Journal of Epidemiology
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Volume 21 , Issue 4
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Editorial
Original Article
  • Tulio C Lins, Rodrigo G Vieira, Breno S Abreu, Paulo Gentil, Ricardo M ...
    Volume 21 (2011) Issue 4 Pages 240-245
    Released: July 05, 2011
    [Advance publication] Released: April 16, 2011
    JOURNALS FREE ACCESS
    Background: Population stratification is the main source of spurious results and poor reproducibility in genetic association findings. Population heterogeneity can be controlled for by grouping individuals in ethnic clusters; however, in admixed populations, there is evidence that such proxies do not provide efficient stratification control. The aim of this study was to evaluate the relation of self-reported with genetic ancestry and the statistical risk of grouping an admixed sample based on self-reported ancestry.
    Methods: A questionnaire that included an item on self-reported ancestry was completed by 189 female volunteers from an admixed Brazilian population. Individual genetic ancestry was then determined by genotyping ancestry informative markers.
    Results: Self-reported ancestry was classified as white, intermediate, and black. The mean difference among self-reported groups was significant for European and African, but not Amerindian, genetic ancestry. Pairwise fixation index analysis revealed a significant difference among groups. However, the increase in the chance of type 1 error was estimated to be 14%.
    Conclusions: Self-reporting of ancestry was not an appropriate methodology to cluster groups in a Brazilian population, due to high variance at the individual level. Ancestry informative markers are more useful for quantitative measurement of biological ancestry.
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  • Yuko Minami, Yasuhiko Hirabayashi, Chisato Nagata, Tomonori Ishii, Hid ...
    Volume 21 (2011) Issue 4 Pages 246-254
    Released: July 05, 2011
    [Advance publication] Released: April 23, 2011
    JOURNALS FREE ACCESS
    Background: Intakes of selected vitamins and dietary fiber may influence the clinical course of systemic lupus erythematosus (SLE). Using a cohort study method, we investigated the associations of dietary intake of vitamin B6 and B12, folate, and dietary fiber with the risk of active disease and atherosclerotic vascular events in SLE.
    Methods: The study included female SLE patients in the Miyagi Lupus Cohort, which was founded in 1995. Dietary nutrients at baseline were estimated by a semiquantitative food frequency questionnaire. The association of each nutrient intake with the risk of active disease was investigated in 216 patients who had inactive disease at baseline. The association with atherosclerotic vascular events was assessed in 196 women who had inactive disease and no history of atherosclerotic diseases at baseline.
    Results: Forty-three cases of active disease were identified during 9966 person-months of follow-up (1995–1999). During 19 575 person-months of follow-up (1995–2005), 20 atherosclerotic vascular events were documented. The Cox proportional hazards model revealed an inverse association between vitamin B6 intake and the risk of active disease (hazard ratio for the highest as compared with the lowest tertile, 0.41; 95% confidence interval, 0.18–0.97; P for trend = 0.04). An inverse association was also found for dietary fiber intake (P for trend = 0.01). However, no significant association was observed between intakes of these nutrients and the risk of atherosclerotic vascular events.
    Conclusions: Higher intake of vitamin B6 and dietary fiber may prevent the occurrence of active disease in SLE.
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  • Kiwamu Nagoshi, Atsuko Sadakane, Yosikazu Nakamura, Masahito Yamada, H ...
    Volume 21 (2011) Issue 4 Pages 255-262
    Released: July 05, 2011
    [Advance publication] Released: May 28, 2011
    JOURNALS FREE ACCESS
    Background: Prion diseases are untreatable, progressive, and fatal brain disorders that occur worldwide, and the annual incidence rate is approximately 1 case per 1 million people. The duration of these diseases in Japan is unclear.
    Methods: Based on data from 1 April 1999 through 4 September 2008 provided by the Japanese Creutzfeldt-Jakob disease (CJD) surveillance program, we analyzed disease duration and its relationship with clinical features. Duration was assumed to be the time from disease onset to death.
    Results: Evaluation by the surveillance committee indicated that during the observed period 1128 individuals received a diagnosis of prion disease and were registered in the surveillance program. Mean disease duration in the 855 patients who died was 17.4 months. Overall, 46.0% of patients died within 1 year and 77.2% died in less than 2 years. Among those with sporadic Creutzfeldt-Jakob disease, which represented 77.0% of cases, mean disease duration was 15.7 months, while that of patients surveyed by the European Creutzfeldt Jakob Disease Surveillance Network (EUROCJD) was only 5 months.
