococcal vaccines among the elderly has been highlighted, but there is a paucity of community-based real-world evidence on their effect. Sera Town in Hiroshima Prefecture, a super-aged community, launched a distinctive pneumococcal vaccination support project for elderly residents and conducted a 5-year follow-up survey. This study evaluates the effectiveness of this vaccination initiative.

Methods: From October 2010 to March 2015, Sera Town recruited elderly residents for PPSV23 vaccination with partial cost subsidies. Participants were surveyed annually for 5 years post-vaccination to assess pneumonia incidence, calculated on a person-years basis. Using vital statistics from 2000 to 2016, we quantified changes in mortality rates associated with the vaccination support project through an interrupted-time-series analysis.

Results: Of approximately 7,900 residents aged 65 and older, 3,422 (43%) participated in the project (median age: 84 years; range: 70-114 years; 56.7% female). Over 14,559 person-years of observation, 295 participants developed pneumonia. The post-vaccination incidence rate was 20.3 per 1,000 person-years (95% confidence interval [CI], 18.0-22.7). Interrupted time series analysis indicated a 25% reduction in Sera Town's pneumonia mortality rate post-project, reversing an annual increase of 0.23 per 1,000 population pre-project to an annual decrease of 0.04 per 1,000 population post-project.

Conclusion: This study provided real-world evidence on the association with PPSV23 vaccination on the general elderly through a community-based study. The results may be particularly useful for regions where PPSV23 serotypes are prevalent, offering insights for areas facing aging challenges.

Background: Multiple tobacco product (MTP) use is a public health concern due to their combined adverse health effects. MTP use may have increased since heated tobacco products (HTPs) became more prevalent in Japan. This study aimed to (1) estimate the recent prevalence of MTP use and clarify the associated factors compared to (2) non-smokers and (3) single-product users.

Methods: We used data from an internet survey conducted in February 2022. The prevalence of MTP use in Japan was estimated using inverse probability-weighted scores from this survey and a nationwide survey by the Japanese government. Tobacco products include six types: cigarettes, HTPs, e-cigarettes, cigars, pipe/water pipes, and smokeless tobacco products. MTP use was defined using the outcome variable (no use, single-product use, and MTP use) based on these six types of use. Using multivariate logistic regression, we calculated the adjusted odds ratios and 95% confidence intervals (CI) to clarify factors associated with MTP use compared to non-smokers, adjusting demographic variables, psychological distress, self-rated health, and alcohol use. Using multivariate Poisson regression, we calculated the adjusted prevalence ratios (aPRs) and 95% CIs to clarify factors associated with MTP use among smokers, adjusting for these covariates and smoking-related factors like workplace and home smoking rules.

Results: We analyzed 30,141 participants whose mean age was 47.8 years (standard deviation, 17.9), and 14,722 participants were male (48.8%). The estimated prevalence of MTP use was 6.8%. The most common combination of MTP use was cigarettes and HTPs. Compared to non-smokers, being younger, male, alcohol drinkers, and having low education, poor psychological distress, and poor self-rated health were factors associated with MTP use. Among smokers, workplace smoking rules, such as a partial smoking ban and no smoking ban, were not associated with MTP use compared to the indoor smoking ban. However, having no home smoking ban was positively associated with MTP use compared with a ban on both cigarettes and HTPs at home (both cigarettes and HTPs allowed aPR 1.36; 95% CI, 1.15-1.61, HTPs only allowed aPR 1.73; 95% CI, 1.43-2.10).

Conclusion: MTP users may account for a high percentage of Japanese smokers.

Background: Japan's stringent licensing policies for older drivers have not been questioned, possibly due to negative perceptions of older drivers potentially influenced by media coverage of their car crashes. We examined whether older drivers' fatal crashes are over-represented in news articles.

Methods: To examine the news coverage of fatal crashes that occurred between January 2016 and December 2020, we extracted driver- and crash-related data from articles reporting fatal crashes in the two best-selling newspapers, Yomiuri and Asahi. We obtained the corresponding data of police-reported fatal crashes during the same period. We calculated the proportion of newspaper-reported fatal crashes to police-reported fatal crashes by at-fault driver's age group and crash characteristics.

