Background: The structure and risk factors for cardiovascular diseases (CVD) in Japan may change because lifestyle, particularly nutrition, socioeconomic status, and medical care, which affect CVD, may markedly change over time. Therefore, a new prospective cohort study on a representative general Japanese population based on national surveys is required.
Methods: In November 2010, the baseline survey of the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010 (NIPPON DATA2010) was performed with the National Health and Nutrition Survey of Japan (NHNS2010) in 300 randomly selected districts throughout Japan. The survey included a questionnaire, electrocardiogram, urinalysis, and blood biomarkers added to the NHNS2010 examinations. Physical measurements, blood biomarkers, and dietary data were also obtained in NHNS2010. Socioeconomic factors were obtained by merging with the Comprehensive Survey of Living Conditions 2010 (CSLC2010) dataset. Participants are followed annually for the incidence of diabetes mellitus, CVD events (acute coronary events, heart failure, atrial fibrillation, and stroke), and cause-specific mortality. The activities of daily living are followed every 5 years.
Results: A total of 2,898 individuals aged 20 years or older agreed to participate in the baseline survey of NIPPON DATA2010. The participation rate was 74.6%. Of these, data from NHNS2010 was merged for 2,891 participants (1,236 men and 1,655 women). The data of 2,807 participants were also merged with CSLC2010 data.
Conclusions: We established NIPPON DATA2010 as a cohort study on a representative general Japanese population that covers all of Japan.
Background: Socioeconomic status (SES) imbalances in developed and developing countries may result in individuals being overweight and obese. However, few studies have investigated this issue in Japan. We herein examined the relationship between SES and being underweight, overweight or obese according to sex and age groups (20–64 or ≥65 years) in Japan.
Methods: In 2010, we established a cohort of participants in the National Health and Nutrition Survey of Japan. We divided 2,491 participants (1,081 men and 1,410 women) according to the WHO definitions of underweight, overweight or obesity and performed multinomial logistic analyses using BMI <18.5 kg/m2 (underweight), BMI 25.0–29.9 kg/m2 (overweight), and BMI ≥30.0 kg/m2 (obese) versus BMI 18.5–24.9 kg/m2 (normal) as the outcome, with SES groups as the main explanatory variables.
Results: In adult men, a lower education level relative to a higher education level was inversely associated with obesity after adjustments for other SESs (odds ratio [OR] 0.41; 95% confidence interval [CI], 0.18–0.96). However, in adult women, lower education level was positively associated with being overweight and obese (OR 1.67; 95% CI, 1.07–2.49 for overweight and OR 2.66; 95% CI, 1.01–7.01 for obese). In adult women, a lower household income was positively associated with being overweight and obese (obese: OR 4.84; 95% CI, 1.36–17.18 for those with a household income <2 million JPY relative to those with ≥6 million JPY).
Conclusions: In adult women, a lower education level and lower household income were positively associated with being overweight or obese. In contrast, in adult men, a lower education level was inversely associated with obesity. Gender and age differences in SESs affect the prevalence of being overweight or obese.
Background: This study examined the relationships among household income, other SES indicators, and macronutrient intake in a cross-sectional study of a representative Japanese population.
Methods: In 2010, we established a cohort of participants in the National Health and Nutrition Survey (NHNS) from 300 randomly selected areas throughout Japan. A total of 2,637 participants (1,145 men and 1,492 women) were included in the study. Data from NHNS2010 and the Comprehensive Survey of Living Conditions 2010 (CSCL2010) were merged, and relationships among macronutrient intake and SES were evaluated. Additionally, socioeconomic factors associated with a risk of a higher carbohydrate/lower fat intake beyond dietary recommendations were evaluated.
Results: Household income was positively associated with fat intake (P = 0.001 for men and <0.001 for women) and inversely associated with carbohydrate intake (P = 0.003 for men and <0.001 for women) after adjustments for age and other SES variables. Similar relationships were observed between equivalent household expenditure (EHE) and macronutrient intake; however, these relationships were weaker than those of household income. Older age was the factor most strongly associated with a high carbohydrate/low fat intake, followed by household income, EHE, education levels, and occupation type.
Conclusions: Older age was the factor most strongly associated with a high carbohydrate/low fat intake, and some aspects of SES, such as household income, EHE, education levels, and occupation type, were independently associated with an imbalanced macronutrient intake. SES may affect the health status of individuals through the intake of macronutrients.
Background: A lower socioeconomic status (SES) may be related to the intake of unhealthy food; however, this relationship has not been examined in detail. This study was undertaken to examine relationships among food group intakes and SES in a representative Japanese population.
Methods: This was a cross-sectional study using the baseline data of NIPPON DATA2010, which is a prospective cohort study of the National Health and Nutrition Survey in Japan. A total of 2,898 participants were included in the baseline survey in 2010. The effects of age (<65 years and ≥65 years), equivalent household expenditure (EHE), and education attainment on food group intakes (gram per 1,000 kcal) were analyzed using a two-way analysis of variance.