    Conclusions: Disease duration among Japanese with prion diseases was much longer than that of patients in Western countries conducting surveillance of prion diseases. This finding suggests that the characteristics of the system for providing life-sustaining treatment for patients with fatal, progressive diseases in Japan are related to the longer duration of these illnesses.
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  • In-Hwan Oh, Youngtae Cho, So-Youn Park, Changmo Oh, Bong-Keun Choe, Jo ...
    Volume 21 (2011) Issue 4 Pages 263-270
    Released: July 05, 2011
    [Advance publication] Released: April 30, 2011
    JOURNALS FREE ACCESS
    Background: Despite the importance of obesity and its association with socioeconomic status, little is known about this condition in Korean adolescents. We examined the relationship between obesity in Korean adolescents and several socioeconomic variables and compared the association of obesity with conventional and subjective indicators of socioeconomic status.
    Methods: The study comprised 60 643 Korean adolescents aged 12 to 18 years who participated in the 2007 Korea Youth Risk Behavior Web-Based Survey. The dependent variable, obesity, and the independent variables of parental education levels, family affluence scale, subjective family economic status, and subjective school achievement were collected by using a self-administered anonymous questionnaire. Data on behavioral and psychological characteristics were also collected and used as confounding factors. Multivariate logistic regression was conducted to identify associations between socioeconomic status and obesity.
    Results: In the descriptive analysis, adolescents with low parental education, low family affluence level, low subjective family economic status, and low subjective school achievement were more likely to be obese. However, after controlling for other risk factors in multivariate analysis, only the associations with subjective family economic status and subjective school achievement remained statistically significant.
    Conclusions: Our results provide further evidence that the prevalent pattern of obesity in Korean adolescents—i.e., the inverse relationship between obesity and socioeconomic status—is similar to that in developed countries. In addition, these findings support the hypothesis that, as compared with objective socioeconomic status, subjective social status is more closely related to obesity.
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  • Fuqiang Cui, Huiming Luo, Lei Zhou, Dapeng Yin, Canjun Zheng, Dingming ...
    Volume 21 (2011) Issue 4 Pages 271-277
    Released: July 05, 2011
    [Advance publication] Released: June 04, 2011
    JOURNALS FREE ACCESS
    Background: Pandemic influenza A (H1N1) virus emerged in North America in April 2009 and spread globally. We describe the epidemiology and public health response to the first known outbreak of 2009 H1N1 in a train, which occurred in June 2009 in China.
    Methods: After 2 provinces provided initial reports of 2009 H1N1 infection in 2 persons who had travelled on the same train, we conducted a retrospective epidemiologic investigation to collect information from the passengers, crew members, contacts, and health care providers. We explored the source of infection and possible routes of transmission in the train. All cases were confirmed by real-time reverse transcription polymerase chain reaction testing.
    Results: Train #1223 traveled 40 hours, made 28 stops in 4 Chinese provinces, and boarded 2555 passengers, who logged a total of 59 144 person-hours of travel time. Nineteen confirmed 2009 H1N1 cases were identified. Of these, 13 were infected and developed symptoms on the train and 6 occurred among contacts who developed illness during medical monitoring. In addition, 3 asymptomatic cases were identified based on RT-PCR testing of respiratory swabs from contacts. The attack rate among contacts of confirmed cases in the same car was higher than that among contacts in other cars (3.15% vs. 0%, P < 0.001). Attack rates increased with exposure time.
    Conclusions: Close contact and long exposure may have contributed to the transmission of 2009 H1N1 virus in the train. Trains may have played an important role in the 2009 influenza pandemic.
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  • Christy Pu, Gao-Jun Tang, Nicole Huang, Yiing-Jenq Chou
    Volume 21 (2011) Issue 4 Pages 278-284
    Released: July 05, 2011
    [Advance publication] Released: May 21, 2011
    JOURNALS FREE ACCESS
    Background: Previous research has investigated differences in the predictive power of self-rated health (SRH) for mortality based on socioeconomic status (SES). However, these studies mainly assessed adults in the general population and did not focus specifically on elderly adults. In addition, this predictive power has never been evaluated using subjective SES, which is an important measure of SES in elderly adults.
