Background: One of the factors for not achieving a reduced salt diet may be the difficulties in screening individuals according to their quantitative salt consumption. Accordingly, we examined the performance of the simplified salt check sheet (13 items) as a quantitative tool for screening excessive salt intake by comparing with the salt intake amount measured by 24-hour urinary sodium (salt equivalent g/day) excretion.

Methods: One hundred fifty-four participants (57 males and 97 females) from Kanagawa, Tokyo, and Nara prefectures in Japan were included. In this study, which the design is a cross-sectional validation study, the salt intake amount was used as a diagnostic criterion, and corresponding receiver operating characteristic (ROC) curves were prepared based on the sensitivity and specificity of each score of the salt check sheet.

Results: The average salt intake were 13.5 and 10.2 g/day for males and females, respectively. When using the total score, among males, the area under the ROC curve (AUC) was moderate (0.702 [95% CI, 0.543-0.862]), confirming its value as a diagnostic tool for salt intake of ≥10 g/day. In females, the AUCs were low for any criteria. When score calculation item was limited to three that contributed to the higher salt intake in this population, the AUC for ≥10 g salt/day was moderate (0.700 [95% CI, 0.595-0.805]).

Conclusions: The salt check sheet was found to be useful in screening for excessive salt intake only in males. For females, it was suggested that it could be used only when three specific items are used.

Background:

Loneliness is prevalent among older adults and is linked to physical and mental health problems. Community social capital has been suggested to mitigate its impact, but its heterogeneity across socioeconomic groups was not explored

Method:

We analysed cross-sectional data from the 2019 Japan Gerontological Evaluation Study (JAGES) with 24,206 participants aged 65 years or older. Loneliness was measured using UCLA’s 3-item scale, and community social capital was assessed by civic participation, social cohesion, and reciprocity. Modified Poisson regression models were used, adjusting for sociodemographic factors and individual responses to the questions on social capital. Interaction effects of gender, education, and income were examined.

Results:

Higher levels of community social cohesion (PR = 0.84, 95% CI: 0.75-0.94) and community reciprocity (PR = 0.64, 95% CI: 0.51-0.80) were inversely associated with loneliness. The relationship between community civic participation and loneliness varied by educational attainment. Interaction analysis indicated that individuals with higher education levels (≥ 13 years) who engaged in community civic participation had a lower prevalence of loneliness (PR = 0.74, 95% CI: 0.57–0.95) compared to those with lower education levels. No clear interactions were observed for gender or income.

Conclusions:

Community social capital, particularly social cohesion and reciprocity, was associated with lower levels of loneliness among older adults. The effect of civic participation differed by education, showing a stronger negative association among individuals with higher education levels (≥ 13 years). Tailored interventions accounting for educational backgrounds are needed while promoting social capital universally.

Background: Non-random participation can undermine the representativeness of seroepidemiological surveys. Despite their critical role in estimating disease spread during pandemics, non-response bias and methods to correct it require further investigation. This study aimed to examine sociodemographic characteristics and COVID-19-related factors influencing participation in a seroepidemiological survey.

Methods: We analyzed data from a national COVID-19 seroepidemiological survey in Japan between December 2022 and March 2023. We performed multivariable logistic regression analyses to estimate adjusted odds ratios (AOR) and their confidence intervals (CIs) after variable selection with the Group Least Absolute Shrinkage and Selection Operator.

Results: Among 6,091 participants, factors associated with higher odds of seroepidemiological surveys participation included being female (AOR 2.08 [95% CI, 1.25-3.47]), living in larger households versus living alone (two: 2.34 [1.20-4.55]; four or above: 2.05 [1.03-4.06]), higher education levels versus junior high school education (high school: 2.66 [1.06-6.15]; junior colleges, technical colleges, vocational schools: 5.51 [1.94-15.07]; university and above: 3.30 [1.26-7.98]), and having a higher household income versus earning <2 million yen (2–4 million yen: 3.32 [1.52-7.33]; 4–6 million yen: 2.73 [1.2-6.23], ≥6 million yen: 4.51 [1.91-10.59]). Lower seroepidemiological survey participation odds were observed in those hesitant or unwilling to vaccinate (0.16 [0.09-0.29]) and those perceiving a higher COVID-19 positivity rate among close contacts (0.98 [0.98-0.99]).

