Journal of Epidemiology
Online ISSN : 1349-9092
Print ISSN : 0917-5040
ISSN-L : 0917-5040
Advance online publication
Displaying 1-32 of 32 articles from this issue
  • Yoko Muto, Mariko Hosozawa, Miyuki Hori, Arisa Iba, Shuhei Maruyama, S ...
    Article ID: JE20240179
    Published: 2025
    Advance online publication: February 08, 2025
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background

    Evidence of post-COVID-19 condition (PCC) in the Alpha- and Delta-variant dominant waves is limited.

    Methods

    In a nationwide multicentre cohort study in collaboration with 20 hospitals, we collected data using self-administered questionnaires and electronic medical records of participants aged 20 or more diagnosed with COVID-19, hospitalized between Apr 1 2021 and Sept 30 2021, and discharged alive. Descriptive statistics were analyzed for PCC and mental health (HADS anxiety and depression scores), comparing Alpa and Delta-dominant waves.

    Results

    We analyzed 1,040 patients (median age, 57 [IQR 49-66] years; men, 66.2%). Of the respondents, 45.4% had at least one PCC symptom one year after infection. The common symptoms included dyspnea (20.7%), fatigue/malaise (17.6%), muscle weakness (15.4%), decrease in concentration (13.4%), and sleep disorder (13.3%), followed by brain fog (8.4%). Among patients with PCC, 14.0% had anxiety (HADS-Anxiety ≥11), and 18.6% had depression (HADS-Depression ≥11), with four times higher proportions than those without PCC; only small variations by age, sex, and waves were observed. Associated factors for PCC were age 40 years or over, women, severity of COVID-19 during hospitalization, ex-smokers who quit smoking before COVID-19 infection and being infected during the Delta-variant dominant wave.

    Conclusion

    The study described the prevalence of PCC, associated factors, and mental health of COVID-19 survivors hospitalized during the Alpha and Delta-variant dominant waves in Japan. Further follow-up will be conducted to examine the longer-term impact of COVID-19 on PCC, complications, daily life, and socioeconomic status.

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  • Yu Wang, Yosuke Inoue, Shohei Yamamoto, Ami Fukunaga, Shuichiro Yamamo ...
    Article ID: JE20240259
    Published: 2025
    Advance online publication: February 08, 2025
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: While evidence from Western countries links low-to-moderate alcohol consumption to a lower risk of type 2 diabetes mellitus (T2D), findings have been inconsistent in Asia. Since T2D in Asia involves both insulin resistance and deficient insulin secretion, both of which are differently affected by alcohol, we prospectively examined whether the association differs according to body mass index (BMI) categories among the Japanese.

    Methods: Participants were 31,524 health checkup examinees (26,819 males and 4,705 females aged 20-64 years) who were free from diabetes at baseline. Self-reported data on alcohol use were used to estimate the average daily alcohol consumption at the baseline. Incident diabetes was identified at annual checkups during the follow-up period. A Cox proportional hazards model was used to estimate hazard ratios and 95% confidence intervals.

    Results: During a median follow-up of 12.0 years, 3,527 male and 287 female participants developed T2D. The association between alcohol consumption and T2D risk differed markedly by BMI in both sexes. Among males, low- and moderate-level alcohol consumption was associated with a lower T2D risk in individuals with BMI ≥25.0 kg/m2, whereas consumption at a level of 2 go/day (approximately 46 g ethanol) was linked to an increased T2D risk in those with BMI ≤22.0 kg/m2. In females, similar patterns were observed, although confidence intervals were broad due to smaller sample size.

    Conclusions: In Japan, low-to-moderate alcohol consumption may lower T2D risk in those with excess body weight, while high alcohol consumption may increase T2D risk in those with lower BMI.

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  • Seitaro Suzuki, Taiki Yamaji, Motoki Iwasaki, Manami Inoue, Shoichiro ...
    Article ID: JE20240033
    Published: 2024
    Advance online publication: August 24, 2024
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    Supplementary material

    Background: Although both a lower and a higher body mass index (BMI) are reportedly associated with head and neck cancer (HNC), reports from Asia are scarce. Moreover, evidence regarding the association between height and HNC is limited.

    Methods: We investigated associations between BMI, height, and the incidence of HNC among 102,668 participants (49,029 men and 53,639 women) aged 40–69 years in the Japan Public Health Center-based Prospective Study. We followed participants from 1990 to 2013. We conducted a Cox proportional hazards regression analysis, which included adjustment for potential confounders, such as smoking status. Baseline weight and height information were self-reported.

    Results: Over an average follow-up of 18.7 years, 311 HNC cases were newly diagnosed. Lower BMI was significantly associated with HNC, with hazard ratios (HR) of 2.75 (95% confidence interval [CI], 1.63–4.64) for <18.5 kg/m2 and 1.63 (95% CI, 1.15–2.30) for 18.5–20.9 kg/m2 compared to 23–24.9 kg/m2. Increased risk was suggested for higher BMI, with an HR of 1.30 (95% CI, 0.84–2.00) for ≥27.5 kg/m2. This trend was also observed in quadratic models. Results were similar among never-smokers. Meanwhile, only lower BMI showed a strong association with HNC risk among former and current smokers (HR 3.09; 95% CI, 1.54–6.20 for <18.5 kg/m2 compared to 23–24.9 kg/m2). Height showed no association with HNC.

    Conclusion: Lower BMI was significantly associated with HNC risk, while increased HNC risk was suggested in higher BMI among never-smokers. Among former and current smokers, only lower BMI was associated with HNC risk.

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  • Md. Mahfuzur Rahman, Md. Shafiur Rahman, Md. Rashedul Islam, Stuart Gi ...
    Article ID: JE20240065
    Published: 2024
    Advance online publication: September 07, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: The burden of cancer in India has been rising, yet testing for early detection remains low. This study explored inequalities in the uptake of breast cancer (BC) examination and cervical cancer (CC) among Indian women, focusing on socioeconomic, regional, and educational differences.

    Methods: Data from the 2019–21 National Family Health Survey (n = 353,518) were used to assess the uptake of BC examination and CC testing. Inequalities were quantified using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). SII measured absolute inequality, while RII and RCI assessed relative inequality between disadvantaged and advantaged groups.

