Concerns have increasingly been raised about the medical economic burden in Japan, of which approximately 20% is attributable to cardiovascular disease, including coronary heart disease and stroke. Because the management of risk factors is essential for the prevention of cardiovascular disease, it is important to understand the relationship between cardiovascular risk factors and medical expenditure in the Japanese population. However, only a few Japanese epidemiological studies analysing data on health checkups and medical insurance have provided evidence on this topic. Patients with cardiovascular risk factors, including obesity, hypertension, and diabetes, may incur medical expenditures through treatment of the risk factors themselves and through procedures for associated diseases that usually require hospitalization and sometimes result in death. Untreated risk factors may cause medical expenditure surges, mainly due to long-term hospitalization, more often than risk factors preventively treated by medication. On an individual patient level, medical expenditures increase with the number of concomitant cardiovascular risk factors. For single risk factors, personal medical expenditure may increase with the severity of that factor. However, on a population level, the medical economic burden attributable to cardiovascular risk factors results largely from a single, particularly prevalent risk factor, especially from mildly-to-moderately abnormal levels of the factor. Therefore, cardiovascular risk factors require management on the basis of both a cost-effective strategy of treating high-risk patients and a population strategy for reducing both the ill health and medical economic burdens that result from cardiovascular disease.
Purpose: To examine the relationship between body mass index (BMI) and the risk of stage ≥3 chronic kidney disease (CKD) in a general Japanese population. Methods: A total of 105 611 participants aged 40–79 years who completed health checkups in Ibaraki Prefecture, Japan, and were free of CKD in 1993 were followed-up through 2006. Stage ≥3 CKD was defined by an estimated glomerular filtration rate <60 mL/min/1.73 m2 reported during at least 2 successive annual surveys or as treatment for kidney disease. Hazard ratios (HRs) for the development of stage ≥3 CKD relative to the BMI categories were calculated using the Cox proportional hazards regression model, which was adjusted for possible confounders and mediators. Results: During a mean follow-up of 5 years, 19 384 participants (18.4%) developed stage ≥3 CKD. Compared to a BMI of 21.0–22.9 kg/m2, elevated multivariable-adjusted HRs were observed among men with a BMI ≥23.0 kg/m2 and women with a BMI ≥27.0 kg/m2. Significant dose-response relationships between BMI and the incidence of stage ≥3 CKD were observed in both sexes (P for trend <0.001). Conclusions: Obesity was associated with the risk of developing stage ≥3 CKD among men and women.
Background: Air pollution can be a contributing cause to the development and exacerbation of coronary heart disease (CHD), but there is little knowledge about the acute effects of air pollution on different clinical subtypes of CHD. Methods: We conducted a time-series study to investigate the association of air pollution (particulate matter with an aerodynamic diameter < 10 µm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) on emergency department (ED) visits due to five different subtypes of CHD in Shanghai, China, from 2010 to 2012. We applied an over-dispersed Poisson generalized addictive model to analyze the associations after controlling for the seasonality, day of the week, and weather conditions. Results: We identified a total of 47 523 ED visits for CHD. A 10-µg/m3 increase in the present-day concentrations of PM10, SO2, and NO2 was associated with respective increases of 1.10% (95% confidence interval [CI] 0.33%–1.87%), 0.90% (95% CI −0.14%–1.93%), and 1.44% (95% CI 0.63%–2.26%) for total ED visits for CHD. These associations varied greatly by clinical type, with strong effects on sudden cardiac death, moderate effects on acute myocardial infarction and angina, weak effects on ischemic cardiomyopathy, and no effect on occult CHD. The associations were stronger among people aged 65 years or more than in younger individuals and in the cool season versus the warm one. Conclusions: Outdoor air pollution may have different effects of air pollution on 5 subtypes of CHD. Our results might be useful for the primary prevention of various subtypes of CHD exacerbated by air pollution.
