Journal of Epidemiology最新文献

Background: Disasters such as earthquakes, terrorism, and pandemics have triggered post-traumatic stress disorder (PTSD), and discrimination against the affected individuals has been linked to the development of PTSD. However, there is limited evidence regarding the association between discrimination against coronavirus disease 2019 (COVID-19) patients and probable PTSD in Japan.

Methods: We conducted a cross-sectional study utilizing a web-based questionnaire targeting individuals who had contracted the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection in Sapporo City. A total of 4,247 individuals with laboratory-confirmed SARS-CoV-2 infection spanning from February 2020 to February 2022 completed the questionnaire (response rate: 15.9%). Probable PTSD was measured using the three-item Posttraumatic Diagnostic Scale. The stratified exact logistic regression was applied to calculate the odds ratios (ORs) of probable PTSD for COVID-19-related discrimination with adjusted factors.

Results: This study included 3,626 patients who had a history of SARS-CoV-2 infection. Among them, 321 patients (8.9%) experienced COVID-19-related discrimination. The prevalence of probable PTSD was 19.6% (63/321) among the patients who experienced COVID-19-related discrimination, and 4.6% (152/3,305) among those who had not encountered such discrimination. The adjusted OR of COVID-19-related discrimination for probable PTSD was 4.68 (95% confidence interval [CI], 3.36-6.53). The population attributable fraction of probable PTSD attributable to COVID-19-related discrimination among COVID-19 patients was estimated to be 23.4% (95% CI, 21.5-25.3%).

Conclusion: The comprehensive epidemiological survey of COVID-19 patients in Japan showed that COVID-19-related discrimination was associated with a higher prevalence of probable PTSD. Mitigating discrimination could be helpful to attenuate PTSD in future pandemics.

Background: Despite the fact that competing risks are inevitable in epidemiological and clinical studies, distinctions between the hazard ratio estimated by handling competing risks as censoring and the subditribution hazard ratio are often overlooked.

Methods: We derived quantitative relationships between subdistribution hazard ratio and cause-specific hazard ratio and derive an approximate calculation method to transform the two into each other. Numerical examinations of hypothetical six scenarios and published information of a randomized clinical trial of cholesterol-lowering therapy and a registry of acute myeloid leukemia were provided.

Results: General and approximate relationships under rare event assumptions between the two types of hazard ratio were given. The approximation formula is based on a survival ratio and has two possible applications. First, one can calculate a subdistribution hazard ratio from published information. Second, this formula allows sample size estimation that takes the presence of competing risks into account.

Conclusion: The distinction between the two types of hazard ratio can be addressed by focusing on two quantities. One is how the event of interest and competing risk is rare, and the other is the survival ratio.

Background: No previous study reported an association of paternal involvement in childcare and housework with maternal physical punishment.

Methods: Using data from the Japanese Longitudinal Survey of Newborns in the 21st century (N = 38,554), we analyzed responses about fathers' involvement in childcare and housework at 6 months and mothers' spanking of children at 3.5 years. Fathers' involvement in childcare and housework was scored and categorized into quartiles. Spanking frequency was asked in the "often", "sometimes", or "not at all" categories. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the mothers' often spanking children were computed for the fathers' involvement in childcare and housework. We also stratified the association by fathers' working hours (40-49, 50-59, or ≥60 hours/week).

Results: Among the 16,373 respondents, the proportion of mothers who often spanked their children was 4.8%. Compared with the lowest quartile, a higher frequency of paternal involvement in housework was associated with a lower risk of spanking children (P_trend = 0.001). Adjustment for covariates attenuated the association, but significant association was observed in the 3^rd quartile of paternal involvement in housework (OR 0.77; 95% CI, 0.62-0.96). When the fathers worked fewer than 50 hours a week, a significant negative association was observed between the fathers' frequency of childcare and the likeliness of the mothers' spanking their children (P_trend = 0.02).

Conclusion: The fathers' active involvement in childcare and housework could reduce the mothers' physical punishment for their children.

Background: Novel tobacco product such as heated tobacco products have recently increased as a result of being promoted less harmful alternatives to cigarettes. The impact of the COVID-19 pandemic on tobacco use may differ depending on the type of tobacco.

Methods: We longitudinally investigated changes in tobacco use over a one-year period using internet-based and self-reported questionnaires among Japanese aged 15 to 79 years. The study was conducted from 2019 to 2021, with participants before the COVID-19 pandemic in February 2020 as prepandemic group and participants after that as pandemic group. Accounting for population bias, we used sampling probability weighting referring to the nationwide data. The association between cessation and the COVID-19 pandemic was evaluated separately for each type of tobacco using logistic regression analysis.

Results: After conducting sampling probability weighting, 1,920 were in the prepandemic group and 2,681 were in the pandemic group. More participants in the pandemic group than in the prepandemic group achieved cessation after one year (13.8% vs. 10.2%, p<0.001). Dual users were more likely to quit during the pandemic than prepandemic (adjusted odds ratio [aOR]=2.56, p<0.001), whereas exclusive novel tobacco users were less likely to quit during the pandemic (aOR=0.66, p=0.041). Tobacco cessation was more frequently achieved among those who had intended to quit at baseline survey among conventional tobacco users (aOR=1.77, p<0.001) and dual users (aOR=2.52, p<0.001); however, this trend was not observed among novel tobacco users (aOR=1.49, p=0.090).

Conclusions: Conventional and novel tobacco use patterns varied in response to the COVID-19 pandemic.

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 (aRRs) and 95% confidence intervals (CIs).

Results: Among 10175 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; 1.13, 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: Amidst the global coronavirus disease (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 1356.3 in 2021 to 1437.8 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.

Conclusions: 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.

BackgroundMultiple 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.MethodWe 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 (aPR) and 95%CI to clarify factors associated with MTP use among smokers, adjusting for these covariates and smoking-related factors like workplace and home smoking rules.ResultsWe 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, low education, poor psychological distress, poor self-rated health, and alcohol use 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, participants with no home smoking ban were positively associated with MTP use compared to those with a ban on both cigarettes and HTPs at home (both cigarettes and HTPs allowed aPR=1.36, 95%CI 1.15 to 1.61, HTPs only allowed aPR=1.73, 95%CI 1.43 to 2.10).ConclusionMTP 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 the 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 reported, whereas their single fatal crashes ending in their own deaths were less 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.