    Results: The ever uptake of tests for early detection of BC and CC were low at 9 and 20 per 1,000 women, respectively. Higher uptake was observed among women from the richest households compared to the poorest (SII: 1.1 for BC and 1.8 for CC). The magnitude of relative socioeconomic inequalities was more pronounced in rural areas (RCI: 22.5 for BC and 21.3 for CC) compared to urban areas. Similarly, higher-educated women were 4.84 times (RII: 4.84) and 2.12 times (RII: 2.12) more likely to undergo BC examination and CC testing, respectively, compared to non-educated women. The Northeastern region exhibited greater socioeconomic inequality, while the Western region showed more education-based inequality.

    Conclusion: The lower uptake of BC examination and CC testing and the marked inequalities underscore the need for targeted interventions to improve access and utilization of testing services, especially among lower-educated women, and those in rural areas.

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  • Chi-Shin Wu, Le-Yin Hsu, Chen-Yang Shen, Wei J. Chen, Shi-Heng Wang
    Article ID: JE20240110
    Published: 2024
    Advance online publication: July 20, 2024
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    Supplementary material

    Background: This study aimed to validate self-reported medical conditions in the Taiwan Biobank (TWBB), in which participants were inquired about 30 disease conditions, by comparing them with claims records from Taiwan’s National Health Insurance (NHI) claims database.

    Methods: We identified 30 clinical diagnoses using International Classification of Diseases - Clinical Modification codes from ambulatory and hospital claims within the NHI claims database, matching diseases included in the TWBB. The concordance between self-reports and claims records was evaluated using tetrachoric correlation to assess the correlation between binary variables.

    Results: A total of 131,834 participants aged 30–70 years with data from the TWBB and NHI records were included. Concordance analysis revealed tetrachoric correlations ranged from 0.420 (chronic obstructive pulmonary disease) to 0.970 (multiple sclerosis). However, several disorders exhibited lower tetrachoric correlations. The concordance was higher among those with higher education attainment, and lower among married individuals.

    Conclusion: The concordance between self-reports in the TWBB and NHI claims records varied across clinical diagnoses, showing inconsistencies depending on participant characteristics. These findings underscore the need for further investigation, especially when these variables are crucial to research objectives. Integrating complementary databases, such as clinical diagnoses, prescription records, and medical procedures, can enhance accuracy through customized algorithms based on disease categories and participant characteristics and optimize sensitivity or positive predictive values to align with specific research objectives.

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  • Hirokazu Tanaka, Shuhei Nomura, Kota Katanoda
    Article ID: JE20240158
    Published: 2024
    Advance online publication: October 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Amidst the global coronavirus disease 2019 (COVID-19) pandemic, Japan has faced a significant public health challenge, evident from the significant increase in mortality rates since 2021. This study described the variations in all-cause and cause-specific changes in mortality up to 2022 in Japan.

    Methods: This study used official Vital Statistics from the Ministry of Health, Labour and Welfare (MHLW) to assess the impact of the pandemic on mortality trends. An analysis of all-cause and cause-specific age-standardized mortality rates (ASMRs) from 1995 to 2022 was conducted, employing the 2015 Japan Standard Population. Sex- and cause-specific ASMRs for a particular year were compared with those from the preceding year to assess annual changes.

    Results: Among men, the annual all-cause ASMR per 100,000 people increased from 1,356.3 in 2021 to 1,437.8 in 2022 (6.0% increase). Among women, the annual all-cause ASMR increased from 722.1 in 2021 to 785.8 in 2022 (6.5% increase). Compared with the period 2020 to 2021, COVID-19 (+29.1 per 100,000 people for men and +13.4 per 100,000 people for women), senility (+14.1 per 100,000 people for men and +12.5 per 100,000 people for women), heart disease, malignant neoplasms (for women) and “other causes not classified as major causes” substantially contributed to the increase in all-cause ASMR from 2021 to 2022.

    Conclusion: Further long-term monitoring from 2023 onwards is necessary, especially for conditions like senility, cardiovascular disease, and cancer, which may have long-term effects due to changes in healthcare settings, even though the strong countermeasures against COVID-19 were lifted in 2023.

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  • Masami Narita, Midori Yamamoto, Kenichi Sakurai, Chisato Mori, the Jap ...
    Article ID: JE20240192
    Published: 2024
    Advance online publication: September 07, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Parents’ educational background is presumed to influence the incidence of vaccine-preventable diseases in children through their decisions about vaccinations and other family lifestyle choices. Regarding voluntary vaccination, a household’s economic situation may also be associated with non-vaccination. Therefore, this study investigated the association between parental education and vaccine-preventable diseases (varicella, mumps, influenza [flu], pertussis, measles, and rubella) in children, which currently remains elusive.

    Methods: We used datasets from the Japan Environment and Children’s Study, which included 104,062 fetal records; our study population comprised 80,930 children up to the age of 3 years. The associations between parental educational background and children’s infectious diseases were examined using binomial logistic regression analysis. The mediating effects of household income, vaccination, and smoking were examined using a path analysis.

    Results: For varicella, mumps, and influenza covered by voluntary vaccination, a higher education level of the father was associated with a lower incidence of infection. The association between mothers’ education and children’s infection was limited. There were both income-mediated and non-income-mediated pathways between parental education and voluntary vaccination. For pertussis, measles, and rubella, which are covered by routine vaccines, there was no association between parental education and the child’s infection.

    Conclusion: An association between parental education and childhood infections was observed. Providing financial support for vaccination and communicating the benefits of vaccination in a way that parents at all levels of education can understand may help reduce the incidence of infectious diseases among children.

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  • Yasufumi Gon, Ling Zha, Toshitaka Morishima, Yasuyoshi Kimura, Kanako ...
    Article ID: JE20240230
    Published: 2024
    Advance online publication: August 24, 2024
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    Supplementary material

    Background: Advancements in cancer care have improved survivorship, potentially leading to changes in mortality causes. This study aimed to investigate the causes of death among cancer survivors, specially focusing on non-cancer-related mortality.

    Methods: This nationwide population-based cohort study analyzed the causes of death based on the time since cancer diagnosis using data from the National Cancer Registry in Japan between January 2016 and December 2019. Non-cancer-related deaths were identified, and mortality risks associated with non-cancer diseases were compared to those of the Japanese general population using standardized mortality ratios (SMRs) with 95% confidence intervals (CIs). The follow-up period was up to 4 years after cancer diagnosis.