Background: The present study examined the prevalence of diabetes in Japan during the late 1990s and early 2000s using the Japan Public Health Center-based Prospective Diabetes cohort. We also investigated the distributions of HbA1c values in noncompliant diabetic participants in the cohort. Methods: A total of 28 183 registered inhabitants aged 46–75 years from 10 public health center areas were included in the initial survey. The 5-year follow-up survey included 20 129 participants. The prevalence of diabetes was estimated using both a self-reported questionnaire and laboratory measurements. Among the participants who reported the presence of diabetes on the questionnaire (self-reported diabetes), the distributions of HbA1c values were described according to their treatment status. Results: The age-standardized prevalence of diabetes in 55- to 74-year-old adults was 8.2% at the initial survey and 10.6% at the 5-year follow-up. At the initial survey, among participants with self-reported diabetes, the mean HbA1c values in the participants who had never and who had previously received diabetes treatment were 7.01% (standard deviation [SD] 1.56%) and 6.56% (SD 1.46%), respectively. Approximately 15% of the participants who had self-reported diabetes but had never received diabetes treatment had an HbA1c ≥ 8.4%. Conclusions: The prevalence of diabetes increased in the JPHC cohort between the late 1990s and early 2000s. A certain proportion of participants who were aware of their diabetes but were not currently receiving treatment had poor diabetic control. Efforts to promote continuous medical attendance for diabetes care may be necessary.
Background: Myelodysplastic syndromes (MDS) are a diverse group of clonal hematopoietic stem cell malignancies that primarily affect the elderly. Although the incidence of MDS in western countries has been well investigated, little is known about the incidence in Asian populations. Methods: To identify the incidence of MDS in Japan, we used population-based registry data from 1993 to 2008. The data represented 33.1% of the Japanese population. A total of 7995 patients were reported to the registry with newly diagnosed MDS during the study period. Results: Median age at diagnosis was 76 years. Incidence sharply increased with age, particularly in those aged over 70 years. The most recent crude incidence rate of MDS was 3.8 (95% CI 3.6–4.1) cases per 100 000 for men and 2.4 (95% CI 2.2–2.6) cases per 100 000 for women in 2008. Age-adjusted incidences of MDS in 2008, standardized by the world standard population, were 1.6 and 0.8 cases per 100 000 for men and women, respectively, while incidences standardized by the 1985 Japanese population were 2.5 and 1.2 cases per 100 000 for men and women, respectively. Conclusions: Our study reveals that some elderly patients suffer from MDS in Japan, but the incidence is lower than in Western countries. In current clinical practice, many elderly MDS patients are treated with supportive therapy based on an incomplete diagnosis, suggesting that the incidence estimated in this study might still be substantially underestimated. Accurate evaluation of the health impact of MDS requires evaluation of the mortality of the disease, continued surveillance, and improvement in the quality of cancer registry data.
Background: Both little and excessive physical activity (PA) may relate to chronic musculoskeletal pain. The primary objective of this study was to characterize the relationship of PA levels with chronic low back pain (CLBP) and chronic knee pain (CKP). Methods: We evaluated 4559 adults aged 40–79 years in a community-based cross-sectional survey conducted in 2009 in Shimane, Japan. We used self-administered questionnaires to assess sociodemographics and health status: PA was assessed by the International Physical Activity Questionnaire, and CLBP and CKP were assessed by a modified version of the Knee Pain Screening Tool. We examined relationships of PA with prevalence of CLBP and CKP using Poisson regression, controlling for potential confounders. Results: CLBP and CKP were both prevalent (14.1% and 10.7%, respectively) and associated with history of injury, medication use, and consultation with physicians. PA was not significantly related to CLBP or CKP (P > 0.05) before or after adjustment for potential confounders. For example, compared with adults reporting moderate PA (8.25–23.0 MET-hours/week), prevalence ratios for CKP adjusted for sex, age, education years, self-rated health, depressive symptom, smoking, chronic disease history, and body-mass index were 1.12 (95% confidential interval [CI] 0.84–1.50) among those with the lowest PA and 1.26 (95% CI 0.93–1.70) among those with the highest PA (P quadratic = 0.08). The prevalence ratios were further attenuated toward the null after additional adjustment for history of injury, medication use, and consultation (P quadratic = 0.17). Conclusions: This cross-sectional study showed that there were no significant linear or quadratic relationships of self-reported PA with CLBP and CKP. Future longitudinal study with objective measurements is needed.