    Methods: This study used data from the Survey of the Health and Living Status of the Middle Aged and the Elderly in Taiwan (SHLS) conducted by the Bureau of Health Promotion, Taiwan. The SHLS is a 15-year longitudinal survey based on a nationally representative sample. It was initiated in 1989 with 4049 respondents aged 60 years or older. Both education and subjective financial satisfaction were used as SES measures in the present study. A Cox regression model was used to estimate the interaction between SRH and SES for 3829 individuals without missing data.
    Results: As compared with those who reported their health as good, those who reported their health as poor and their education as high had a higher hazard ratio (hazard ratio = 1.97, 95% confidence interval = 1.35–2.88) for 6–15-year mortality, after adjusting for depressive symptoms, activities of daily living, and instrumental activities of daily living. This HR was significantly higher than those for adults with middle (1.16, 0.93–1.44) and low (1.27, 1.05–1.54) education, based on the χ2 test (P < 0.05 for both comparisons). A similar pattern was observed when financial satisfaction was used as the SES measure. However, the pattern was attenuated when using 5-year mortality from baseline.
    Conclusions: The use of SRH as a single health measure in elderly adults may yield inconsistent results across different SES groups, especially when used as a predictor of a longer-term mortality. This is true regardless of whether objective or subjective measures of SES are used, where both are important measures of SES in elderly adults.
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  • Francesca Valent, Milena Horvat, Darja Mazej, Vekoslava Stibilj, Fabio ...
    Volume 21 (2011) Issue 4 Pages 285-292
    Released: July 05, 2011
    [Advance publication] Released: May 28, 2011
    JOURNALS FREE ACCESS
    Background: Low selenium (Se) status is associated with several diseases. International organizations have proposed intakes of Se for general populations, including infants. Studies of the association of Se concentration in breast milk and maternal diet have yielded inconsistent results. We evaluated the relation between the intake of food items during pregnancy and Se concentration in human milk after delivery and compared infant intake of Se from breast milk with the recommended intakes.
    Methods: This cross-sectional study was part of the baseline assessment of a prospective cohort of Italian mother–child pairs enrolled in 1999–2001. Se concentration was measured in the milk of 100 women included in the cohort and correlated with the intake of food items during pregnancy and lactation as reported in a food frequency questionnaire.
    Results: Among foods consumed in pregnancy, only eggs had a positive, but weak, correlation with Se concentration in milk (r = 0.20, P = 0.04). Fish intake during lactation was also weakly correlated with Se in milk (r = 0.21, P = 0.04). Se content of breast milk in our population was lower than that noted in other international studies; however, very few children who were exclusively breastfed were estimated not to have met the recommended Se intake.
    Conclusions: Future research should aim to verify whether infants in this part of Italy still meet the recommended nutrient intake of Se and to assess the influence of the concurrent diet of lactating mothers on the Se content of their milk.
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  • Dambadarjaa Davaalkham, Yosikazu Nakamura, Davaakhuu Baigalmaa, Gomboj ...
    Volume 21 (2011) Issue 4 Pages 293-298
    Released: July 05, 2011
    [Advance publication] Released: June 18, 2011
    JOURNALS FREE ACCESS
    Background: Kawasaki disease (KD) has been reported in many countries. However, the incidence of KD in Mongolia is not known. This is the first report of incident cases of KD in Mongolia, which were identified using data from 2 nationwide surveys.
    Methods: Two nationwide retrospective surveys were conducted: medical histories were collected from patients aged 0 to 16 years who were hospitalized countrywide between 1996 and 2008. Hospital records for these patients were also reviewed. Nationwide training seminars on KD were conducted before each survey.
    Results: For the nationwide surveys, the participation rates among all hospitals with pediatric wards were 97% and 94%. Inpatient medical histories from 1996 through 2008 were reviewed, and, among children younger than 16 years, 9 patients with KD were investigated. The age of KD patients ranged from 1.4 to 14 years; 7 of 9 patients were male. Six (67%) patients fulfilled all 6 clinical diagnostic criteria; the other 3 (33%) were defined as having KD based on the presence of 5 such criteria. Fever persisting 5 or more days, bilateral conjunctival congestion, and changes of the lips and oral cavity were the most common symptoms, and cervical lymphadenopathy was the least common symptom. Cardiac sequelae developed in 5 of the patients, 4 of whom were older than 10 years.