Results: Of 12,987 police-reported fatal crashes, 5,888 (45%) and 2,909 (22%) crashes were reported in Yomiuri and Asahi newspapers, respectively. Excluding 2,098 crashes where at-fault drivers or their ages were not identifiable, Yomiuri reported 39%, 35%, and 31%, and Asahi reported 20%, 16%, and 14% of fatal crashes caused by drivers aged <30 years, 30-69 years, and 70 years or older, respectively. Crashes that caused more fatalities or killed children tended to be reported regardless of at-fault drivers' age groups. Compared with young and middle-aged drivers, older drivers' fatal crashes involving child fatalities were more often reported, whereas their single fatal crashes ending in their own deaths were less often reported.

Conclusion: Older drivers' at-fault fatal crashes were not over-represented in the news coverage of overall fatal crashes, and their crashes killing themselves were under-reported.

Introduction: Relative or absolute safety of heated tobacco products (HTPs) remains unknown, while independent literature suggests that these products do not favor tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP use on conventional tobacco smoking (use transitions).

Methods: We used Pubmed/MEDLINE, Embase, and the Cochrane Library to identify all articles published up to February 2022 on HTP use. For the present review, we included all representative cross-sectional studies dealing with HTP use, and all prospective cohort studies or cross-sectional studies on conventional tobacco smoking transitions due to HTP use. From 610 non-duplicate articles, 76 were eligible (71 cross-sectional and 5 prospective cohort studies).

Results: Compared with young adults, HTP use was less frequent among middle-aged (15 studies; pooled odds ratio [OR] 0.59; 95% confidence interval [CI], 0.48-0.74) and older adults (12 studies; OR 0.17; 95% CI, 0.07-0.38). HTP use was more frequent among former (6 studies; OR 2.73; 95% CI, 1.03-7.25) and current smokers (12 studies; OR 14.53; 95% CI, 6.34-33.31). Overall, 68.3% of HTP users were dual users (n = 26). Eight studies (including 5 cohorts) showed that HTP users were more likely than non-users to start conventional cigarette smoking (2 studies; OR 6.31; 95% CI, 4.13-9.65), whereas current cigarette smokers using HTPs were less likely to quit (4 studies; OR 0.84; 95% CI, 0.80-0.89).

Conclusion: We found that HTPs are specifically popular among young generations. More than two out of three HTP users are dual users. Prospective studies consistently show that, in real life, HTPs are not effective smoking-cessation tools.

Background: Spontaneous pregnancy loss (SPL) precedes an increased risk of reduced fertility, while its etiology mechanism remains largely unknown. Liver dysfunction presenting in early pregnancy may represent a pre-existing undiagnosed liver condition affecting fetal development. Here, we investigated whether maternal abnormal liver function in early pregnancy contributed to the incidence of SPL.

Methods: Data on pregnant women were leveraged from the Maternal Health Care Information System in Shanghai City from 2017 to 2021. Liver dysfunction status was defined as having any elevated liver function biomarker levels (LFBs) at the first antenatal visit. SPL cases were defined as fetal death occurring before 28 weeks gestation. Generalized linear models were used to estimate crude and adjusted risk ratios (RRs and aRRs, respectively) and 95% confidence intervals (CIs).

Results: Among 10,175 leveraged pregnant women, 918 (9.0%) SPL cases were recorded. Maternal liver dysfunction in early pregnancy was associated with a 49% increased risk of SPL (RR 1.49; 95% CI, 1.22-1.84). This positive association persisted after adjustment for covariates (aRR 1.55; 95% CI, 1.26-1.92). Higher γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were also linked with increased risk of SPL in a linear fashion (aRRs per 1 standard deviation increase: 1.13; 95% CI, 1.08-1.17 and 1.13; 95% CI, 1.07-1.20, respectively). Similar magnitudes of associations were observed between normal weight and overweight pregnant women in subgroup analysis.

