Journal of Epidemiology
Online ISSN : 1349-9092
Print ISSN : 0917-5040
ISSN-L : 0917-5040
26 巻 , 3 号
Young Investigator Award Winner’s Special Article
  • Nayu Ikeda
    2016 年 26 巻 3 号 p. 106-114
    発行日: 2016/03/05
    公開日: 2016/03/05
    [早期公開] 公開日: 2016/02/20
    ジャーナル フリー
    Secondary data analysis of national health surveys of the general population is a standard methodology for health metrics and evaluation; it is used to monitor trends in population health over time and benchmark the performance of health systems. In Japan, the government has established electronic databases of individual records from national surveys of the population’s health. However, the number of publications based on these datasets is small considering the scale and coverage of the surveys. There appear to be two major obstacles to the secondary use of Japanese national health survey data: strict data access control under the Statistics Act and an inadequate interdisciplinary research environment for resolving methodological difficulties encountered when dealing with secondary data. The usefulness of secondary analysis of survey data is evident with examples from the author’s previous studies based on vital records and the National Health and Nutrition Surveys, which showed that (i) tobacco smoking and high blood pressure are the major risk factors for adult mortality from non-communicable diseases in Japan; (ii) the decrease in mean blood pressure in Japan from the late 1980s to the early 2000s was partly attributable to the increased use of antihypertensive medication and reduced dietary salt intake; and (iii) progress in treatment coverage and control of high blood pressure is slower in Japan than in the United States and Britain. National health surveys in Japan are an invaluable asset, and findings from secondary analyses of these surveys would provide important suggestions for improving health in people around the world.
Original Article
  • Tomofumi Nishikawa, Tomonori Okamura, Hirofumi Nakayama, Naomi Miyamat ...
    2016 年 26 巻 3 号 p. 115-122
    発行日: 2016/03/05
    公開日: 2016/03/05
    [早期公開] 公開日: 2015/10/03
    ジャーナル フリー
    Background: An immediate ambulance call offers the greatest opportunity for acute stroke therapy. Effectively using ambulance services requires strengthening the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset, and encouraging the public to use ambulance services.
    Methods: The present study utilized data from the Acquisition of Stroke Knowledge (ASK) study, which administered multiple-choice, mail-in surveys regarding awareness of early stroke symptoms and response to a stroke attack before and after a 2-year stroke education campaign in two areas subject to intensive and moderate intervention, as well as in a control area, in Japan. In these three areas, 3833 individuals (1680, 1088 and 1065 participants in intensive intervention, moderate intervention, and control areas, respectively), aged 40 to 74 years, who responded appropriately to each survey were included in the present study.
    Results: After the intervention, the number of correctly identified symptoms significantly associated with intention to call an ambulance (P < 0.05) increased (eg, from 4 to 5 correctly identified symptoms), without increasing choice of decoy symptoms in the intensive intervention area. Meanwhile, in other areas, rate of identification of not only correct symptoms but also decoy symptoms associated with intention to call an ambulance increased. Furthermore, the association between improvement in the knowledge of stroke symptoms and intention to call an ambulance was observed only in the intensive intervention area (P = 0.009).
    Conclusions: Our results indicate that intensive interventions are useful for strengthening the association between correct knowledge of early stroke symptoms and intention to call an ambulance, without strengthening the association between incorrect knowledge and intention to call an ambulance.
  • Toshiaki Kawachi, Keiko Wada, Kozue Nakamura, Michiko Tsuji, Takashi T ...
    2016 年 26 巻 3 号 p. 123-130
    発行日: 2016/03/05
    公開日: 2016/03/05
    [早期公開] 公開日: 2015/10/31
    ジャーナル フリー
    Background: Few studies have assessed the associations between sleep duration and stroke subtypes. We examined whether sleep duration is associated with mortality from total stroke, ischemic stroke, and hemorrhagic stroke in a population-based cohort of Japanese men and women.
    Methods: Subjects included 12 875 men and 15 021 women aged 35 years or older in 1992, who were followed until 2008. The outcome variable was stroke death (ischemic stroke, hemorrhagic stroke, and total stroke).
