Journal of Epidemiology
Online ISSN : 1349-9092
Print ISSN : 0917-5040
ISSN-L : 0917-5040
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Editorial
Original Article
  • Kaoru Araki, Megumi Hara, Chisato Shimanoe, Yuichiro Nishida, Muneaki ...
    2019 Volume 29 Issue 8 Pages 282-287
    Published: August 05, 2019
    Released: August 05, 2019
    [Advance publication] Released: October 20, 2018
    JOURNALS OPEN ACCESS

    Background: Selection of test-negative controls takes less time and costs less than traditional control selection for evaluating vaccine effectiveness (VE). Here, rotavirus VE was evaluated using hospital controls and compared with test-negative controls to determine whether using the latter can substitute for the former.

    Methods: We recorded gastroenteritis in children from 2 months to 2 years of age at six medical facilities in Saga City between January 4th and May 31st, 2014. Stools from all identified acute gastroenteritis patients were tested for rotavirus using immunochromatography. Rotavirus gastroenteritis (RVGE) cases had test-positive stool, whereas test-negative controls had gastroenteritis but no rotavirus infection; hospital controls were outpatients visiting the same facility for indications other than gastroenteritis. Vaccination status was verified by inspecting maternal and child health records, and demographic data were obtained from a questionnaire completed by the patients’ guardians or from the medical records. Unconditional logistic regression analysis was used to adjust for possible confounding factors.

    Results: Sixty-four RVGE cases, 260 test-negative controls, and 589 hospital controls were enrolled. The characteristics of the two control groups, including RV vaccination history, were similar. The RVGE cases were more likely to have used daycare services than children from either of the two control groups. The VE against RVGE estimated using hospital controls was 86.6% (95% confidence interval [CI], 55.9–96.0%), very similar to the VE using test-negative controls (84.9% [95% CI, 49.6–95.5%]).

    Conclusions: The estimated VE using test-negative controls and hospital controls is similar. Therefore, test-negative controls are considered appropriate for establishing VE.

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  • Yasuyuki Okumura, Naoya Sugiyama, Toshie Noda, Hisateru Tachimori
    2019 Volume 29 Issue 8 Pages 288-294
    Published: August 05, 2019
    Released: August 05, 2019
    [Advance publication] Released: September 15, 2018
    JOURNALS OPEN ACCESS

    Background: A better understanding of resource use of new psychiatric admissions is important for healthcare providers and policymakers to improve psychiatric care. This study aims to describe the pattern of new psychiatric admissions and length of stay in Japan.

    Methods: A retrospective cohort study was conducted using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). All patients newly admitted to psychiatric wards from April 2014 through March 2016 were included and followed up until discharge to the community.

    Results: Our sample included 605,982 admissions from 1,621 hospitals over 2 years. The average monthly number of admissions was 25,024 in fiscal year 2014 and 25,475 in fiscal year 2015. There was a seasonal trend in the number of admissions, with a peak in summer (in July). The discharge rates within 90 days and 360 days were 64.1% and 85.7%, respectively, and varied by type of hospital fee and by hospital. For example, the range of hospital-level discharge rate within 90 days in psychiatric emergency units was 46.0–75.3% in the 1st (lowest) quintile, while it was 83.6–96.0% in the 5th (highest) quintile. The prefecture-level indicators in the NDB and the 630 survey had correlations of >0.70.

    Conclusions: Our study provides fundamental information on resource use of new psychiatric admissions in Japan. Although using the NDB has substantial benefits in monitoring resource use, the results should be interpreted with some caution owing to methodological issues inherent in the database.

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  • Yuiko Nagamine, Naoki Kondo, Kenichi Yokobayashi, Asami Ota, Yasuhiro ...
    2019 Volume 29 Issue 8 Pages 295-301
    Published: August 05, 2019
    Released: August 05, 2019
    [Advance publication] Released: November 17, 2018
    JOURNALS OPEN ACCESS

    Background: Studies on sex-specific socioeconomic gradients in objectively evaluated diabetes among older adults are scarce.

    Methods: We used cross-sectional data of 9,893 adults aged 65 years and older in Aichi Prefecture without long-term care insurance from the Japan Gerontological Evaluation Study (JAGES) in 2010 (Response rate: 66.3%). We collected demographic, socioeconomic (income, years of education, and longest occupation) and behavioral information using a mail-in self-reported survey. Blood samples for the objectively evaluated diabetes and self-reported medical history were collected at annual municipal health checkups. Poisson regression analysis stratified by sex with multiple imputations was conducted to calculate prevalence ratio and 95% confidence interval.

    Results: A clear income gradient in diabetes prevalence was observed among women, from 11.7% in the lowest income quartile (Q1) to 7.8% in the highest (Q4). Among men, the findings were 17.6% in Q1 to 15.1% in Q4. The prevalence ratios for diabetes with incomes Q1 to Q4 were 1.43 (95% confidence interval [CI], 1.07–1.90) for women and 1.16 (95% CI, 0.90–1.50) for men after adjusting for age and other socioeconomic factors. Even after adjusting for marital status, body mass index, other metabolic risk factors, and lifestyle factors, the income-based gradient remained among women. Education and occupation were not significantly associated with diabetes in the study population.

    Conclusions: Only women showed an income-based gradient in diabetes. Monitoring income gradient in diabetes is important in public health actions, even in older populations. Future longitudinal and intervention studies should evaluate the causal link of income to diabetes onset, determine the mechanisms of the potential sex differences in the income/diabetes association, and identify ways to mitigate the income-based inequality.

