Journal of Epidemiology
Online ISSN : 1349-9092
Print ISSN : 0917-5040
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Volume 23 , Issue 1
Showing 1-12 articles out of 12 articles from the selected issue
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Editorial
Review Article
  • Derek R. Smith, Koji Wada
    Volume 23 (2013) Issue 1 Pages 4-11
    Released: January 05, 2013
    [Advance publication] Released: November 10, 2012
    JOURNALS FREE ACCESS
    Background: Although there has been a downward trend in smoking rates among medical doctors in recent years, rates have been higher among Japanese doctors when compared internationally.
    Methods: We extensively reviewed all published English- and Japanese-language articles that reported the smoking rates of Japanese doctors.
    Results: A total of 36 articles were examined, most of which had been conducted as postal surveys, usually by a national, prefectural, or local medical association. Sample sizes ranged from 17 to 11 773, and response rates ranged from 33% to 91%. National surveys conducted between 1965 and 2009 suggest that there has been a statistically significant (P < 0.0001) decline in smoking rates among Japanese doctors (from around 68% to 16% among males and from 19% to 5% among females).
    Conclusions: Overall, the published data reveal a significant decline in smoking rates among Japanese doctors since 1965, especially among men. Although less than one-fifth of Japanese male doctors now smoke, more work needs to be done in tobacco control to help further reduce the burden of smoking, especially in medical schools.
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Original Article
  • Hidenobu Takami, Mariko Nakamoto, Hirokazu Uemura, Sakurako Katsuura, ...
    Volume 23 (2013) Issue 1 Pages 12-20
    Released: January 05, 2013
    [Advance publication] Released: October 06, 2012
    JOURNALS FREE ACCESS
    Background: It is unclear whether consumption of coffee and green tea is associated with metabolic syndrome.
    Methods: This cross-sectional study enrolled 554 adults who had participated in the baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study in Tokushima Prefecture, Japan. Consumption of coffee and green tea was assessed using a questionnaire. Metabolic syndrome was diagnosed using the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the Japan Society for the Study of Obesity (JASSO). Logistic regression analysis was used to examine the association between consumption of coffee and green tea and prevalence of metabolic syndrome and its components.
    Results: After adjustment for sex, age, and other potential confounders, greater coffee consumption was associated with a significantly lower prevalence of metabolic syndrome, as defined by NCEP ATP III criteria (P for trend = 0.03). Participants who drank more coffee had a lower odds ratio (OR) for high serum triglycerides (P for trend = 0.02), but not for increased waist circumference or high blood pressure. Using JASSO criteria, moderate coffee consumption (1.5 to <3 cups/day) was associated with a significantly lower OR for high plasma glucose (OR = 0.51, 95% CI 0.28–0.93). Green tea consumption was not associated with the prevalence of metabolic syndrome or any of its components.
    Conclusions: Coffee consumption was inversely correlated with metabolic syndrome diagnosed using NCEP ATP III criteria, mainly because it was associated with lower serum triglyceride levels. This association highlights the need for further prospective studies of the causality of these relationships.
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  • Yoshiharu Fukuda, Ayako Hiyoshi
    Volume 23 (2013) Issue 1 Pages 21-27
    Released: January 05, 2013
    [Advance publication] Released: December 01, 2012
    JOURNALS FREE ACCESS
    Background: Socioeconomic inequalities in health and social determinants of health are important issues in public health and health policy. We investigated associations of cardiovascular risk factors with household expenditure (as an indicator of socioeconomic status) and marital status in Japan.
    Methods: We combined data from 2 nationally representative surveys—the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, 2003–2007—and analyzed sex-specific associations of household expenditure quartiles and marital status with cardiovascular risk factors, including obesity, hypertension, dyslipidemia, and diabetes, among 6326 Japanese adults (2664 men and 3662 women) aged 40 to 64 years.
    Results: For men, there was no statistically significant association between household expenditure and cardiovascular risk factors. For women, lower household expenditure was significantly associated with obesity, hypertension, diabetes, and the presence of multiple risk factors: the ORs for the lowest versus the highest quartile ranged from 1.39 to 1.71. In a comparison of married and unmarried participants, the prevalence of cardiovascular risk factors was higher among married women and lower among married men.
    Conclusions: Lower socioeconomic status, as indicated by household expenditure, was associated with cardiovascular risk factors in Japanese women. Socioeconomic factors should be considered in health promotion and prevention of cardiovascular disease.
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  • Masakazu Nakamura, Masahiko Kiyama, Akihiko Kitamura, Yoshinori Ishika ...
    Volume 23 (2013) Issue 1 Pages 28-34
    Released: January 05, 2013
    [Advance publication] Released: October 27, 2012
    JOURNALS FREE ACCESS
    Background: We developed a monitoring system that uses total errors (TEs) to evaluate measurement of blood chemistry data from the National Health and Nutrition Survey (NHNS) and Prefectural Health and Nutrition Surveys (PHNS).
