Objectives To examine the relationship between dietary diversity and food access among elderly living alone.
Methods In September 2013, a cross-sectional study using a self-administered questionnaire was conducted with 4,348 elderly aged 65–89 years, living in A city in Saitama Prefecture. The subjects answered about their health conditions, frequency of food consumption, difficulty of food store access, social support, food preparation, and so on. The response rate was 59.6%. The dietary diversity score (DDS) was calculated as the number of food groups consumed in a day (0 to 10). The DDS was validated by its association with independence and health status of the elderly. As indicators of food access, objective food access was measured using a geographic information system (GIS), and subjective food access was measured by the questionnaire. Responses of 1,043 subjects (452 male and 591 female) were analyzed after excluding those who live with others in an actual household composition. We classified the subjects into two groups according to the DDS: low group (three or less) and high group (four or more). Multiple logistic regression analyses were conducted using the DDS groups as the dependent variable, and subjective food access and other factors as independent variables, adjusting for age, income, subjective economic status, education, and frailty status.
Results The number of subjects in each group were as follows: low=107 (23.7%), high=345 (76.3%) for males, high=263 (44.5%), low=328 (55.5%) for females. A multiple logistic regression analysis showed that the difficulty in subjective food store access was associated with a low DDS in males [OR=4.00, 95% CI (1.36–11.82)] as well as in females [OR=2.24, 95% CI (1.11–4.51)]. Further, for females, social support and preparation of supper by oneself were significantly associated with their DDS. No significant relationships were found between objective food store access and DDS in both males and females.
Conclusion The DDS was strongly associated with subjective food store access among the elderly living alone. For females, social support and meal preparation skills were also suggested as important factors affecting their DDS.

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Objectives This study aimed to reveal the geographic pattern of hospital selection among cancer inpatients in Japan, focusing on the existence of designated regional cancer hospitals (DRCHs) in the secondary healthcare service areas (SHSAs) of patients' residence.
Methods We combined the individual data from the Patient Survey and Survey of Medical Institutions carried out by the Ministry of Health, Labour and Welfare, Japan, in 2011, and added information about SHSAs and DRCHs to the combined data set. We categorized the inpatients' hospital selection into four patterns: within the municipality they lived in, out of the municipality but within the SHSA they lived in, out of the SHSA but within the prefecture they lived in, and out of the prefecture they lived in. Additionally, we categorized the location of the cancer inpatients' residence into two groups: living in an SHSA with a DRCH, or living in an SHSA without a DRCH. Subsequently, we descriptively analyzed the relationship between the hospital selection pattern and geographical area where the patients lived. In addition to cancer, the analyzed disease groups included all-cause diseases, diabetes mellitus, and cardiovascular diseases.
Results The estimated number of cancer inpatients was 132,700, 47.6% of whom selected a hospital within the municipality they lived in. The percentage of selecting hospitals out of their SHSA was 27.5%, 18.2%, and 20.1% for patients with cancer, diabetes mellitus, and cardiovascular diseases, respectively (P<0.01). Inpatients who selected geographically farther hospitals tended to be younger. Further, 114,200 cancer inpatients lived in an SHSA with a DRCH, accounting for 86.5% of all cancer inpatients. It was revealed that inpatients living in the SHSAs with a DRCH were less likely to select hospitals out of the SHSA they lived in, than were those living in the SHSAs without a DRCH (23.2% and 55.1%, respectively, P<0.01). Inpatients living in the SHSAs with a DRCH were more likely to select a DRCH, than were those living in the SHSAs without a DRCH (40.6% and 28.9%, respectively, P<0.01).
Conclusion Cancer inpatients tended to select hospitals out of the SHSA they lived in than did inpatients with other diseases. The pattern of hospital selection among cancer inpatients was associated with whether they lived in SHSAs with or without a DRCH, as well as with patients' age and cancer sites. It is possible that the existence of a DRCH in the neighborhood affects inpatients' accessibility to standard cancer care.

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[in Japanese]

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Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH), Vol. 62 (2015) No. 6 p. 294-299

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