Conclusions: Education, income, household size, sex, vaccination status, and perceived infection risk influenced seroepidemiological survey participation. The findings highlight the need to account for non-response bias using weighted methods like inverse probability weighting.

Background: Socioeconomic inequalities in cancer screening participation remain a public health issue worldwide. We assessed trends in cancer screening participation according to socioeconomic status in Japan between 2013 and 2022, considering the potential impact of the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Data from the nationally representative Comprehensive Survey of Living Conditions (2013–2022: approximately 500,000 persons per survey) were analyzed for age-standardized self-reported cancer screening rates for stomach, lung, colon, breast (aged 40–69 years), and cervical (aged 20–69 years) cancers, stratified by education levels. An age-adjusted Poisson model was used to assess the statistical significance of changes between the survey years.

Results: A clear socioeconomic gradient was observed, particularly in stomach cancer screening, where the 2022 rates ranged from 28.3% (low education) to 58.2% (high education) for men and 20.2% to 43.2% for women, depending on education level. Between 2019 and 2022, screening rates for stomach, lung, and colorectal cancers changed by −1.2%, −0.9%, and +0.6% for men and −1.0%, +0.1%, and +1.4% for women, respectively. Breast and cervical cancer screening rates declined by 0.5% and 0.4%, respectively. The COVID-19 pandemic worsened inequalities, with a 3.1% decline in breast cancer screening among individuals with low education level, compared to a 1.0% decline among those with higher education level.

Conclusion: The COVID-19 pandemic had a minor impact on screening rates (counteracting increasing trends of screening rates), except for colorectal cancer screening rates; however, the impact was relatively severe for individuals with lower socioeconomic status, especially for women.

Background: The Ministry of Health, Labour and Welfare in Japan has published a meal-based dietary guideline (Healthy Meal); however, its relationship with health outcomes remains unclear. This observational study examined the association between adherence to Healthy Meal and all-cause and cause-specific mortalities.

Methods: We analyzed data from the Japan Public Health Center-based Prospective Study (JPHC Study) with a mean follow-up of 19.0 years, including 40,222 men and 47,350 women aged 45–75 years with no history of cancer, stroke, ischemic heart disease, chronic liver disease, or kidney disease. Adherence to Healthy Meal was scored using dietary intake from a validated food frequency questionnaire. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortalities across score quartiles.

Results: A higher Healthy Meal adherence score was significantly associated with a lower risk of all-cause mortality. The multivariable-adjusted HRs (95% CIs) for the highest versus the lowest adherence group were 0.86 (0.82–0.91, p<0.001 for trend) in men and 0.92 (0.87–0.98, p=0.005 for trend) in women. Significant associations with a lower risk of cerebrovascular disease and respiratory disease mortalities were observed in both sexes. In contrast, significant associations were observed for cancer, cardiovascular disease, and heart disease mortalities in men only.

Conclusions: Higher adherence to the Japanese meal-based dietary guideline was associated with a lower risk of all-cause, cerebrovascular disease, and respiratory disease mortalities in Japanese men and women, and cancer, cardiovascular disease, and heart disease mortalities in men only.

Background

Insulin resistance in adipocytes, manifested as high basal circulating free fatty acid (FFA) is thought to contribute to the development of type 2 diabetes mellitus (T2DM). However, the association between adipocyte insulin resistance (Adipo-IR) index and T2DM has rarely been explored in prospective studies. We examined this association in a middle-aged Japanese workers’ cohort. Since the association may differ according to the degree of overall adiposity, the analysis was stratified by the presence of overweight/obesity defined with body mass index (BMI).

Methods

A total of 3,257 subjects (men 2501, women 756) aged 35-66 years were followed-up for up to 17 years. T2DM incidence was defined as fasting blood glucose level ≥ 126 mg/dL, glycated hemoglobin level ≥ 6.5 %, or self-reported initiation of glucose-lowering medications. Adipo-IR was calculated as the product of FFA (mmol/L) and insulin (pmol/L) obtained from baseline fasting blood samples and divided into sex- and BMI category (<25 or ≥25 kg/m²)-specific tertiles. Cox-proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for age, BMI, smoking status, physical activity, drinking habit and family history of diabetes.