    Results: During follow-up, 611 stroke deaths (354 from ischemic stroke, 217 from hemorrhagic stroke, and 40 from undetermined stroke) were identified. Compared with 7 h of sleep, ≥9 h of sleep was significantly associated with an increased risk of total stroke and ischemic stroke mortality after controlling for covariates. Hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.51 (95% CI, 1.16–1.97) and 1.65 (95% CI, 1.16–2.35) for total stroke mortality and ischemic stroke mortality, respectively. Short sleep duration (≤6 h of sleep) was associated with a decreased risk of mortality from total stroke (HR 0.77; 95% CI, 0.59–1.01), although this association was of borderline significance (P = 0.06). The trends for total stroke and ischemic stroke mortality were also significant (P < 0.0001 and P = 0.0002, respectively). There was a significant risk reduction of hemorrhagic stroke mortality for ≤6 h of sleep as compared with 7 h of sleep (HR 0.64; 95% CI, 0.42–0.98; P for trend = 0.08). The risk reduction was pronounced for men (HR 0.31; 95% CI, 0.16–0.64).
    Conclusions: Data suggest that longer sleep duration is associated with increased mortality from total and ischemic stroke. Short sleep duration may be associated with a decreased risk of mortality from hemorrhagic stroke in men.
  • Eiichi Yoshimura, Susumu S. Sawada, I-Min Lee, Yuko Gando, Masamitsu K ...
    2016 年 26 巻 3 号 p. 131-136
    発行日: 2016/03/05
    公開日: 2016/03/05
    [早期公開] 公開日: 2015/11/28
    ジャーナル フリー
    Background: In Japan, the incidence of kidney stones has increased markedly in recent decades. Major causes of kidney stones remain unclear, and limited data are available on the relationship between overweight/obesity and the incidence of kidney stones. We therefore evaluated body mass index (BMI) and the incidence of kidney stones in Japanese men.
    Methods: Of the workers at a gas company, 5984 males aged 20–40 years underwent a medical examination in 1985 (baseline). This study includes 4074 of the men, who were free of kidney stones at baseline and underwent a second medical examination performed between April 2004 and March 2005. BMI was calculated from measured height and weight in 1985, and men were categorized into tertiles. The development of kidney stones during follow-up was based on self-reports from questionnaires at the second medical examination.
    Results: The average duration of follow-up was 19 years, with 258 participants developing kidney stones during this period. Using the lowest BMI (1st tertile) group as a reference, the hazard ratios (95% confidence intervals [CIs]) for the 2nd and 3rd BMI tertiles were: 1.26 (95% CI, 0.92–1.73) and 1.44 (95% CI, 1.06–1.96), respectively (P for trend = 0.019). After additionally adjusting for potential confounders, such as age, systolic blood pressure, cardiorespiratory fitness, cigarette smoking, and alcohol consumption, the hazard ratios were 1.28 (95% CI, 0.93–1.76) and 1.41 (95% CI, 1.02–1.97), respectively (P for trend = 0.041).
    Conclusions: These results suggest that increased BMI is a risk factor for kidney stones in Japanese men.
  • Youngdeok Kim, Tiago V. Barreira, Minsoo Kang
    2016 年 26 巻 3 号 p. 137-144
    発行日: 2016/03/05
    公開日: 2016/03/05
    [早期公開] 公開日: 2015/10/17
    ジャーナル フリー
    Background: Independent associations of physical activity (PA) and sedentary behavior (SB) with obesity are well documented. However, little is known about the combined associations of these behaviors with obesity in adolescents. The present study examines the prevalence of concurrent levels of PA and SB, and their associations with obesity among US adolescents.
    Methods: Data from a total of 12 081 adolescents who participated in the Youth Risk Behaviors Survey during 2012–2013 were analyzed. A latent class analysis was performed to identify latent subgroups with varying combined levels of subjectively measured PA and screen-based SB. Follow-up analysis examined the changes in the likelihood of being obese as determined by the Center for Disease Control and Prevention Growth Chart between latent subgroups.
    Results: Four latent subgroups with varying combined levels of PA and SB were identified across gender. The likelihood of being obese was significantly greater for the subgroups featuring either or both Low PA or High SB when compared with High PA/Low SB across genders (odds ratio [OR] ranges, 2.1–2.7 for males and 9.6–23.5 for females). Low PA/High SB showed the greater likelihood of being obese compared to subgroups featuring either or both High PA and Low SB (OR ranges, 2.2–23.5) for female adolescents only.