    Results: A total of 3,990,661 patients (45.8% women) were included in the analysis, yielding 6,237,269 person-years of follow-up. Of these, 1,001,857 (25.1%) patients died during the study period. Cancer-related and non-cancer-related causes accounted for 86.6% and 13.4% of deaths, respectively. The proportion of non-cancer-related deaths increased from 10.2% at 6 months to 31.6% at 4 years after cancer diagnosis. Heart disease (21.8%), cerebrovascular disease (9.8%), and pneumonia (9.1%) were the leading cause of non-cancer-related deaths: the SMRs for these diseases were 2.69 (95% CI, 2.66–2.72), 2.07 (95% CI, 2.03–2.10), and 2.41 (95% CI, 2.36–2.45), respectively. The SMR for suicide was 1.81 (95% CI, 1.74–1.89); however, it lost significance in males and females 2 and 2.5 years after cancer diagnosis, respectively.

    Conclusion: The proportion of non-cancer-related deaths among cancer patients has increased over time, emphasizing the need to manage cancer and its comorbidities carefully.

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  • Hong Pan
    Article ID: JE20240235
    Published: 2024
    Advance online publication: August 03, 2024
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  • Naoko Otsuki, Tomoaki Mameno, Yuya Kanie, Masahiro Wada, Maki Shinzawa ...
    Article ID: JE20240165
    Published: 2025
    Advance online publication: January 25, 2025
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    Supplementary material

    Background: Several studies reported an association between the number of teeth and the incidence of hip fractures in observational studies, mainly in middle-aged adults. This retrospective cohort study aimed to clarify the association between the number of teeth and the incidence of hip fractures.

    Methods: In this retrospective cohort study, a total of 256,772 participants aged 75 years or older who underwent public dental checkups in Japan were evaluated. Exposure in this study was the number of teeth, with a maximum number of 28, excluding third molars. Outcome measures were the incidence of hip fractures needing surgery, using the Japanese procedure codes in medical claims.

    Results: A total of 190,998 participants met the inclusion criteria and were available for analysis. Adjusted Fine and Gray models identified a significant association between the number of teeth, including sound, filled, and decayed teeth, and the incidence of hip fractures among women but not for men. The continuous net reclassification improvement (NRI) of the sound and filled teeth count model increased by 0.078 compared with that of the sound, filled, and decayed teeth count model among women.

    Conclusions: The number of sound and filled teeth predicted the risk of hip fractures in women, whereas no association was observed between the number of teeth and hip fractures in men.

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  • Yuta Taniguchi, Atsushi Miyawaki, Masao Iwagami, Takehiro Sugiyama, Ta ...
    Article ID: JE20240197
    Published: 2025
    Advance online publication: January 25, 2025
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    Supplementary material

    Background

    Studies have shown that informal caregiving is associated with an increased risk of cardiovascular diseases. However, there is limited evidence on the mechanisms involved. To fill this knowledge gap, we investigated the association of informal caregiving with changes in health-related behaviors.

    Methods

    We analyzed a nationally representative sample aged 50–59 years as of 2005 using fifteen waves of the Longitudinal Survey of Middle-Aged and Older Adults, conducted between 2005–2019. We investigated the association between the change in informal caregiving status and the change in health-related behaviors, including (1) heavy drinking, (2) smoking, (3) no exercise habits, and (4) no attendance at annual health checkups. We used multivariable logistic regression models with correlated random effects, adjusting for individual-level time-invariant characteristics.

    Results

    Among 268,165 observations from 30,530 participants (median age 55 [interquartile range 52–57] at baseline; 51.6% women), 32,164 (12.0%) observations from 10,224 individuals provided informal care. After adjusting for potential confounders, informal caregiving was associated with higher probabilities of deteriorating health-related behaviors, including heavy drinking (adjusted odds ratio [aOR] 1.16; 95% confidence interval [CI] 1.03–1.32; adjusted p=0.032) and no exercise habits (aOR 1.09; 95%CI 1.04–1.15; adjusted p<0.001). We observed similar patterns for smoking (aOR 1.12; 95%CI 1.001–1.26; adjusted p=0.053) and no attendance at health checkups (aOR 1.05; 95%CI 0.999–1.10; adjusted p=0.053).

    Conclusion

    This study showed that the transition into informal caregiving was associated with deteriorating cardiovascular-related health behaviors in Japan. These findings highlighted the importance of continued efforts to prevent the deterioration of caregivers’ health-related behaviors.

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  • Yuri Yokoyama, Yu Nofuji, Takumi Abe, Kumiko Nonaka, Yumi Ozone, Yuka ...
    Article ID: JE20240288
    Published: 2025
    Advance online publication: January 25, 2025
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: We launched the Wako Cohort Study in 2023 to identify individual and socio-environmental factors related to the extension of healthy life expectancy and the reduction of health disparities among community-dwelling adults and to develop health promotion and care prevention strategies. This study profile aims to describe the study design and participants’ profile at baseline.

    Methods: The Wako Cohort Study is a prospective study of community-dwelling adults aged ≥ 40 years living in Wako City, Saitama Prefecture, Japan. The Wako Cohort Study consists of two surveys: a mail-in survey for persons aged ≥ 40 years and a face-to-face assessment (on-site survey) for those aged ≥ 65 years. The survey items were designed considering the following points: 1) life course perspective (transition from middle to old age in the life course), 2) health indifference, and 3) employment in older age.

    Results: A total of 8,824 individuals participated in the mail-in survey (2,395 persons aged 40–64 years and 6,429 aged ≥ 65 years). Of those aged ≥ 65 years who returned the mail survey, 1,004 participated in the subsequent on-site survey. Men aged ≥ 65 years tended to have higher health interests than those aged 40–64 years; however, this was not true for women. In the mail-in survey, 30.4 % of those aged ≥ 65 years were employed.

    Conclusions: The Wako Cohort Study is expected to provide new insights into the development of strategies to extend healthy life expectancy and reduce health disparities in Japan.

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  • Marco Scala, Giulia Dallera, Giuseppe Gorini, Jérémie Achille, Anne Ha ...
    Article ID: JE20240189
    Published: 2025
    Advance online publication: January 11, 2025
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    Supplementary material

    Introduction: Relative or absolute safety of heated tobacco products (HTP) remains unknown, while independent literature suggests that these products do not favour tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP use on conventional tobacco smoking (use transitions).