Results

During a median of 14.6 years of follow-up, 365 developed T2DM. Compared with the lowest tertile, T2DM risk was significantly increased among the highest tertile category in overweight/obese men (HR: 2.94, 95% CI, 1.76-4.90) and women (HR: 4.24, 95% CI, 1.08-16.61).

Conclusion

Adipo-IR was positively associated with T2DM risk in overweight/obese men and women.

Introduction: Changes in nutritional status during the COVID-19 pandemic may be attributed to the obesity-causing environment that had existed before. This paper aimed to investigate trends in thinness, overweight, and obesity among Chinese children aged 2 to 18 from 2010 to 2020 and assess the potential influence of pandemic.

Methods: The Chinese Family Panel Studies that were conducted every two years between 2010 and 2020 included 48,642 children between the ages of 2 and 18. Height and mass were reported, and the body mass index (BMI) was calculated. The prevalence of thinness, overweight and obesity was estimated using sex-, and age-specific BMI cut-offs adopted by the International Obesity Task Force and population-weighted procedures. Linear regressions were used to estimate trends.

Results: The prevalence of thinness decreased from 25.5% to 22.2% but increased among children aged 2 to 6. The prevalence of overweight and obesity decreased from 24.6% and 14.2% to 22.5% and 10.0%, respectively. However, these decreases in the prevalence of overweight and obesity were attributed mostly to children aged 2 to 6 and the prevalence increased slightly among children aged 13 to 18. The prevalence of obesity in 2020 among only boys aged 13 to 15 was greater than the estimated projections using data from 2010 to 2018.

Conclusions: From 2010 to 2020, the prevalence of all forms of malnutrition among Chinese children decreased, with age disparities. During the pandemic, overweight became more common among pubertal boys. Future interventions as well as policies ought to give high-risk groups priority.

Background: The discomfort experienced due to residual tobacco smoke, a form of thirdhand smoke exposure brought into workplaces by smokers, and its health impacts on non-smokers have been inadequately investigated. This study explored associations between non-smokers’ discomfort and work performance and mental health.

Methods: This observational internet-based survey was conducted in 2021 as part of the Japan Society and New Tobacco Internet Survey. Participants comprised 6,519 adult workers without firsthand or secondhand smoking. Work performance and mental health were evaluated using the Work Functioning Impairment Scale (WFun) and Kessler Psychological Distress Scale (K6), respectively. The proportion of participants who experienced discomfort from the residual tobacco smoke in their workplace by smokers in the previous year was calculated according to the workplace’s smoke-free policy, and the difference was assessed using the χ² test. The association between such discomfort and WFun and K6 scores was examined using univariable and multivariable logistic regression analyses.

Results: Among respondents, 17.1% reported experiencing discomfort due to the residual tobacco smoke. A strict smoke-free workplace policy was associated with a lower proportion of respondents experiencing such discomfort (P < 0.001). Those who experienced discomfort more frequently had significantly higher scores on the WFun (15.5% “never”, 21.3% “sometimes”, 26.2% “frequently”) and K6 (37.8% “never”, 48.2% “sometimes”, 50.8% “frequently”). Adjusting for potential covariates in multivariable analyses did not change these results.

Conclusion: Discomfort from thirdhand smoke was associated with worse work performance and mental health problems. Promotion of strict smoke-free workplace policies is required to reduce such experiences.

Background: We examined the association between the coronavirus disease 2019 (COVID-19)-specific prefectural bed utilization rate and in-hospital mortality during the first 3 years of the pandemic in Japan.

Methods: This nationwide study included 58,175 COVID-19 patients from the COVID-19 Registry Japan, hospitalized between May 1, 2020 and November 30, 2022. Based on the weekly COVID-19-specific bed utilization rate in each prefecture at diagnosis, patients were categorized into four groups (<25%, 25% to <50%, 50% to <75%, and ≥75%). Odds ratios (ORs) were estimated by fitting a generalized linear mixed model with prefecture as a random intercept and adjusting for covariates (age, gender, body mass index, smoking and drinking status, and comorbidities). Additional analyses according to age group, gender, and wave of the pandemic were conducted.

