Journal of Epidemiology最新文献

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.

Background: Several studies reported an association between the number of teeth and the incidence of hip fractures in observational studies, mainly in middle-aged adults. This retrospective cohort study aimed to clarify the association between the number of teeth and the incidence of hip fractures.

Methods: In this retrospective cohort study, a total of 256,772 participants aged 75 years or older who underwent public dental checkups in Japan were evaluated. Exposure in this study was the number of teeth, with a maximum number of 28, excluding third molars. Outcome measures were the incidence of hip fractures needing surgery, using the Japanese procedure codes in medical claims.

Results: A total of 190,998 participants met the inclusion criteria and were available for analysis. Adjusted Fine and Gray models identified a significant association between the number of teeth, including sound, filled, and decayed teeth, and the incidence of hip fractures among women but not for men. The continuous net reclassification improvement (NRI) of the sound and filled teeth count model increased by 0.078 compared with that of the sound, filled, and decayed teeth count model among women.

Conclusions: The number of sound and filled teeth predicted the risk of hip fractures in women, whereas no association was observed between the number of teeth and hip fractures in men.

Background: Healthy life expectancy (HLE) is a population health indicator that is widely used in developed countries, but little is known about its relationships with combinations of non-communicable disease risk factors. This study was conducted to examine HLE at age 65 according to combinations of blood pressure levels, body mass index, smoking status, and diabetes mellitus (DM) in a Japanese population.

Methods: In a nationwide cohort study (NIPPON DATA90), data on these risk factors were obtained from participants in 1990 through physical examinations, blood tests, interviews, and questionnaires. Subsequently, participants aged ≥65 years underwent surveys on activities of daily living in 1995 and 2000, and multistate life tables were used to calculate combination-specific HLEs and their 95% confidence intervals (CIs).

Results: The study population comprised 6,569 participants (men: 2,797; women: 3,772) who were followed-up until 2010. HLE at age 65 in men with grade II/III hypertension, obesity, current smoker status, and DM (HLE: 12.9 years, 95% CIs: 12.9-13.0 years) was 9.7 years shorter than men without these risk factors (HLE: 22.6 years, 95% CIs: 22.4-22.8 years). Similarly, HLE at age 65 in women with grade II/III hypertension, obesity, current smoker status, and DM (HLE: 16.2 years, 95% CIs: 15.9-16.5 years) was 10.1 years shorter than women without these risk factors (HLE: 26.3 years, 95% CIs: 26.3-26.3 years).

Conclusion: The large discrepancies in HLEs underscore the impact of non-communicable disease risk factors, which should be considered when formulating health interventions to improve HLE in Japanese older adults.

Introduction: Relative or absolute safety of heated tobacco products (HTP) remains unknown, while independent literature suggests that these products do not favour 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 (pooled odds ratio, OR=0.59; 95% confidence interval, CI: 0.48-0.74; number of studies, n=15) and older adults (OR=0.17; 95%-CI: 0.07-0.38; n=12). HTP use was more frequent among former (OR=2.73; 95%-CI: 1.03-7.25; n=6) and current smokers (OR=14.53; 95%-CI: 6.34-33.31; n=12). 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 (OR=6.31; 95%-CI: 4.13-9.65; n=2), whereas current cigarette smokers using HTPs were less likely to quit (OR=0.84; 95%-CI: 0.80-0.89; n=4).

Conclusions: 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.