    Methods: We used Pubmed/MEDLINE, Embase and the Cochrane Library to identify all articles published up to February 2022 on HTP use. For the present review, we included all representative cross-sectional studies dealing with HTP use, and all prospective cohort studies or cross-sectional studies on conventional tobacco smoking transitions due to HTP use. From 610 non-duplicate articles, 76 were eligible (71 cross-sectional and 5 prospective cohort studies).

    Results: Compared with young adults, HTP use was less frequent among middle-aged (pooled odds ratio, OR=0.59; 95% confidence interval, CI: 0.48–0.74; number of studies, n=15) and older adults (OR=0.17; 95%-CI: 0.07–0.38; n=12). HTP use was more frequent among former (OR=2.73; 95%-CI: 1.03–7.25; n=6) and current smokers (OR=14.53; 95%-CI: 6.34–33.31; n=12). Overall, 68.3% of HTP users were dual users (n=26). Eight studies (including 5 cohorts) showed that HTP users were more likely than non-users to start conventional cigarette smoking (OR=6.31; 95%-CI: 4.13–9.65; n=2), whereas current cigarette smokers using HTPs were less likely to quit (OR=0.84; 95%-CI: 0.80–0.89; n=4).

    Conclusions: We found that HTPs are specifically popular among young generations. More than two out of three HTP users are dual users. Prospective studies consistently show that in real life HTPs are not effective smoking cessation tools.

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  • Rumi Tsukinoki, Yoshitaka Murakami, Takehito Hayakawa, Aya Kadota, Aki ...
    Article ID: JE20240298
    Published: 2025
    Advance online publication: January 11, 2025
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Healthy life expectancy (HLE) is a population health indicator that is widely used in developed countries, but little is known about its relationships with combinations of non-communicable disease risk factors. This study was conducted to examine HLE at age 65 according to combinations of blood pressure levels, body mass index, smoking status, and diabetes mellitus (DM) in a Japanese population.

    Methods: In a nationwide cohort study (NIPPON DATA90), data on these risk factors were obtained from participants in 1990 through physical examinations, blood tests, interviews, and questionnaires. Subsequently, participants aged ≥65 years underwent surveys on activities of daily living in 1995 and 2000, and multistate life tables were used to calculate combination-specific HLEs and their 95% confidence intervals (CIs).

    Results: The study population comprised 6,569 participants (men: 2,797; women: 3,772) who were followed-up until 2010. HLE at age 65 in men with grade II/III hypertension, obesity, current smoker status, and DM (HLE: 12.9 years, 95% CIs: 12.9-13.0 years) was 9.7 years shorter than men without these risk factors (HLE: 22.6 years, 95% CIs: 22.4-22.8 years). Similarly, HLE at age 65 in women with grade II/III hypertension, obesity, current smoker status, and DM (HLE: 16.2 years, 95% CIs: 15.9-16.5 years) was 10.1 years shorter than women without these risk factors (HLE: 26.3 years, 95% CIs: 26.3-26.3 years).

    Conclusion: The large discrepancies in HLEs underscore the impact of non-communicable disease risk factors, which should be considered when formulating health interventions to improve HLE in Japanese older adults.

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  • Akihiro Nishi, Kosuke Inoue
    Article ID: JE20240412
    Published: 2025
    Advance online publication: January 11, 2025
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  • Bin Zhang, Zhaolong Zhan, Sijie Xi, Feng Wang, Xiaosong Yuan
    Article ID: JE20240275
    Published: 2024
    Advance online publication: December 21, 2024
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    Supplementary material

    Background: There is still uncertainty regarding the association between maternal serum levels of retinol-binding protein 4 (RBP4) and pregnancy outcomes. This study aimed to determine the association between RBP4 levels and incidence of small/large for gestational age (SGA/LGA) infants among the Chinese population.

    Methods: This was a retrospective study of 11,854 pregnant women who delivered at Changzhou Maternal and Child Health Care Hospital between 2016 and 2017 and whose serum RBP4 levels were measured at the time of admission. The incidence of SGA/LGA deliveries was retrieved from the medical records of the participants.

    Results: Maternal RBP4 levels in the second, third and fourth quartiles (28.8–34.0, 34.1–40.0, and >40.0 mg/L, respectively) were associated with lower birthweights relative to those in the first quartile (<28.8 mg/L), with estimated average decreases of 51.30 g (95% CI: -70.51, -32.10), 86.86 g (95% CI: -106.50, -67.22) and 124.08 g (95% CI: -144.51, -103.64), respectively (P for trend <0.01). Pregnant women in the fourth quartile for RBP4 levels had a greater SGA risk (OR: 2.14, 95% CI: 1.72, 2.65) and lower LGA risk (OR: 0.53, 95% CI: 0.45, 0.63) than those in the first quartile after controlling for demographic variables, gestational age, pregnancy complications and other laboratory results. The sensitivity analysis indicated the consistency of these findings.

    Conclusion: High RBP4 levels in late pregnancy are associated with an increased SGA risk and decreased LGA risk, indicating that serum RBP4 levels at the time of admission for delivery could be a promising predictor of SGA/LGA delivery.

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  • Hiroshi Murayama, Mika Sugiyama, Hiroki Inagaki, Ayako Edahiro, Fumiko ...
    Article ID: JE20240277
    Published: 2024
    Advance online publication: December 21, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Community social capital is associated with various health outcomes; however, its impact on mortality is not fully understood, particularly in non-Western settings. This study examined the association between community-level social capital and all-cause mortality among community-dwelling older Japanese adults.

    Methods: The baseline data were obtained from a 2015 questionnaire survey for all 132,005 residents aged ≥65 years without long-term care insurance certification in Adachi Ward (consisting of 262 small districts) of the Tokyo metropolitan area. We measured two aspects of social capital: neighborhood cohesion as cognitive social capital and neighborhood network as structural social capital. For district-level social capital, we aggregated the individual responses of neighborhood cohesion and neighborhood network in each district.

    Results: A total of 75,338 were analyzed. A multilevel survival analysis with an average follow-up of 1,656 days showed that higher district-level neighborhood cohesion was associated with a lower risk of all-cause mortality in men (hazard ratio [95% confidence interval]: 0.92 [0.84–0.99] for the highest quintile and 0.91 [0.82–0.99] for the second, compared to the lowest), not in women. This association was more pronounced in men aged 65–74 years.