Results: We observed 2,312 (4.0%) all-cause in-hospital deaths. All-cause in-hospital mortality increased with higher COVID-19 bed utilization rates at diagnosis (OR for multivariable model 1.35; 95% confidence interval [CI], 1.19–1.54 for 25% to <50%; OR 1.89; 95% CI, 1.66–2.16 for 50 to <75%; OR 2.16; 95% CI, 1.80–2.58 for ≥75%; P for trend <0.0001). Stronger associations were noted among the younger population (aged <70 years: OR 3.18; 95% CI, 1.96–5.19) and during the fourth (March 1–June 30, 2021: OR 3.81; 95% CI, 2.13–6.80) and sixth pandemic waves (January 1–June 30, 2022: OR 2.67; 95% CI, 1.68–4.23).

Conclusion: Our results emphasize that preventing hospital bed shortages during outbreaks is an important public health strategy to reduce the associated mortality, particularly when new strains emerge and in younger people.

Background: Resilience is an important ability in reducing subsequent health risks from poverty. This study aimed to examine whether reading books in fourth grade boosts resilience in sixth grade and whether poverty status modifies the association.

Methods: We used a part of longitudinal data from 2018 to 2020 from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. In this analysis, we used all fourth-grade elementary school students and their caregivers’ follow-up data (n = 3,136, 9- to 10-year-olds, 49.6% boys, follow-up rate =87%). Poverty and child reading books in fourth grade were assessed at baseline. Child resilience in fourth and sixth grade was assessed by caregivers using the Children’s Resilient Coping Scale.

Results: In fourth grade, 20% of children read no books, while 15% read 4 or more books per week. Children who read more books at baseline became more resilient in sixth grade, even after adjustment of resilience in fourth grade. Poverty in fourth grade was associated with lower resilience in both fourth and sixth grade; however, when stratified by poverty status, the number of reading books was significantly associated with higher resilience only among children in poverty (e.g., coefficient=5.13, 95% confidence interval (CI): 1.20 to 9.06 for ≥4 books vs. none).

Conclusions: For elementary school children in Japan, reading books boosts resilience, especially among children in poverty. Educational policy on reading books during elementary school may be important to address child poverty.

Background. Preventable behavioural risk factors account for approximately one third of mortality, morbidity, and disability worldwide. This study aims to quantify the interest in behavioural risk factors within major medical journals in 2022 and to derive trends over the past 30 years in the entire medical literature.

Methods. We analysed the proportion of publications dealing with tobacco smoking, alcohol drinking, use of illicit drugs, excess body weight and physical activity among all the 1,128 articles published in JAMA, BMJ, Lancet and New England Journal of Medicine in 2022. A joinpoint analysis was conducted running in PubMed/MEDLINE specific search strings to evaluate trends over the last 30 years in the four journals and in the whole medical literature.

Results. In 2022, of all publications from the four considered medical journals, 2.8% dealt with tobacco smoking, 1.6% alcohol drinking, 1.1% use of illicit drugs, 3.8% excess body weight, 2.7% physical activity and 8.0% dealt with any behaviours. The joinpoint analysis on the whole medical literature showed that papers on modifiable risk factors significantly increased from 3.9% in 1993 to 6.2% in 2014 (annual percent change, APC: between +1.83% and +4.09%), and subsequently decreased between 2014 and 2019 (APC=-0.31%), with an acceleration thereafter (APC =-2.41% in 2019-2022).

Conclusions. For the first time we quantified the volume of medical research focused on preventable behavioural risk factors. This appears to be limited and declining over the last decade. Research on primary prevention should be a priority to face the emergence of associated non-communicable diseases globally.

The Iodine Status in Pregnancy and Offspring Health Cohort (ISPOHC) was initiated in Shanghai to address the need for a comprehensive and longitudinal study on iodine nutrition and its effects on maternal and offspring health. The findings based on the Shanghai population can serve as a reference for other megacities experiencing significant dietary changes simultaneously. ISPOHC utilized a stratified cluster random sampling design, enrolling 5,099 pregnant women from all 16 districts of Shanghai. The survey has been conducted in three phases. Data collected at different time points include health status, living habits, dietary intake, birth, feeding, early development, anthropometric measurements, and biomarkers, allowing for an in-depth evaluation of iodine nutrition’s impact on offspring development. Data were collected through a combination of questionnaires, home visits, anthropometric measurements, and biological sample collection. The integration of detailed food investigation and on-site weighing of household seasonings provides a more precise assessment of dietary iodine intake, particularly iodized salt consumption, distinguishing this study. The study has provided significant insights into the relationship between iodine nutrition during pregnancy and various health outcomes.