Background: Urban populations usually have higher levels of cardiovascular risk factors than rural populations in developing countries. However, association between cardiovascular risk factors and duration of urban dwelling, particularly for early stages of urban migrations, has not yet been adequately studied. We examined cardiovascular risks in relation to timing of urbanization in Thailand, paying attention to recent internal migrants. Methods: Our study base was a large national cohort (n = 87 151) of distance-learning Thai open university students recruited in 2005 and followed up in 2009. After exclusion of longitudinal dropouts and reverse migrants, 51 936 remained for analyses. The information collected included historical residence, urban migration and its lifecycle timing, self-reported doctor-diagnosed diseases, and socio-demographic and personal attributes that could influence health. To relate cardiovascular outcomes (prevalence and incidence of hypertension and hyperlipidaemia) and life-course urbanization status (ie at age 12, 4 years ago  and at present ), we applied logistic regression. Included in the models were 10 other covariates that could confound the urbanization effect. Results: Recent migration (arriving within four years) among young cohort members (born after 1980) was associated with higher risk of hypertension (OR 1.80 for prevalence and 1.68 for four-year incidence). Higher hyperlipidaemia prevalence (and incidence) was associated with any urban dwelling. Recent migrants quickly developed hyperlipidaemia, particularly the youngest (born after 1980) and oldest participants (born before 1960). Conclusions: Increased cardiovascular risks appear among rural-urban migrants within four years after they arrive. Given the scale of continuing urbanization, interventions are needed to support and educate recent migrants in Thai cities.
Background: Previous studies have reported a high incidence of amyotrophic lateral sclerosis (ALS) in endemic foci in the Kii Peninsula, Japan. However, little is known about the ALS frequency in the whole country. Furthermore, the presence of ethnic variation in the incidence of ALS remains unknown. Methods: We conducted a nationwide survey of ALS frequency in 2013 to estimate its annual prevalence and incidence. ALS was diagnosed based on the El Escorial Criteria. The study period was the 2009 fiscal year, from April 2009 to March 2010. To compare the incidence of ALS among prefectures, standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated under the assumption of Poisson distribution. Results: The annual crude prevalence and incidence rates per 100 000 people per year were 9.9 (95% CI 9.7–10.1) and 2.2 (95% CI 2.1–2.3), respectively. The age group with the highest prevalence as well as incidence was 70–79 years, and the male-female ratio was approximately 1.5. The annual incidence rate adjusted for age and sex using the 2000 U.S. standard population was 2.3 (95% CI 2.2–2.4) per 100 000 people. Some prefectures had significantly high SIRs: Okinawa, Nara and Wakayama in the Kii Peninsula, and Niigata for males; Kumamoto for females. Conclusions: This is the first report on the annual prevalence and incidence of ALS in the representative population of Japan. We identified some prefectures with a high incidence of ALS. However, the incidence of ALS in the Japanese population was much lower than in the Caucasian populations of Europe and North America.
Background: The aim of this study was to determine the validity of acute myocardial infarction (AMI) diagnosis coding in the National Health Insurance Research Database (NHIRD) by cross-comparisons of discharge diagnoses listed in the NHIRD with those in the medical records obtained from a medical center in Taiwan. Methods: This was a cross-sectional study comparing records in the NHIRD and discharge notes in one medical center (DNMC) in the year 2008. Positive predictive values (PPVs) for AMI diagnoses were evaluated by reviewing the relevant clinical and laboratory data recorded in the discharge notes of the medical center. Agreement in comorbidities, cardiac procedures, and antiplatelet agent (aspirin or clopidogrel) prescriptions between the two databases was evaluated. Results: We matched 341 cases of AMI hospitalizations from the two databases, and 338 cases underwent complete chart review. Of these 338 AMI cases, 297 were confirmed with clinical and lab data, which yielded a PPV of 0.88. The consistency rate for coronary intervention, stenting, and antiplatelet prescription at admission was high, yielding a PPV over 0.90. The percentage of consistency in comorbidity diagnoses was 95.9% (324/338) among matched AMI cases. Conclusions: The NHIRD appears to be a valid resource for population research in cardiovascular diseases.