    Conclusions: This study provides valuable insights from the Asian population. Men, who typically have fewer social networks and support systems than women, could receive more benefits from residing in a cohesive community, which may contribute to their longevity. These findings support public health strategies that bolster community social capital as a means of archiving longevity among older men, underscoring the importance of social integration in aging societies.

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  • Midori Yamamoto, Kenichi Sakurai, Rieko Takatani, Aya Hisada, Chisato ...
    Article ID: JE20240284
    Published: 2024
    Advance online publication: December 21, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: Coronavirus disease 2019 (COVID-19) in children is often asymptomatic, posing challenges in detecting infections. Additionally, factors contributing to infection remain poorly understood. This study aimed to investigate trends in anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid antibody seroprevalence, the relationship between seroprevalence and parental perception of child infection, and factors related to COVID-19 in children.

    Methods: In December 2020, 355 children aged 6–12 years in one elementary school were enrolled in the study. The anti-SARS-CoV-2 nucleocapsid antibody seroprevalence was assessed, and questionnaires were administered annually for three years. Parents’ perceptions of infection and factors contributing to infection were examined.

    Results: The seroprevalence was 0.6%, 2.2%, and 60.9% in the first, second, and third years, respectively. The third-year seroprevalence among children reported as ‘infected,’ ‘not tested but had symptoms,’ and ‘not infected’ by parents was 97.3%, 83.3%, and 35.7%, respectively. Increased odds of seropositivity at the third-year measurement were observed in lower grades (adjusted odds ratio [aOR]=2.79 compared with higher grades) and in children more likely to play with others (aOR=3.97 for ‘somewhat’ and 2.84 for ‘often,’ compared with ‘rarely’). No significant associations with seropositivity were found for sex, siblings, body mass index, serum 25-OH vitamin D3 concentration, or sleep duration.

    Conclusion: The Omicron variant outbreak from the end of 2021 led to a sharp increase in seroprevalence among children, with many unaware of their infection. Frequent play with others may facilitate transmission in children. These data provide useful information for developing countermeasures against COVID-19 and other future pandemics.

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  • Keiko Murakami, Misako Nakadate, Taku Obara, Misato Aizawa, Ippei Taka ...
    Article ID: JE20240293
    Published: 2024
    Advance online publication: December 21, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: The Tohoku Medical Megabank Project has initiated the Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study) including genomic and omics investigations, and conducted a self-administered food frequency questionnaire with the response option “constitutionally unable to eat or drink it” for individual food items (TMM-FFQ) for pregnant women. This study evaluated the validity of the TMM-FFQ among pregnant women.

    Methods: Participants comprised 122 pregnant women aged ≥20 years residing in Miyagi Prefecture who completed weighed food records (WFRs) for 3 days as reference intake and the TMM-FFQ during mid-pregnancy. Correlations between nutrient or food group intakes based on the WFR and the TMM-FFQ were calculated using Spearman’s rank correlation coefficients (CCs), adjusting for energy intake and correcting for random within-individual variation of WFR. Cross-classification was also conducted according to quintiles using the WFR and TMM-FFQ data.

    Results: The percentages of participants who chose the “constitutionally unable to eat or drink it” option were >3% for seven food and drink items. CCs were >0.30 for 31 nutrients; the median across energy and 44 nutrients was 0.41. CCs were >0.30 for 14 food groups; the median across 20 food groups was 0.35. The median percentages of cross-classification into exact plus adjacent quintiles and extreme quintiles were 63.1% and 3.3% for energy and nutrients and 61.9% and 4.1% for food groups, respectively.

    Conclusions: The validity of the TMM-FFQ compared with the WFR was reasonable for certain nutrients and food groups among pregnant women in the TMM BirThree Cohort Study.

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  • Dong Hang, Chen Zhu, Xiaolin Yang, Jinjin He, Huizhang Li, Tingting Pa ...
    Article ID: JE20240252
    Published: 2024
    Advance online publication: December 07, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: The fecal immunochemical test (FIT) has been widely used in colorectal cancer (CRC) screening, yet the practical performance of FIT combined with questionnaire-based risk assessment (QRA) remains undetermined. Moreover, risk factors for distinct CRC precursors identified in screening have been rarely compared.

    Methods: This study was based on a population-based CRC screening in China, with 2,120,340 participants completing both FIT and QRA. Those with positive FIT or high QRA scores were recommended for colonoscopy. We reported the compliance, detection rate, and colonoscopy workload according to FIT and QRA results. We also explored risk factors for conventional adenomas and serrated polyps.

    Results: The compliance rate of colonoscopy in the subgroup of FIT (+) and QRA (+) was 41.4%, higher than the rates in FIT (+) and QRA (-), as well as FIT (-) and QRA (+), which were 38.7% (P<0.001) and 16.4% (P<0.001), respectively. The corresponding detection rates of advanced neoplasia were 18.2%, 13.2%, and 9.3% (all P <0.001), respectively. Moreover, the required numbers of colonoscopies to detect one advanced neoplasia in the three subgroups were 5.5, 7.6, and 10.8, respectively. Increased body mass index, smoking, alcohol consumption, red meat intake, and type 2 diabetes were associated with higher risk of advanced adenomas and advanced serrated polyps, whereas vegetable intake was inversely associated advanced adenomas.

    Conclusion: FIT and QRA can synergistically identify individuals at high risk of colorectal advanced neoplasia, with those testing positive for both deserving immediate attention. Modifiable factors were identified to complement screening for preventing CRC precursors.

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  • Aya Sugiyama, Masaaki Kataoka, Kentaro Tokumo, Kanon Abe, Hirohito Ima ...
    Article ID: JE20240285
    Published: 2024
    Advance online publication: December 07, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background

    With global aging, especially in Asia, preventing pneumonia among seniors is vital. The necessity of introducing pneumococcal vaccines among the elderly has been highlighted but there is a paucity of community-based real-world evidence on their effect. Sera Town in Hiroshima Prefecture, a super-aged community, launched a distinctive pneumococcal vaccination support project for elderly residents and conducted a 5-year follow-up survey. This study evaluates the effectiveness of this vaccination initiative.

    Methods

    From October 2010 to March 2015, Sera Town recruited elderly residents for PPSV23 vaccination with partial cost subsidies. Participants were surveyed annually for five years post-vaccination to assess pneumonia incidence, calculated on a person-years basis. Using vital statistics from 2000 to 2016, we quantified changes in mortality rates associated with the vaccination support project through interrupted time series analysis.