Results: When EHE was lower, cereal intake was higher in men and women. Among men, fish, milk, and alcohol intakes were reduced with lower EHE. Among women, vegetable intake was reduced with lower EHE. In men and women, cereal intake was higher with lower education attainment. In contrast, meat intake was reduced with lower education attainment.
Conclusions: Lower SES was associated with a higher cereal intake and lower vegetable, fish, meat, and milk intakes in a representative Japanese population. Socioeconomic discrepancies need to be considered in order to promote healthier dietary habits.
Background: Although socioeconomic status (SES) may affect food and nutrient intakes, few studies have reported on sodium (Na) and potassium (K) intakes among individuals with various SESs in Japan. We investigated associations of SES with Na and K intake levels using urinary specimens in a representative Japanese population.
Methods: This was a cross-sectional study of 2,560 men and women (the NIPPON DATA2010 cohort) who participated in the National Health and Nutrition Survey Japan in 2010. Casual urine was used to calculate estimated excretion in 24-hour urinary Na (E24hr-Na) and K (E24hr-K). The urinary sodium-to-potassium (Na/K) ratio was calculated from casual urinary electrolyte values. An analysis of covariance was performed to investigate associations of aspects of SES, including equivalent household expenditure (EHE), educational attainment, and job category, with E24hr-Na, E24hr-K, and the Na/K ratio for men and women separately. A stratified analysis was performed on educational attainment and the job category for younger (<65 years) and older (≥65 years) participants.
Results: In men and women, average E24hr-Na was 176.2 mmol/day and 172.3, average E24hr-K was 42.5 and 41.3, and the average Na/K ratio was 3.61 and 3.68, respectively. Lower EHE was associated with a higher Na/K ratio in women and lower E24hr-K in men and women. A shorter education was associated with a higher Na/K ratio in women and younger men, and lower E24hr-K in older men and women.
Conclusion: Lower EHE and a shorter education were associated with a lower K intake and higher Na/K ratio estimated from casual urine specimens in Japanese men and women.
Background: The relationships among socioeconomic status and lifestyle improvements have not yet been examined in a representative Japanese population.
Methods: We analyzed data from 2,647 participants (1,087 men and 1,560 women) who participated in NIPPON DATA2010. This survey inquired about lifestyle improvements and socioeconomic status. Education was categorized as low (≤9 years), middle (10–12 years), and high (≥13 years). Marital status was categorized as married, divorced, widowed, and never married/other. A multivariable logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of lifestyle improvements with the intention of preventing cardiovascular diseases for educational attainment and marital status, with adjustments for age and awareness of cardiovascular disease risk factors.
Results: Overall, 1,507 (56.9%) participants practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome, and the OR of lifestyle improvements was significantly higher with a high education than with a low education in men (OR 2.86; 95% CI, 1.96–4.17) and women (OR 2.36; 95% CI, 1.67–3.33). The number of participants who practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome was significantly lower in divorced than in married men (OR 0.46; 95% CI, 0.22–0.95) and women (OR 0.53; 95% CI, 0.33–0.86).
Conclusions: Specific differences caused by educational attainment and marital status may exist in lifestyle improvements.
Background: Long-term passive exposure to cigarette smoke has been reported to affect the health of non-smokers. This study aims to investigate the relationships among socioeconomic factors and passive smoking at home in the non-current smokers of a representative sample from a general Japanese population.
Methods: Data are from NIPPON DATA2010. Among 2,891 participants, 2,288 non-current smokers (1,763 never smokers and 525 past smokers) were analyzed in the present study. Cross-sectional analyses were performed on the relationships among socioeconomic factors and passive smoking at home (several times a week or more) in men and women separately. Socioeconomic factors were employment, length of education, marital status, and equivalent household expenditure. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a multivariable logistic regression model.
Results: The multivariable-adjusted model showed that employed women had a higher risk of passive smoking than unemployed women (OR 1.44; 95% CI, 1.06–1.96). Women with 9 years or less of education had a higher risk of passive smoking at home than women with 13 years and more of education (OR 2.37; 95% CI, 1.49–3.78). Single women had a lower risk of passive smoking at home (OR 0.53; 95% CI, 0.37–0.77) than married women. No significant associations were observed in men.
Conclusions: An employed status, lower education, and being single were associated with passive smoking at home in the non-current smoking women of a representative Japanese population.
Background: The relationship between socioeconomic status (SES) and knowledge of cardiovascular risk factors remains unknown in a general Japanese population.
Methods: Of 8,815 participants from 300 randomly selected areas throughout Japan, 2,467 participants who were free of cardiovascular disease and who provided information on SES in the National Health and Nutrition Survey of Japan 2010 were enrolled in this cross-sectional analysis. SES was classified according to the employment status, length of education, marital and living statuses, and equivalent household expenditure (EHE). Outcomes were ignorance of each cardiovascular risk factor (hypertension, diabetes, hypercholesterolemia, low high-density lipoprotein [HDL] cholesterol, arrhythmia, and smoking) and insufficient knowledge (number of correct answers <4 out of 6).