Conclusion: We provide new evidence that maternal abnormal liver function in early pregnancy, as well as GGT and ALP, predisposes to an increased risk of SPL.

Background: Although both a lower and a higher body mass index (BMI) are reportedly associated with head and neck cancer (HNC), reports from Asia are scarce. Moreover, evidence regarding the association between height and HNC is limited.

Methods: We investigated associations between BMI, height, and the incidence of HNC among 102,668 participants (49,029 men and 53,639 women) aged 40-69 years in the Japan Public Health Center-based Prospective Study. We followed participants from 1990 to 2013. We conducted a Cox proportional hazards regression analysis, which included adjustment for potential confounders, such as smoking status. Baseline weight and height information were self-reported.

Results: Over an average follow-up of 18.7 years, 311 HNC cases were newly diagnosed. Lower BMI was significantly associated with HNC, with hazard ratios (HR) of 2.75 (95% confidence interval [CI], 1.63-4.64) for <18.5 kg/m² and 1.63 (95% CI, 1.15-2.30) for 18.5-20.9 kg/m² compared to 23-24.9 kg/m². Increased risk was suggested for higher BMI, with an HR of 1.30 (95% CI, 0.84-2.00) for ≥27.5 kg/m². This trend was also observed in quadratic models. Results were similar among never-smokers. Meanwhile, only lower BMI showed a strong association with HNC risk among former and current smokers (HR 3.09; 95% CI, 1.54-6.20 for <18.5 kg/m² compared to 23-24.9 kg/m²). Height showed no association with HNC.

Conclusion: Lower BMI was significantly associated with HNC risk, while increased HNC risk was suggested in higher BMI among never-smokers. Among former and current smokers, only lower BMI was associated with HNC risk.

In epidemiological or clinical studies with follow-ups, data tables generated and processed for statistical analysis are often of the "wide-format" type, consisting of one row per individual. However, depending on the situation and purpose of the study, they may need to be transformed into the "long-format" type, which allows for multiple rows per individual. This tutorial clarifies the typical situations wherein researchers are recommended to split follow-up times to generate long-format data tables. In such applications, the major analytical aims consist of (i) estimating the outcome incidence rates or their ratios between ≥2 groups, according to specific follow-up time periods; (ii) examining the interaction between the exposure status and follow-up time to assess the proportional hazards assumption in Cox models; (iii) dealing with time-varying exposures for descriptive or predictive purposes; (iv) estimating the causal effects of time-varying exposures while adjusting for time-varying confounders that may be affected by past exposures; and (v) comparing different time periods within the same individual in self-controlled case-series analyses. This tutorial also discusses how to split follow-up times according to their purposes in practical settings, providing example codes in Stata, R, and SAS.

Background: Informal caregiving of older parents adversely affects the mental health of family caregivers. However, the psychological effects of caregiving cessation and the trajectories of these effects have rarely been examined in Japan. This study addresses this gap.

Methods: Based on a 17-wave nationwide population-based survey in Japan, we analyzed longitudinal data from 8,280 individuals aged 50-59 years in 2005 who started caring for their older parents in 2006 or later and ceased caregiving by 2021. We identified the timings of caregiving onset and cessation and examined the trajectory of psychological distress (PD), defined as a Kessler score ≥5 on the 6-item Kessler scale (range 0-24). Linear mixed models were used to assess the trajectory of PD that evolved after caregiving cessation over the subsequent 3 years.

Results: After adjusting for covariates, the probability of PD decreased by 5.6 percentage points (from 40.8%; 95% confidence interval [CI], 4.1-7.0%) for female caregivers and by 1.9 percentage points (from 31.7%; 95% CI, 0.3-3.5%) for male caregivers at caregiving cessation, remaining stable in subsequent years. For women, higher PD risks related to co-residence with a care recipient diminished quickly upon cessation of caregiving, while the unfavorable impacts of no social activity, extended duration of care, and long-hour daily care persisted in subsequent years. For male caregivers, the impact was generally more limited.

Conclusion: These results suggest that changes in mental health following caregiving cessation warrant serious consideration when developing support programs for former family caregivers.