Background: The interaction and substitution effects of physical activity (PA) and sitting time (ST) living in non-western countries have not been well investigated. This study aimed to examine the association of moderate-to-vigorous physical activity (MVPA) and ST with disability and mortality in older adults.

Methods: This prospective study analyzed data from 10,164 adults aged over 65 years who participated in the Kyoto-Kameoka study in Japan. We evaluated MVPA and ST using the validated International Physical Activity Questionnaire-Short Form. Participants were categorized into four groups based on their levels of MVPA (150 min/week) and ST (300 min/day): low MVPA/high ST, low MVPA/low ST, high MVPA/high ST, and high MVPA/low ST. Outcomes were gathered between July 30, 2011, and November 30, 2016.

Results: Over a median follow-up of 5.3 years (45,461 person-years), 2,273 disability cases were documented. The low MVPA/high ST groups were associated with higher disability risk than those in the high MVPA/low ST groups (hazard ratio [HR] 1.52; 95% confidence interval [CI], 1.31–1.75), and the interaction between MVPA and ST accounted for 48.5% of the relative excess risk of disability in the low MVPA/high ST group (P for interaction = 0.006). Daily replacement of 10 minutes of ST with 10 minutes of MVPA was associated with a reduced risk of disability (HR 0.980; 95% CI, 0.971–0.989) and all-cause mortality (HR 0.975; 95% CI, 0.962–0.988).

Conclusion: These findings indicate that even a small substitution of ST with MVPA could help lower both the risk of disability and mortality.

Background

This study aimed to describe the clinical outcomes and medical costs of hospitalized children requiring daily medical care (CRDMC), a patient group for which government-led support has developed rapidly in Japan.

Methods

A retrospective longitudinal study was conducted using a nationwide administrative database. All hospitalizations of children aged under 18 years discharged from April 2014 to March 2021 were included. Clinical outcomes and medical costs were compared between CRDMC and non-CRDMC hospitalizations. The estimated increase in the proportion of CRDMC medical costs among all pediatric hospitalizations during the study period was also calculated.

Results

Among the 1,531,456 hospitalizations included, 91,413 were identified as CRDMC. CRDMC accounted for 3.7% of the annual unique inpatients. The 30-day readmission rate among CRDMC was 27.5%, and the rate among those receiving multiple types of medical care was higher at 33.7%. The inpatient medical cost of CRDMC accounted for 20.3% of pediatric inpatient medical costs, with an estimated rise of 1.2881 (95% CI, 1.2110-1.3702) during the study period. In the breakdown of the medical costs, the proportion of injection drug fees increased most rapidly.

Conclusions

The high 30-day readmission rate in CRDMC was distinctive among the clinical outcomes. The proportion of medical costs for CRDMC in pediatric inpatients was high, although CRDMC accounted for only a small proportion of annual unique inpatients. Further support for CRDMC must be based on the unique characteristics of this population.

Background: Long-term sickness absence (LTSA) is an important public health challenge, yet limited data exist on its incidence in Japan. We aimed to describe the incidence of all-cause and cause-specific LTSA by sex and age, using 10-year data from a large Japanese working population, focusing on sex differences.

Methods: The study participants were employees from 16 worksites in the Japan Epidemiology Collaboration on Occupational Health Study between April 2012 and March 2022. LTSA, defined as sickness absence from work lasting 30 days or more, was recorded at each worksite. The causes of LTSA were classified using the International Classification of Diseases, 10th Revision. Incidence rates for all-cause and cause-specific LTSA were calculated based on sex and age.

Results: During 730,391 and 161,513 person-years of follow-up, 6,518 and 1,866 spells of LTSA were recorded in males and females, respectively. Females had higher incidence rates of all-cause LTSA than males (115.5 vs. 89.2 per 10,000 person-years), especially among females in their 20s and 30s. This was partly attributed to younger females experiencing higher LTSA incidence rates due to mental disorders, neoplasms, and pregnancy-related illnesses. In older age, females had higher LTSA incidence rates than males for musculoskeletal diseases and injuries/external causes, whereas LTSA incidence rates due to circulatory diseases were lower than those in males.