    Conclusions: The results of these nationwide surveys reveal that KD cases do exist in Mongolia. However, knowledge of KD among Mongolian pediatricians is likely to be poor. Thus, there is a need to augment their understanding to improve management of KD patients. Further studies are crucial to clarify the epidemiologic characteristics of KD in Mongolia.
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  • Kaori Fujii, Chisato Nagata, Kozue Nakamura, Toshiaki Kawachi, Naoyosh ...
    Volume 21 (2011) Issue 4 Pages 299-304
    Released: July 05, 2011
    [Advance publication] Released: June 04, 2011
    JOURNALS FREE ACCESS
    Background: Several studies have reported the prevalence of tinnitus among general populations; however, most of these studies were conducted in Europe or the United States. We estimated the prevalence of tinnitus among the general adult population in Japan.
    Methods: The subjects were participants in the Takayama Study, a population-based cohort study. In 2002, a total of 14 423 adults (6450 men and 7973 women) aged 45 to 79 years responded to a self-administered questionnaire that inquired about history of tinnitus, which was defined as episodes lasting longer than 5 minutes, excluding those occurring immediately after noise exposure. Respondents were also asked about the loudness and severity of tinnitus.
    Results: Overall, 11.9% of the subjects reported having tinnitus; the percentage was somewhat higher among men (13.2%) than women (10.8%). The prevalence of tinnitus increased with age in both sexes. Approximately 0.4% of the overall population reported that tinnitus had a severe effect on their ability to lead a normal life. Medical history of hypertension or ischemic heart diseases, use of steroid or antihypertensive medication, and employment as a factory worker or machine operator were associated with tinnitus status in both men and women.
    Conclusions: Tinnitus is relatively common in Japan. Although the use of various definitions of tinnitus in different studies makes it difficult to compare prevalence among populations, the present prevalence estimate was similar to those in studies in Europe and the United States.
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Short Communication
  • Shinya Hayasaka, Yosuke Shibata, Tatsuya Noda, Yasuaki Goto, Toshiyuki ...
    Volume 21 (2011) Issue 4 Pages 305-308
    Released: July 05, 2011
    [Advance publication] Released: April 09, 2011
    JOURNALS FREE ACCESS
    Background: Bathing is a deeply ingrained custom among Japanese; however, data on the incidence rate of symptoms and accidents during bathing have not yet been reported for the Japanese general public.
    Methods: We conducted a population-based cross-sectional study of 617 Japanese adults who attended a specialized health checkup. Participants completed a self-administered questionnaire to assess weekly frequencies of bathtub bathing and showering and the frequency of symptoms/accidents (falling, loss of consciousness, and other) during these activities in the past year. We calculated the incidence rates of accidents per 10 000 baths/showers and 95% confidence intervals (CIs) and compared the clinical characteristics of participants who had symptoms/accidents with those who did not.
    Results: The incidence rates of accidents per 10 000 bathtub baths and showers were 0.43 (95% CI: 0.22–0.84) and 0.24 (95% CI: 0.04–1.37). Although these rates are low, there were 740 000 bathtub bathing-related accidents in Japan, due to the fact that bathing is an almost-daily habit. There was no significant difference in clinical characteristics between groups
    Conclusions: We collected basic information on the incidence of bathing-related accidents in Japan. Falls and loss of consciousness during bathing or showering can potentially lead to a serious accident, so the general public should be educated about the possibility of such accidents during bathing.
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  • Truong-Minh Pham, Tatsuhiko Kubo, Yoshihisa Fujino, Kotaro Ozasa, Shin ...
    Volume 21 (2011) Issue 4 Pages 309-312
    Released: July 05, 2011
    [Advance publication] Released: May 28, 2011
    JOURNALS FREE ACCESS
    Background: We used disability-adjusted life years (DALY) to estimate the cancer burden in Japan for the year 2000.
    Methods: We estimated years of life lost (YLL) by using mortality data and years lived with disability (YLD) by using incidence data. The DALY for cancer was calculated as the sum of YLL and YLD.
    Results: For all cancers combined, 2 733 884 years of DALY were estimated in men and 2 091 874 years were estimated in women. Among men, stomach and lung cancers accounted for the largest proportions of DALY, followed by liver cancer and colorectal cancer. Among women, the greatest contributors to DALY were stomach, colorectal, breast, and lung cancers.
    Conclusions: The national cancer burden in Japan was expressed in terms of DALY, which might be useful in assessing future changes with respect to mortality and morbidity in Japan.
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