Results: A short education and low EHE were significantly associated with a greater ignorance of most cardiovascular risk factors. A short education (<10 years) was also associated with insufficient knowledge of overall cardiovascular risk factors: age- and sex-adjusted odds ratios (OR) were 1.92 (95% confidence interval [CI], 1.51–2.45) relative to participants with ≥13 years of education. Low EHE was also associated with insufficient knowledge (age- and sex-adjusted OR 1.24; 95% CI, 1.01–1.51 for the lowest quintile vs the upper 4 quintiles). These relationships remained significant, even after further adjustments for regular exercise, smoking, weekly alcohol consumption, body mass index, hypertension, diabetes mellitus, hypercholesterolemia, and low HDL cholesterol.
Conclusion: Participants with a short education and low EHE were more likely to have less knowledge of cardiovascular risk factors.
Background: This study investigated relationships among socioeconomic factors and participation in health examinations for Japanese National Health Insurance (NHI) using a representative Japanese population.
Methods: We used the linkage database of NIPPON DATA2010 and Comprehensive Survey of Living Conditions 2010. Participants with NHI aged 40–74 years were included in the analysis. Prevalence ratios (PRs) for participation in health examinations in the past year were set as an outcome. Participant characteristics, including sex, age, socioeconomic factors (educational attainment, employment, equivalent household expenditure [EHE], house ownership, and marital status), laboratory measures, and lifestyle were included in an age-stratified modified Poisson regression analysis to examine relationships.
Results: The number of study participants was 812, and 564 (69.5%) participated in health examinations in the past year. Among those aged 40–64 years, there was no significant PR for socioeconomic factors. Among those aged 65–74 years, high (≥13 years) educational attainment (adjusted PR, 1.22; 95% confidence interval [CI], 1.05–1.41) and house ownership (PR 1.40; 95% CI, 1.11–1.77) were positively associated with participation, while high (4th quartile) EHE (PR 0.84; 95% CI, 0.73–0.97) was negatively associated.
Conclusion: These results suggest that high educational attainment, house ownership, and low EHE were positive factors for participation in health examinations among those aged 65–74 years.
Background: Most studies on socioeconomic inequalities in oral health have not considered the effects of behavioral and biological factors and age differences. Furthermore, the nationwide status of inequalities remains unclear in Japan.
Methods: We analyzed data from 2,089 residents aged ≥40 years throughout Japan. The lowest quartile of the number of remaining teeth for each 10-year age category was defined as poor oral health. Behavioral and biological factors included smoking status, obesity, diabetes mellitus, high-sensitivity C-reactive protein, and the use of dental devices. Multiple logistic regression analyses were conducted to examine the associations of educational attainment and equivalent household expenditure (EHE) with oral health, and stratified analyses by age category were also conducted (40–64 years and ≥65 years).
Results: Lower education and lower EHE were significantly associated with an increased risk of poor oral health after adjusting for age, sex, employment status, marital and living statuses, and EHE/education; the odds ratio for junior high school education compared with ≥college education was 1.84 (95% confidence interval [CI], 1.36–2.49), and the odds ratio of the lowest compared with the highest EHE quartile was 1.91 (95% CI, 1.43–2.56). Further adjustments for behavioral and biological factors attenuated but did not eliminate these associations. EHE was significantly associated with oral health among elderly adults only, with a significant interaction by age category.
Conclusions: Those with a lower education and those with lower EHE had a significantly higher risk of poor oral health, even after adjustments for behavioral and biological factors.
Background: The distributions of socioeconomic status (SES) factors have been changing in Japan. We examined the relationships among SES and self-rated health (SRH) in Japanese adults.
Methods: We analyzed 1,178 men and 1,555 women. We showed the distribution of SRH by sex and age and examined cross-sectional relationships among educational attainment, marital/living statuses, working status, household income and expenditure, and fine SRH (defined as excellent, very good, or good). We adjusted for age, subjective symptoms, visiting doctors, monthly equivalent household expenditure (EHE), and living in their own house.
Results: The age-standardized prevalence of fine SRH was 79% and 73% among men and women, respectively. Among men, graduating from high school (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI], 1.07–2.19, relative to graduating from elementary or junior high school) and university or junior college (aOR 1.74; 95% CI, 1.15–2.62) was associated with fine SRH. Among women, graduating from university or junior college was associated with fine SRH (aOR 1.65; 95% CI, 1.12–2.46). Neither marital/living status nor working status was associated with SRH after adjustments for age in either sex. Among women, high EHE and income were associated with fine SRH (the highest expenditure group: aOR 1.80; 95% CI, 1.22–2.65; the highest income group: aOR 2.15; 95% CI, 1.34–3.46, relative to the corresponding lowest group). These simple relationships were not observed for men.
Conclusions: High educational attainment was associated with fine SRH. Relationships among household income, EHE, and fine SRH differed by sex.