Conclusion: The incidence of total and cause-specific LTSA varied greatly by sex and age, highlighting the need to consider employees’ characteristics in the prevention and management of LTSA.

Background: Menarche timing may affect female health. While previous studies evaluated self-reported age at menarche reproducibility, they did not assess types of respondents. This study compared the reproducibility of age at menarche among self-responders and proxy respondents and assessed proxy-respondent reproducibility by relationship and survey age.

Methods: Data on age at menarche reported in both the 1969 and 1978 mail questionnaires among 9,043 females from the Life Span Study of atomic bomb survivors cohort were analyzed. The reproducibility of menarcheal age was assessed by the type of respondents, by proxy's relationship to participant, and by age at the 1969 survey using Bland-Altman's method and the intraclass correlation coefficient (ICC).

Results: Reproducibility was moderate (95% limits of agreement: -2.3 to 2.4 years; ICC: 0.72, 95% CI, 0.71-0.73). Both self-respondents (N=6,664) and the total study population (N=9,043) maintained moderate reproducibility even at older ages. Groups with proxy reports showed lower reproducibility than self-respondents, with spouse proxy reports showing highest reproducibility and parent proxy reports showing lowest reproducibility among proxy reports, although the comparisons are based on different survey ages in 1969.

Conclusion: This is the first study to evaluate menarcheal-age reproducibility between self- and proxy-reports using appropriate measures. Nine-year interval mail questionnaires showed moderate reproducibility across all ages, including elderly self-respondents. Reproducibility varied by the respondent–target relationship, with spouse proxies showing highest and parent proxies showing lowest reproducibility among proxy reports. Additional data are required to establish appropriate methods for handling specific proxy responses.

Background

Older Japanese adults have the highest drowning mortality rates globally, likely due to the in-home bathing customs. However, epidemiological evidence of preventive strategies based on national data is lacking. We aimed to describe the trends in bathtub drowning deaths (International Classification of Diseases, Tenth Revision code: W65) across Japan and explore factors that may reduce W65-coded deaths.

Methods

We collected the data of all W65-coded deaths that occurred at home from 1995 to 2020 using death certificates from the Ministry of Health, Labour, and Welfare. The national age-adjusted mortality rates (AMRs) and prefecture-specific age-standardized mortality ratios (SMRs) were calculated. Data on demographic, socioeconomic, environmental factors, and nursing care services were obtained from the Japan Portal Site of Official Statistics. Mixed-effects analysis was used to examine the association between SMR and potential contributing factors at the prefecture level.

Results

We identified 99,930 W65-coded deaths at home, with the highest incidence among individuals aged 80–84 years, peaking in January. Since 2010, AMRs have consistently exceeded 3.0 per 100,000. An inverse association was found between SMR and the number of geriatric health service facilities and senior welfare centers per capita (coefficients per 1 standard deviation increase, −0.09 [95% confidence interval (CI), −0.13 to −0.05, P < 0.001] and −0.07 [95% CI, −0.11 to −0.02, P = 0.004]), after adjusting for demographic, socioeconomic, and environmental factors.

Conclusions

Sustained high AMRs suggest that the rising death toll was not solely due to aging. Increased access to nursing care facilities may help prevent W65-coded deaths.

Purpose: New long-term care insurance (LTCI) certifications and mortality are key outcomes in cohort studies involving older adults; however, the coronavirus disease 2019 (COVID-19)’s comprehensive impacts on these outcomes remain underexplored. We examined the pandemic’s impact on new LTCI applications and all-cause mortality in a metropolitan cohort.

Methods: In 2016, 15,500 individuals aged 65–84 years were randomly selected through stratified sampling from Ota City, Tokyo. LTCI and death records were tracked through December 2023; the monthly LTCI applications and all-cause deaths per 10,000 people were calculated. The COVID-19 pandemic period was defined as beginning in March 2020, after the World Health Organization Director-General characterized the situation as a pandemic on March 11, 2020. Interrupted time-series segmented regression analysis was used to compare trends pre- (January 2018–February 2020) and post-pandemic onset (March 2020–December 2023).