    Conclusions: The findings imply that promoting sufficient levels of PA while reducing SB should be encouraged in order to reduce obesity risk among adolescents, particularly for males. The risk of obesity for female adolescents can be reduced by engaging in either high levels of PA or low levels of SB.
  • Kyoung Ae Kong, Kyung-Hee Jung-Choi, Dohee Lim, Hye Ah Lee, Won Kyung ...
    2016 年 26 巻 3 号 p. 145-154
    発行日: 2016/03/05
    公開日: 2016/03/05
    [早期公開] 公開日: 2015/10/17
    ジャーナル フリー
    Background: Smoking is a major modifiable risk factor for premature mortality. Estimating the smoking-attributable burden is important for public health policy. Typically, prevalence- or smoking impact ratio (SIR)-based methods are used to derive estimates, but there is controversy over which method is more appropriate for country-specific estimates. We compared smoking-attributable fractions (SAFs) of deaths estimated by these two methods.
    Methods: To estimate SAFs in 2012, we used several different prevalence-based approaches using no lag and 10- and 20-year lags. For the SIR-based method, we obtained lung cancer mortality rates from the Korean Cancer Prevention Study (KCPS) and from the United States-based Cancer Prevention Study-II (CPS-II). The relative risks for the diseases associated with smoking were also obtained from these cohort studies.
    Results: For males, SAFs obtained using KCPS-derived SIRs were similar to those obtained using prevalence-based methods. For females, SAFs obtained using KCPS-derived SIRs were markedly greater than all prevalence-based SAFs. Differences in prevalence-based SAFs by time-lag period were minimal among males, but SAFs obtained using longer-lagged prevalence periods were significantly larger among females. SAFs obtained using CPS-II-based SIRs were lower than KCPS-based SAFs by >15 percentage points for most diseases, with the exceptions of lung cancer and chronic obstructive pulmonary disease.
    Conclusions: SAFs obtained using prevalence- and SIR-based methods were similar for males. However, neither prevalence-based nor SIR-based methods resulted in precise SAFs among females. The characteristics of the study population should be carefully considered when choosing a method to estimate SAF.
  • Tetsuhisa Kitamura, Kosuke Kiyohara, Tasuku Matsuyama, Toshihiro Hatak ...
    2016 年 26 巻 3 号 p. 155-162
    発行日: 2016/03/05
    公開日: 2016/03/05
    [早期公開] 公開日: 2015/12/05
    ジャーナル フリー
    Background: Outcomes after out-of-hospital cardiac arrests (OHCAs) might be worse during academic meetings because many medical professionals attend them.
    Methods: This nationwide population-based observation of all consecutively enrolled Japanese adult OHCA patients with resuscitation attempts from 2005 to 2012. The primary outcome was 1-month survival with a neurologically favorable outcome. Calendar days at three national meetings (Japanese Society of Intensive Care Medicine, Japanese Association for Acute Medicine, and Japanese Circulation Society) were obtained for each year during the study period, because medical professionals who belong to these academic societies play an important role in treating OHCA patients after hospital admission, and we identified two groups: the exposure group included OHCAs that occurred on meeting days, and the control group included OHCAs that occurred on the same days of the week 1 week before and after meetings. Multiple logistic regression analysis was used to adjust for confounding variables.
    Results: A total of 20 143 OHCAs that occurred during meeting days and 38 860 OHCAs that occurred during non-meeting days were eligible for our analyses. The proportion of patients with favorable neurologic outcomes after whole arrests did not differ during meeting and non-meeting days (1.6% [324/20 143] vs 1.5% [596/38 855]; adjusted odds ratio 1.02; 95% confidence interval, 0.88–1.19). Regarding bystander-witnessed ventricular fibrillation arrests of cardiac origin, the proportion of patients with favorable neurologic outcomes also did not differ between the groups.
    Conclusions: In this population, there were no significant differences in outcomes after OHCAs that occurred during national meetings of professional organizations related to OHCA care and those that occurred during non-meeting days.