Background: Anti-tobacco television advertisement campaigns may convey messages on smoking-related health consequences and create norms against giving cigarettes. Methods: Altogether, 156 and 112 slots of a television advertisement “Giving cigarettes is giving harm” were aired on Suzhou and Yizheng, respectively, over one month in 2010. Participants were recruited from 15 locations in Suzhou and 8 locations in Yizheng using a street intercept method. Overall 2306 residents aged 18–45 years completed questionnaires, including 1142 before the campaign and 1164 after, with respective response rates of 79.1% and 79.7%. Chi square tests were used to compare the difference between categorical variables. Results: After the campaign, 36.0% of subjects recalled that they had seen the advertisement. Residents of Suzhou had a higher recall rate than those of Yizheng (47.6% vs. 20.6%, P < 0.001). The rate of not giving cigarettes dropped from 32.1% before the campaign to 28.5% after (P = 0.05). In the post-campaign evaluation, participants who reported seeing the advertisement were more likely not to give cigarettes in the future than those who reported not seeing the advertisement (38.7% vs. 27.5%, P < 0.001). Conclusions: Our study showed that an anti-tobacco television advertisements helped change societal norms and improve health behavior. Continuous and adequate funding of anti-tobacco media campaigns targeted at different levels of the general population is needed, in conjunction with a comprehensive tobacco control effort.
Background: The Strengths and Difficulties Questionnaire (SDQ) has been widely used as a brief behavioral screening. The aim of this study was to examine the internal consistency and test-retest reliability of the 3- to 4-year-old version of the SDQ (SDQ 3–4) in Japanese preschool children. Methods: The SDQ 3–4 was administered to 754 parents who had 4- to 6-year-old children attending kindergartens or childcare centers in Wako City, Japan, at 2 different times (Time 1 and Time 2) over a 2-week interval between June and July 2012. Cronbach’s α and correlation coefficients were used to examine internal consistency and test-retest reliability, respectively. Results: Of 393 parents who returned their responses at Time 1 (response rate 52.1%), 383 were used for analysis after excluding 10 responses with missing data. Their children’s mean age was 4.7 (standard deviation 0.7) years. The internal consistency (Cronbach’s α) was good for the total difficulties score (0.74) and the prosocial behavior scale (0.70). However, it was slightly worse for the emotional symptoms, conduct problems, and hyperactivity scales (0.61–0.66) and poor for the peer problems scale (0.45). Of the 383 included respondents at Time 1, 211 parents returned their responses at Time 2 (response rate: 55.1%). Test-retest reliability (correlation coefficients) was good (0.73–0.82), except for the peer problems scale (0.58). Conclusions: The results support the reliability of the SDQ 3–4 being satisfactory for the total difficulties score and prosocial behavior scale and being acceptable for the emotional symptoms, conduct problems, and hyperactivity scales in Japanese preschool children aged 4–6 years.
Background: Further evidence into the effects of social relationships on health (including those at both the individual and community levels) is needed in Japan. The Yabu Cohort Study was launched in 2012 to identify the associations between social relationships and health among community-dwelling older Japanese people and to evaluate population approaches for preventive long-term care in the community. This report describes the study design and the profile of the participants at baseline. Methods: The Yabu Cohort Study is a prospective study of community-dwelling individuals aged 65 years and older in Yabu, Hyogo Prefecture, Japan. The baseline survey, using a mailed self-administered questionnaire, was conducted from July through August 2012. It included information on socioeconomic status, general and psychological health, and social relationships (social network, social support, and social capital). Survival time, long-term care insurance certification, and medical and long-term care costs after the baseline survey will be followed. Results: Of 7271 questionnaires distributed, a total of 6652 were returned (91.5% response rate), and 6241 were included in the analysis. Mean age was 71.9 ± 5.2 years, 43.2% were men, and 83.8% had lived in their neighborhood for more than 40 years. Approximately 45.2% expressed general trust. About 82.4%, 49.9%, and 55.5% have participated in neighborhood association activities, municipal seminars for preventive long-term care, and salon activities in the community, respectively. Conclusions: The study is expected to provide valuable evidence on the effects of social relationships on health and to suggest the usefulness of population approaches for preventive long-term care in Japanese communities.