Results: From January 2018 to December 2023, 4083 new LTCI applications and 2457 deaths were recorded. New monthly LTCI applications showed a modest upward trend pre-pandemic (0.4 per 10,000 people, 95% confidence interval [CI]: 0.1–0.8), declined sharply at the pandemic’s onset (-9.6 per 10,000 people, 95% CI: -16.0 to -3.2), and subsequently increased at a higher rate than pre-pandemic levels (0.8 per 10,000 people, 95% CI: 0.6–1.0). Monthly all-cause deaths remained stable before and immediately after the pandemic's onset but rose slightly in the post-pandemic period (0.3 per 10,000 people per month, 95% CI: 0.2–0.5).

Conclusions: The COVID-19 pandemic influenced both new LTCI applications and all-cause mortality in this study. These impacts should be carefully considered in cohort studies examining these outcomes.

Background This study aimed to assess a clinical relevance of three-dimensional occupational stress (job stressor score [A score], psychological and physical stress response score [B score], and social support for workers score [C score]) of the Brief Job Stress Questionnaire (BJSQ) in the national stress check program in Japan to irregular menstruation.

Methods The present retrospective cohort study included 2,078 female employees aged 19–45 years who had both annual health checkups and the BJSQ between April 2019 and March 2022 in a national university in Japan. The outcome was self-reported irregular menstruation measured at annual health checkups until March 2023. A dose-dependent association between BJSQ scores and incidence of irregular menstruation was examined using Cox proportional hazards models to calculate multivariable-adjusted hazard ratios (HRs) of four quantile (0–49% [Q_0–49], 50–74% [Q_50–74], 75–89% [Q_75–89], and 90–100% [Q_90–100]) of the BJSQ scores.

Results During 2.0 years of the median observational period, 257 (12.4%) women reported irregular menstruation. B score, not A or C scores, was identified as a significant predictor of irregular menstruation (adjusted HR [95% confidence interval] of A, B, and C scores per 1 standard deviation: 1.06 [0.89–1.27], 1.35 [1.15–1.57], and 0.93 [0.80–1.08], respectively). Women with higher B score had a significantly higher risk of irregular menstruation in a dose-dependent manner (adjusted HR [95% confidence interval] of Q_0–49, Q_50–74, Q_75–89, and Q_90–100: 1.00 [reference], 1.38 [1.00–1.90], 1.48 [1.00–2.18], and 2.18 [1.38–3.43], respectively).

Conclusions Psychological and physical stress response predicted irregular menstruation.

Background

Despite Japan's universal health insurance system, health disparities have increased since the 1990s. However, the impact of area deprivation on various aspects of child health remains understudied.

Methods

This population-based cohort study followed 38,554 children born in Japan (May 10–24, 2010) from birth to age 5.5 years. Using an outcome-wide approach, Bayesian three-level logistic regression models (individuals in municipalities within eight major regions) assessed associations between municipality-level Area Deprivation Index (ADI) at birth and multiple preschool health outcomes (hospitalizations for all causes; respiratory infections; gastrointestinal diseases; Kawasaki disease; medical visits for asthma, allergic rhinitis, atopic dermatitis, food allergy, injury, intussusception; prevalence of overweight/obesity), adjusting for individual-level factors.

Results

Higher ADI was associated with increased risk of all-cause hospitalization (adjusted odds ratio [aOR] per 1-standard-deviation increase in ADI, 1.11; 95% credible interval [CI], 1.07-1.14), respiratory infections (aOR, 1.16; 95% CI, 1.11-1.21), gastrointestinal diseases (aOR, 1.19; 95% CI, 1.12-1.27), asthma (aOR, 1.06; 95% CI, 1.02-1.10), and allergic rhinitis (aOR, 1.02; 95% CI,1.00-1.04). Overweight/obesity at age 5.5 years also increased with higher ADI (aOR, 1.08; 95% CI, 1.03-1.11). Higher ADI was inversely associated with Kawasaki disease (aOR, 0.91; 95% CI, 0.83-0.998), though not robust in sensitivity analysis. Geographic clustering was observed for all outcomes, particularly at municipality level.

Conclusions

We found persistent municipal-level health inequalities across various childhood health outcomes in Japan, despite its universal health insurance system. These findings suggest that policymakers should address health inequalities through comprehensive strategies targeting broader social determinants beyond health care access.