    Results

    Of approximately 7,900 residents aged 65 and older, 3,422 (43%) participated in the project (median age: 84 years; range: 70-114 years; 56.7% female). Over 14,559 person-years of observation, 295 participants developed pneumonia. The post-vaccination incidence rate was 20.3 per 1,000 person-years (95% CI: 18.0-22.7). Interrupted time series analysis indicated a 25% reduction in Sera Town's pneumonia mortality rate post-project, reversing an annual increase of 0.23 per 1,000 population pre-project to an annual decrease of 0.04 per 1,000 population post-project.

    Conclusion

    This study provided real-world evidence on the association with PPSV23 vaccination on the general elderly through a community-based study. The results may be particularly useful for regions where PPSV23 serotypes are prevalent, offering insights for areas facing aging challenges.

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  • Yuta Takano, Toshiyuki Hirasawa, Yuichi Inoue
    Article ID: JE20240295
    Published: 2024
    Advance online publication: December 07, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Few have examined the condition of subjective daytime sleepiness in workers and its relation to their work productivity. This study aimed to clarify the association between the presence of subjective daytime sleepiness and work productivity measures, including presenteeism and absenteeism, as well as factors related to the presence of the symptom in daytime workers.

    Methods: This cross-sectional study included 17963 daytime workers who attended the annual medical check-up. They were categorized into four groups; the daytime sleepiness group was defined as having only subjective daytime sleepiness, the insomnia group as having only insomnia symptoms, the combination group as having both subjective daytime sleepiness and insomnia symptoms, and the healthy group as having no sleep complaints. This study used demographics, health status, workplace, work productivity, and sleep items included in the self-reported medical check-up questionnaire.

    Results: The combination group had significantly worse presenteeism than other groups. The daytime sleepiness and insomnia groups had significantly worse presenteeism than the healthy group. The results of absenteeism were the same as presenteeism. Factors related to the positivity for subjective daytime sleepiness were presence of psychiatric disease, the positivity for habitual snoring and/or witnessed apnea, shorter sleep duration on workdays, long working hours, female sex, living alone, the amount of social jetlag, and younger age.

    Conclusions: Subjective daytime sleepiness, not just insomnia symptoms, has a significant negative impact on work productivity, and both workplace and individual approaches should not be ignored for addressing subjective daytime sleepiness among daytime workers.

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  • Keiko Murakami, Junko Ishihara, Ribeka Takachi, Shiori Sugawara, Misat ...
    Article ID: JE20240064
    Published: 2024
    Advance online publication: August 03, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: The Tohoku Medical Megabank Project (TMM) was established to realize personalized healthcare and medicine using genomic and omics data. This study evaluated the validity and reproducibility of food group intakes derived from a self-administered food frequency questionnaire (TMM-FFQ) that included the response option “constitutionally unable to eat/drink it” among community-dwelling Japanese adults.

    Methods: Participants comprised 89 men and 124 women aged ≥20 years from Miyagi Prefecture. Participants completed weighed food records (WFRs) for 3 consecutive days per season as reference intake and FFQs in 2019 (FFQ1) and 2021 (FFQ3). Spearman’s rank correlation coefficients (CCs) were calculated for correlations between food group intakes estimated from the 12-day WFR and FFQ3 (validity), and for correlations between those estimated from the FFQ1 and FFQ3 (reproducibility). Cross-classification according to quintiles using FFQ and WFR data was also performed.

    Results: The percentage of participants who chose the “constitutionally unable to eat/drink it” option was non-negligible for some food groups. In the validity analysis, CCs were >0.40 for many food groups; the median across 21 food groups was 0.49 in men and 0.45 in women. The median percentages of cross-classification into exact plus adjacent quintiles were 73.0% in men and 66.9% in women. In the reproducibility analysis, CCs were >0.50 for many food groups; the median across 21 food groups was 0.60 in men and 0.51 in women.

    Conclusion: The validity of the TMM-FFQ compared with 12-day WFR and the reproducibility of the TMM-FFQ were reasonable for food groups in the TMM cohort studies.

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  • Takeshi Makiuchi, Masako Kakizaki, Tomotaka Sobue, Tetsuhisa Kitamura, ...
    Article ID: JE20240114
    Published: 2024
    Advance online publication: August 24, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: The health statuses of closely connected individuals are interdependent. Little is known about mortality risk associated with partner’s cancer diagnosis and cause-specific mortality risk associated with partner’s death.

    Methods: Relative risks for all-cause and cause-specific mortality following a partner’s cancer diagnosis or death compared to the period when the partner is cancer-free and alive were investigated in the population-based prospective cohort study that enrolled 140,420 people at the age between 40–69 years in 1990–1994.

    Results: 55,050 participants (27,665 men and 27,385 women) who were identified as married couples were followed-up for 1,073,746.1 (518,368.5 in men and 555,377.6 in women) person-years, during which 9,816 deaths were observed (7,217 in men and 2,599 in women). After a partner’s cancer diagnosis, the mortality rate ratio (MRR) of all-cause mortality was not increased among both men and women, while an increase of externally-caused MRR was observed. The suicide MRR significantly increased among men (MRR 2.90; 95% confidence interval, 1.70–4.93), and it persisted for more than 5 years. After a partner’s death, the MRRs of all-cause, cardiovascular disease (CVD), respiratory disease (RD), and externally-caused mortality significantly increased only among men. Stratified analysis by smoking status among men showed significantly increased MRRs of CVD and RD mortality among former/current smokers, but not among never-smokers.

    Conclusion: Partner’s cancer diagnosis did not increase all-cause mortality risk, but increased externally-caused mortality risk, especially suicide among men. The impact of partner’s death on mortality risk differed by the mortality causes and sex, and smoking affected some of cause-specific mortality risk.

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  • Makiko Kanai, Osamu Kanai, Takahiro Tabuchi
    Article ID: JE20240180
    Published: 2024
    Advance online publication: November 23, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background:

    Novel tobacco product such as heated tobacco products have recently increased as a result of being promoted less harmful alternatives to cigarettes. The impact of the COVID-19 pandemic on tobacco use may differ depending on the type of tobacco.

    Methods:

    We longitudinally investigated changes in tobacco use over a one-year period using internet-based and self-reported questionnaires among Japanese aged 15 to 79 years. The study was conducted from 2019 to 2021, with participants before the COVID-19 pandemic in February 2020 as prepandemic group and participants after that as pandemic group. Accounting for population bias, we used sampling probability weighting referring to the nationwide data. The association between cessation and the COVID-19 pandemic was evaluated separately for each type of tobacco using logistic regression analysis.