    Methods: Blood chemistry data from the NHNS and PHNS were analyzed by SRL, Inc., a commercial laboratory in Tokyo, Japan. Using accuracy and precision from external and internal quality controls, TEs were calculated for 14 blood chemistry items during the period 1999–2010. The acceptable range was defined as less than the upper 80% confidence limit for the median, the unacceptable range as more than twice the cut-off value of the acceptable range, and the borderline range as the interval between the acceptable and unacceptable ranges.
    Results: The TE upper limit for the acceptable and borderline ranges was 5.7% for total cholesterol (mg/dL), 9.9% for high-density lipoprotein cholesterol (mg/dL), 10.0% for low-density lipoprotein cholesterol (mg/dL), 10.4% for triglycerides (mg/dL), 6.6% for total protein (g/dL), 7.6% for albumin (g/dL), 10.8% for creatinine (mg/dL), 6.5% for glucose (mg/dL), 9.7% for γ-glutamyl transpeptidase (U/L), 7.7% for uric acid (mg/dL), 8.7% for urea nitrogen (mg/dL), 9.2% for aspartate aminotransferase (U/L), 9.5% for alanine aminotransferase (U/L), and 6.5% for hemoglobin A1c (%).
    Conclusions: This monitoring system was established to assist health professionals in evaluating the continuity and comparability of NHNS and PHNS blood chemistry data among survey years and areas and to prevent biased or incorrect conclusions.
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  • Charles Tzu-Chi Lee, Yi-Wen Chiu, Kai-Chen Wang, Chi-Shin Hwang, Kuan- ...
    Volume 23 (2013) Issue 1 Pages 35-40
    Released: January 05, 2013
    [Advance publication] Released: October 27, 2012
    JOURNALS FREE ACCESS
    Background: Amyotrophic lateral sclerosis (ALS) is a rare disease in Taiwan; thus, estimation of ALS mortality is difficult. We evaluated factors associated with ALS survival in Taiwan.
    Methods: The study enrolled 1149 Taiwanese with a primary diagnosis of ALS during 1999–2008. Follow-up information was available for all patients; mean (SD) duration of follow-up was 2.91 (2.62) years. Medical interventions, including noninvasive positive pressure ventilation (NIPPV), tracheotomy, gastrostomy, and riluzole, were included in time-dependent survival analysis.
    Results: Of the 1149 ALS patients, 438 (38.12%) died during follow-up. Mortality in the first year was 16%, which was 13 times (95% CI 11.1–15.2) the age- and sex-standardized rate of the general population in Taiwan. The average annual crude mortality rate was 13.1% (person-years). Factors significantly associated with increased mortality were male sex, advanced age, rural residence, lower economic status, no tracheotomy, and no riluzole treatment. Significant predictors of long-term versus average survival were younger age at diagnosis, being a dependent or receiving social welfare, and NIPPV support. Significant predictors of short-term versus average survival were older age, being employed, no tracheotomy, and no riluzole use.
    Conclusions: The results support the use of riluzole to improve ALS survival. Patients who received riluzole and underwent tracheotomy had the best survival.
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  • Yoshihisa Fujino, Ryuichi Tanaka, Tatsuhiko Kubo, Shinya Matsuda
    Volume 23 (2013) Issue 1 Pages 41-46
    Released: January 05, 2013
    [Advance publication] Released: December 15, 2012
    JOURNALS FREE ACCESS
    Background: This cohort study examined the association between taxation categories of long-term care insurance premiums and survival among elderly Japanese.
    Methods: A total of 3000 participants aged 60 years or older were randomly recruited in Y City, Japan in 2002, of whom 2964 provided complete information for analysis. Information on income level, mobility status, medical status, and vital status of each participant was collected annually from 2002 to 2006. Follow-up surveys on survival were conducted until August 2007. Hazard ratios (HRs) were estimated by a Cox model, using taxation categories at baseline. In these analyses, age-adjusted and age- and mobility-adjusted models were used.
    Results: A significantly higher mortality risk was seen only in the lowest taxation category among men: as compared with men in the second highest taxation category, the HR in the lowest category was 2.53 (95% CI, 1.26–5.08, P = 0.009). This significant association between taxation category and mortality was lost after adjustment for mobility. There was no other difference in mortality among taxation categories in men or women.
    Conclusions: The present findings only partly supported our hypothesis that taxation category is a good indicator of socioeconomic status in examining health inequalities among elderly Japanese.
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  • Imako Kondo, Toshiyuki Ojima, Mieko Nakamura, Shinya Hayasaka, Atsushi ...
    Volume 23 (2013) Issue 1 Pages 47-54
    Released: January 05, 2013
    [Advance publication] Released: December 01, 2012
    JOURNALS FREE ACCESS
    Background: Recent Western studies show an inverse association between milk and dairy product intake and cardiovascular disease (CVD). We studied the association between consumption of milk and dairy products and CVD death in Japan.