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  • Joo-Young Lee, Eun-Song Lee, Gyung-Min Kim, Hoi-In Jung, Jeong-Woo Lee ...
    2019 Volume 29 Issue 8 Pages 302-307
    Published: August 05, 2019
    Released: August 05, 2019
    [Advance publication] Released: October 20, 2018
    JOURNALS OPEN ACCESS

    Background: Some previous studies reported hearing ability can be reduced by impaired masticatory ability, but there has been little evidence reported of an association between hearing loss and unilateral mastication. Therefore, this study aimed to investigate the relationship between unilateral mastication (UM), estimated from individual functional tooth units (FTUs), and hearing loss in a representative sample of Korean adults.

    Methods: The analyzed data were obtained from 1,773 adults aged 40–89 years who participated in Korean national survey. Hearing loss was defined as a pure-tone average of >25 dB at frequencies of 0.5, 1, 2, and 4 kHz in either ear. In each subject, UM was calculated as the difference in the sums of the FTU scores, which is an index of posterior tooth occlusion, on the two sides of the oral cavity. The scores were used to classify the UM into low, moderate, and high. The adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) were calculated in multivariable logistic regression analyses.

    Results: When controlling for sociodemographic factors, the aOR for hearing loss was 3.12 (95% CI, 1.21–8.03) for high UM relative to low UM. This association remained in a fully-adjusted model containing factors related to noise exposure (aOR 2.88; 95% CI, 1.12–7.46).

    Conclusion: Adults with high UM as measured using FTUs showed a higher occurrence of hearing loss than those with low UM.

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  • Aya Goto, Yusuke Tsugawa, Keiya Fujimori
    2019 Volume 29 Issue 8 Pages 308-314
    Published: August 05, 2019
    Released: August 05, 2019
    [Advance publication] Released: December 15, 2018
    JOURNALS OPEN ACCESS

    Background: Little is known about the association between the anxiety toward the effects of radiation on reproduction caused by the Fukushima nuclear accident and the birth rate of people in Fukushima. Therefore, we examined changes and associated factors of future pregnancy intention among mothers in Fukushima Prefecture.

    Methods: Using data from three postal surveys among women who registered their pregnancies in the prefecture (N = 6,751 in 2012, N = 6,871 in 2013, and N = 6,725 in 2014), we analyzed the factors associated with women’s intention of future pregnancy using multivariable logistic regression models.

    Results: The proportion of mothers with pregnancy intention increased from 53.5% in 2012 to 57.9% in 2014, especially among multiparas (P for trend <0.001). Factors inversely associated with pregnancy intention of both groups were older maternal age (adjusted odds ratio [aOR] 0.92 for primipara and 0.87 for multipara), poor subjective health (aOR 0.75 and 0.81, respectively), and presence of depressive symptoms (aOR 0.71 and 0.79, respectively) (P < 0.01 for all items). In addition, not living with husband (aOR 0.24), dissatisfaction with obstetrical care (aOR 0.89) and child abnormalities (aOR 0.72) were inversely associated with pregnancy intention among primiparas, while receiving infertility treatment (aOR 2.05) was positively associated among multiparas (P < 0.01 for all items). A separate analysis of 2012 and 2013 data showed that concern about radiation contamination of breast milk was associated with pregnancy intention among primiparas (aOR 0.61, P < 0.001).

    Conclusions: Mothers’ concern about radiation was associated with lower pregnancy intention, especially among primiparas. Providing quality obstetrical and mental health care and parenting support may be the keys to maintaining the temporal increase in fertility.

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Study Profile
  • Robab Breyer-Kohansal, Sylvia Hartl, Otto Chris Burghuber, Matthias Ur ...
    2019 Volume 29 Issue 8 Pages 315-324
    Published: August 05, 2019
    Released: August 05, 2019
    [Advance publication] Released: October 20, 2018
    JOURNALS OPEN ACCESS

    Background: The Lung, hEart, sociAl, boDy (LEAD) Study (ClinicalTrials.gov; NCT01727518; http://clinicaltrials.gov) is a longitudinal, observational, population-based Austrian cohort that aims to investigate the relationship between genetic, environmental, social, developmental and ageing factors influencing respiratory health and comorbidities through life. The general working hypothesis of LEAD is the interaction of these genetic, environmental and socioeconomic factors influences lung development and ageing, the risk of occurrence of several non-communicable diseases (respiratory, cardiovascular, metabolic and neurologic), as well as their phenotypic (ie, clinical) presentation.

    Methods: LEAD invited from 2011–2016 a random sample (stratified by age, gender, residential area) of Vienna inhabitants (urban cohort) and all the inhabitants of six villages from Lower Austria (rural cohort). Participants will be followed-up every four years. A number of investigations and measurements were obtained in each of the four domains of the study (Lung, hEart, sociAl, boDy) including data to screen for lung, cardiovascular and metabolic diseases, osteoporosis, and cognitive function. Blood and urine samples are stored in a biobank for future investigations.

    Results: A total of 11.423 males (47.6%) and females (52.4%), aged 6–80 years have been included in the cohort. Compared to governmental statistics, the external validity of LEAD with respect to age, gender, citizenship, and smoking status was high.

    Conclusions: In conclusion, the LEAD cohort has been established following high quality standards; it is representative of the Austrian population and offers a platform to understand lung development and ageing as a key mechanism of human health both in early and late adulthood.

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