    Results:

    After conducting sampling probability weighting, 1,920 were in the prepandemic group and 2,681 were in the pandemic group. More participants in the pandemic group than in the prepandemic group achieved cessation after one year (13.8% vs. 10.2%, p<0.001). Dual users were more likely to quit during the pandemic than prepandemic (adjusted odds ratio [aOR]=2.56, p<0.001), whereas exclusive novel tobacco users were less likely to quit during the pandemic (aOR=0.66, p=0.041). Tobacco cessation was more frequently achieved among those who had intended to quit at baseline survey among conventional tobacco users (aOR=1.77, p<0.001) and dual users (aOR=2.52, p<0.001); however, this trend was not observed among novel tobacco users (aOR=1.49, p=0.090).

    Conclusions:

    Conventional and novel tobacco use patterns varied in response to the COVID-19 pandemic.

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  • Huibin Yang, Tianyi Tang, Qianlei Qian, Xiaohua Zhang, Yinan Liu, Xiao ...
    Article ID: JE20240233
    Published: 2024
    Advance online publication: November 23, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Spontaneous pregnancy loss (SPL) precedes an increased risk of reduced fertility, while its etiology mechanism remains largely unknown. Liver dysfunction presenting in early pregnancy may represent a pre-existing undiagnosed liver condition affecting fetal development. Here, we investigated whether maternal abnormal liver function in early pregnancy contributed to the incidence of SPL.

    Methods: Data on pregnant women were leveraged from the Maternal Health Care Information System in Shanghai City from 2017 to 2021. Liver dysfunction status was defined as having any elevated liver function biomarker levels (LFBs) at the first antenatal visit. SPL cases were defined as fetal death occurring before 28 weeks gestation. Generalized linear models were used to estimate crude and adjusted risk ratios (aRRs) and 95% confidence intervals (CIs).

    Results: Among 10175 leveraged pregnant women, 918 (9.0%) SPL cases were recorded. Maternal liver dysfunction in early pregnancy was associated with a 49% increased risk of SPL (RR 1.49, 95% CI 1.22–1.84). This positive association persisted after adjustment for covariates (aRR 1.55, 95% CI 1.26–1.92). Higher γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were also linked with increased risk of SPL in a linear fashion (aRRs per 1 standard deviation increase: 1.13, 95% CI 1.08–1.17; 1.13, 1.07–1.20, respectively). Similar magnitudes of associations were observed between normal weight and overweight pregnant women in subgroup analysis.

    Conclusion: We provide new evidence that maternal abnormal liver function in early pregnancy, as well as GGT and ALP, predisposes to an increased risk of SPL.

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  • Takafumi Yamamoto, Hazem Abbas, Upul Cooray, Tetsuji Yokoyama, Takahir ...
    Article ID: JE20240153
    Published: 2024
    Advance online publication: October 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background

    Multiple tobacco product (MTP) use is a public health concern due to their combined adverse health effects. MTP use may have increased since heated tobacco products (HTPs) became more prevalent in Japan. This study aimed to (1) estimate the recent prevalence of MTP use and clarify the associated factors compared to (2) non-smokers and (3) single-product users.

    Method

    We used data from an internet survey conducted in February 2022. The prevalence of MTP use in Japan was estimated using inverse probability-weighted scores from this survey and a nationwide survey by the Japanese government. Tobacco products include six types: cigarettes, HTPs, e-cigarettes, cigars, pipe/water pipes, and smokeless tobacco products. MTP use was defined using the outcome variable (no use, single-product use, and MTP use) based on these six types of use. Using multivariate logistic regression, we calculated the adjusted odds ratios and 95% confidence intervals (CI) to clarify factors associated with MTP use compared to non-smokers, adjusting demographic variables, psychological distress, self-rated health, and alcohol use. Using multivariate Poisson regression, we calculated the adjusted prevalence ratios (aPR) and 95%CI to clarify factors associated with MTP use among smokers, adjusting for these covariates and smoking-related factors like workplace and home smoking rules.

    Results

    We analyzed 30,141 participants whose mean age was 47.8 years (standard deviation = 17.9), and 14,722 participants were male (48.8%). The estimated prevalence of MTP use was 6.8%. The most common combination of MTP use was cigarettes and HTPs. Compared to non-smokers, being younger, male, low education, poor psychological distress, poor self-rated health, and alcohol use were factors associated with MTP use. Among smokers, workplace smoking rules, such as a partial smoking ban and no smoking ban, were not associated with MTP use compared to the indoor smoking ban. However, participants with no home smoking ban were positively associated with MTP use compared to those with a ban on both cigarettes and HTPs at home (both cigarettes and HTPs allowed aPR=1.36, 95%CI 1.15 to 1.61, HTPs only allowed aPR=1.73, 95%CI 1.43 to 2.10).

    Conclusion

    MTP users may account for a high percentage of Japanese smokers.

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  • Chi-Shin Wu, Le-Yin Hsu, Chen-Yang Shen, Wei J. Chen, Mei-Chen Lin, Ch ...
    Article ID: JE20240297
    Published: 2024
    Advance online publication: October 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: This study investigated fundamental demographic variables within the Taiwan Biobank (TWBB) and compared them with national demographic statistics. Additionally, a matched cohort analysis compared TWBB participants with nonparticipants to uncover disparities in sociodemographic and clinical characteristics.

    Methods: A total of 128,663 individuals aged 30 to 70 without cancer were recruited within the TWBB, and 514,652 nonparticipants matched by age and sex were randomly selected from the National Health Insurance claims database. Sociodemographic variables, healthcare utilization metrics, underlying medical conditions, and subsequent mortality and cancer risk were analyzed.

    Results: TWBB participants were more likely to be female, older, married, higher educated, with higher incomes, and urban residency. Healthcare utilization metrics showed minimal differences. Pre-cohort entry, TWBB participants had a higher prevalence of certain medical conditions, such as peptic ulcer disease, osteoarthritis, osteoporosis, and uterine leiomyoma in females. During follow-up periods, elevated mortality rates were observed among TWBB participants but decreased cancer risk.