    Methods: Men and women aged 30 years or older were followed for 24 years. All had participated in a national nutrition survey in 300 health districts throughout Japan in 1980. The Cox proportional hazards model was used to assess mortality risk according to tertiles of milk and dairy product intake, with the high consumption group as reference. Hazard ratios (HRs) per 100-g/day increase in consumption were also estimated.
    Results: During the 24-year follow-up period, there were 893 CVD deaths, 174 deaths from coronary heart disease (CHD), and 417 stroke deaths among 9243 participants. For women, the HRs for death from CVD, CHD, and stroke in the low consumption group were 1.27 (95% CI: 0.99–1.58; P for trend = 0.045), 1.67 (0.99–2.80; P = 0.02), and 1.34 (0.94–1.90; P = 0.08), respectively, after adjustment for age, body mass index, smoking status, alcohol drinking habits, history of diabetes, use of antihypertensives, work category, and total energy intake. With each 100-g/day increase in consumption of milk and dairy products, HRs tended to decrease for deaths from CVD (HR, 0.86; 95% CI, 0.74–0.99), CHD (0.73; 0.52–1.03), and stroke (0.81; 0.65–1.01) in women. No significant association was observed in men.
    Conclusions: Consumption of milk and dairy products was inversely associated with CVD death among women in Japan.
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  • Toshitaka Morishima, Yuichi Imanaka, Tetsuya Otsubo, Kenshi Hayashida, ...
    Volume 23 (2013) Issue 1 Pages 55-62
    Released: January 05, 2013
    [Advance publication] Released: November 24, 2012
    JOURNALS FREE ACCESS
    Background: The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women.
    Methods: This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors.
    Results: We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum.
    Conclusions: We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.
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Statistical Data
  • Syuichi Ooki
    Volume 23 (2013) Issue 1 Pages 63-69
    Released: January 05, 2013
    [Advance publication] Released: November 03, 2012
    JOURNALS FREE ACCESS
    Background: Most twins after assisted reproductive technology (ART) are dizygotic. Analysis of dizygotic twin pairs is useful in assessing familial aggregation in the development of birth defects.
    Methods: Using nationwide post-ART data from the Japan Society of Obstetrics and Gynecology, recurrence risk ratios (RRRs)—defined as probandwise concordance rates of birth defects in twins divided by the prevalence of birth defects in the general population—were calculated as indicators of familial aggregation. Birth defects were then reclassified according to the ICD-10 categories corresponding to codes Q00–Q99. From 2004 to 2009, there were 17 258 twin pregnancies.
    Results: At least 1 birth defect was noted in 236 twin pairs: 11 concordant and 225 discordant pairs. Regarding major organ systems, high probandwise concordance rates were observed for congenital malformations of eye, ear, face, and neck (11.8%), cleft lip and cleft palate (10.5%), congenital malformations of the nervous system (9.8%), and other congenital malformations of the digestive system (9.5%). High RRRs were observed for congenital malformations of eye, ear, face, and neck (RRR = 233), specifically other congenital malformations of the ear (RRR = 449); congenital malformations of the great arteries (RRR = 235), specifically those of the patent ductus arteriosus (RRR = 530); and for cleft lip and cleft palate (RRR = 208), specifically cleft palate with cleft lip (RRR = 609). The probandwise concordance rate of any birth defect (8.9%) was nearly identical to the approximated recurrence risk of sib-pairs (8.8%), which assumed multifactorial inheritance.
    Conclusions: The present findings suggest that familial aggregation is a factor in some birth defects.
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  • Shinji Nakahara, Masao Ichikawa
    Volume 23 (2013) Issue 1 Pages 70-73
    Released: January 05, 2013
    [Advance publication] Released: October 20, 2012
    JOURNALS FREE ACCESS
    Introduction: On 11 March 2011, a magnitude 9.0 earthquake caused a huge tsunami that struck Northeast Japan, resulting in nearly 20 000 deaths. We investigated mortality patterns by age, sex, and region in the 3 most severely affected prefectures.
    Methods: Using police data on earthquake victims in Iwate, Miyagi, and Fukushima prefectures, mortality rates by sex, age group, and region were calculated, and regional variability in mortality rates across age groups was compared using rate ratios (RRs), with the rates in Iwate as the reference.
    Results: In all regions, age-specific mortality showed a tendency to increase with age; there were no sex differences. Among residents of Iwate, mortality was markedly lower among school-aged children as compared with other age groups. In northern Miyagi and the southern part of the study area, RRs were higher among school-aged children than among other age groups.
    Conclusions: The present study could not address the reasons for the observed mortality patterns and regional differences. To improve preparedness policies, future research should investigate the reasons for regional differences.
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