    Conclusion: The TWBB cohort exhibits disparities in sociodemographic and health-related attributes compared to the general population, comprising older, females, married, higher educated, higher income, and predominantly in urban areas. While mortality rates are slightly elevated within the TWBB cohort, cancer incidence rates are lower. Despite limitations in representativeness, the TWBB's size and exposure measures offer valuable insights into associations between exposures and health conditions.

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  • Masao Ichikawa, Rie Tanaka, Akito Nakanishi, Yukie Sano
    Article ID: JE20240299
    Published: 2024
    Advance online publication: October 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: Japan’s stringent licensing policies for older drivers have not been questioned, possibly due to negative perceptions of older drivers potentially influenced by media coverage of their car crashes. We examined whether older drivers’ fatal crashes are over-represented in the news articles.

    Methods: To examine the news coverage of fatal crashes that occurred between January 2016 and December 2020, we extracted driver- and crash-related data from articles reporting fatal crashes in the two best-selling newspapers, Yomiuri and Asahi. We obtained the corresponding data of police-reported fatal crashes during the same period. We calculated the proportion of newspaper-reported fatal crashes to police-reported fatal crashes by at-fault driver’s age group and crash characteristics.

    Results: Of 12,987 police-reported fatal crashes, 5,888 (45%) and 2,909 (22%) crashes were reported in Yomiuri and Asahi newspapers, respectively. Excluding 2,098 crashes where at-fault drivers or their ages were not identifiable, Yomiuri reported 39%, 35%, and 31%, and Asahi reported 20%, 16%, and 14% of fatal crashes caused by drivers aged <30 years, 30-69 years, and 70 years or older, respectively. Crashes that caused more fatalities or killed children tended to be reported regardless of at-fault drivers’ age groups. Compared with young and middle-aged drivers, older drivers’ fatal crashes involving child fatalities were more reported, whereas their single fatal crashes ending in their own deaths were less reported.

    Conclusion: Older drivers’ at-fault fatal crashes were not over-represented in the news coverage of overall fatal crashes, and their crashes killing themselves were under-reported.

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  • Yurou Xu, Youyi Wang, Xiajing Yao, Qi Zhao, Bo Chen, Na Wang, Tiejun Z ...
    Article ID: JE20240224
    Published: 2024
    Advance online publication: October 12, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: As the most common chronic liver disease worldwide, the natural history of metabolic dysfunction-associated steatotic liver disease (MASLD) in general population is barely reported.

    Methods: The Shanghai Suburban Adult Cohort and Biobank study recruited 36,404 adults between 2016 and 2017, and followed up 25,085 participants between 2019 and 2023 in Songjiang District. A questionnaire survey was conducted by face-to-face interview, and physical examination and laboratory tests were conducted. MASLD was diagnosed by liver ultrasound and the cardiometabolic risk factors (CMRF).

    Results: A total of 36,122 and 21,831 participants met the criteria for baseline and follow-up analyses. The prevalence of MASLD at baseline was 36.8% overall, and 73.6% among those with a BMI over 28 kg/m2. After a median follow-up time of 4.26 years, the incidence density for MASLD was 8.4, and the recovery density was 11.4 per 100 person-years overall, and was 20.0 and 8.4 per 100 person-years for those with baseline BMI over 28 kg/m2. Per 1 kg/m2 increase in baseline BMI was associated with an 15% increase in incidence (HR=1.15, 95%CI: 1.14-1.17) and an 8% decrease in recovery (HR=0.92, 95%CI: 0.90-0.93). From baseline to follow-up visit, participants who remained non-obese, or remained normal cardiometabolic status always showed the lowest incidence and the highest recovery rate, followed by those with improved status.

    Conclusions: The prevalence and incidence of MASLD were high among Shanghai residents, and active recovery was also observed. Obesity was the most important risk factor, and weight loss and lipid level reduction were beneficial for preventing or reversing MASLD.

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  • Takashi Oshio, Ruru Ping
    Article ID: JE20240190
    Published: 2024
    Advance online publication: September 28, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Informal caregiving of older parents adversely affects the mental health of family caregivers. However, the psychological effects of caregiving cessation and the trajectories of these effects have rarely been examined in Japan. This study addresses this gap.

    Methods: Based on a 17-wave nationwide population-based survey in Japan, we analyzed longitudinal data from 8,280 individuals aged 50–59 years in 2005 who started caring for their older parents in 2006 or later and ceased caregiving by 2021. We identified the timings of caregiving onset and cessation and examined the trajectory of psychological distress (PD), defined as a Kessler score ≥ 5 on the 6-item Kessler scale (range 0–24). Linear mixed models were used to assess the trajectory of PD that evolved after caregiving cessation over the subsequent three years.

    Results: After adjusting for covariates, the probability of PD decreased by 5.6 percentage points (from 40.8%; 95% confidence interval [CI], 4.1–7.0) for female caregivers and by 1.9 percentage points (from 31.7%; 95% CI, 0.3–3.5) for male caregivers at caregiving cessation, remaining stable in subsequent years. For women, higher PD risks related to co-residence with a care recipient diminished quickly upon cessation of caregiving, while the unfavorable impacts of no social activity, extended duration of care, and long-hour daily care persisted in subsequent years. For male caregivers, the impact was generally more limited.

    Conclusions. These results suggest that changes in mental health following caregiving cessation warrant serious consideration when developing support programs for former family caregivers.

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  • Masao Iwagami, Miho Ishimaru, Yoshinori Takeuchi, Tomohiro Shinozaki
    Article ID: JE20240245
    Published: 2024
    Advance online publication: September 28, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    In epidemiological or clinical studies with follow-ups, data tables generated and processed for statistical analysis are often of the “wide-format” type—consisting of one row per individual. However, depending on the situation and purpose of the study, they may need to be transformed into the “long-format” type—which allows for multiple rows per individual. This tutorial clarifies the typical situations wherein researchers are recommended to split follow-up times to generate long-format data tables. In such applications, the major analytical aims consist of (i) estimating the outcome incidence rates or their ratios between ≥ 2 groups, according to specific follow-up time periods; (ii) examining the interaction between the exposure status and follow-up time to assess the proportional hazards assumption in Cox models; (iii) dealing with time-varying exposures for descriptive or predictive purposes; (iv) estimating the causal effects of time-varying exposures while adjusting for time-varying confounders that may be affected by past exposures; and (v) comparing different time periods within the same individual in self-controlled case series analyses. This tutorial also discusses how to split follow-up times according to their purposes in practical settings, providing example codes in Stata, R, and SAS.

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