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Highlights

Journal of Epidemiology

Volume 31, Issue 7 (July 2021)

Loss of Working Life Years Due to Mortality, Sickness Absence, or Ill-health Retirement: A Comprehensive Approach to Estimating Disease Burden in the Workplace
  • No study has simultaneously assessed disease burden in terms of mortality and morbidity.
  • We developed a new method of quantifying disease burden in the workplace.
  • Mental and behavioral disorders made a considerable contribution to the disease burden due to sickness absence and ill-health retirement.
  • Neoplasms and diseases of the circulatory system made marked contributions to the number of working years lost due to mortality.
  • This method may facilitate corporate management by enhancing our understanding of the disease burden in the workplace.
Changes in Drug Utilization After Publication of Clinical Trials and Drug-Related Scandals in Japan: An Interrupted Time Series Analysis, 2005–2017
  • In Japan, scandals caused by breaches of ethics in medical research and pharmaceutical marketing occurred following the publication of the results of clinical trials of first-generation angiotensin II receptor blockers.
  • The publication of apparently-successful clinical trials was followed by an increase in the use of first-generation ARBs, and the subsequent research-related and marketing-related scandals were followed by a decrease.
  • Going a step further, to the extent that new drugs and other improvements in medical care are generally adopted slowly and cautiously, whereas reactions to unethical behavior and breaches of trust are quick and strong, these lessons from Japan could well be relevant worldwide.
Skipping Breakfast and Subsequent Overweight/Obesity in Children: A Nationwide Prospective Study of 2.5- to 13-year-old Children in Japan
  • Skipping breakfast at 2.5 years was not associated with overweight/obesity at 2.5 and 4.5 years, but was associated at 7 and 10 years, in both sexes.
  • Skipping breakfast at 2.5 years was significantly associated with overweight/obesity at 13 years in boys, but not in girls.
  • Skipping breakfast in early childhood increased overweight/obesity in later childhood, but there may be gender differences at 13 years.
Updated Trends in Cancer in Japan: Incidence in 1985-2015 and Mortality in 1958-2018 - A Sign of Decrease in Cancer Incidence
  • Trends in cancer incidence and mortality in Japan were examined using most recent representative data.
  • The age-standardized rate of all-cancer incidence started to decrease significantly in males and level off in females in 2010, after a long-term intermittent increase.
  • The convergence of an increase in all-cancer incidence was mainly due to the slowing down of prostate and breast cancers in males and females, respectively.
  • The ASR of all-cancer mortality continued to decrease, the main contributing cancer sites of which were still stomach, liver, and male lung.

Volume 31, Issue 6 (June 2021)

Incidence and Mortality of Dementia-Related Missing and Their Associated Factors: An Ecological Study in Japan
  • The incidence rate and mortality rate of dementia-related missing in Japan were 21.72 and 0.652 (per 100,000 person-year), respectively.
  • One increase in the number of public health nurses per 100,000 persons was associated with a 3.2% (1.6–4.9) decrease in the incidence rate.
  • One facility increases in the number of nursing care facilities for older adults per 100,000 persons aged 65-years-old or more was associated with a 7.9% (95% confidence interval, 3.3–12.4) decrease in the incidence rate.
  • A ten percent increase in the proportion of people who live in an urban area was associated with a 20.3% (8.7–33.2) increase in the incidence rate and a 12.9% (5.6–19.8) decrease in the mortality rate.
  • Identified associated factors may be useful for managing or predicting dementia-related missing persons cases and associated deaths.
Widening Socioeconomic Inequalities in Smoking in Japan, 2001–2016
  • Japan is one of the world’s largest tobacco epidemic countries.
  • No studies addressed trends in socioeconomic inequalities in smoking in Japan.
  • Socioeconomic inequalities in smoking widened between 2001 and 2016 in Japan.
  • Smoking is a potential factor responsible for health inequality in the future.
Changes in Smoking Behavior Since the Declaration of the COVID-19 State of Emergency in Japan: A Cross-sectional Study From the Osaka Health App
  • We examined the effect of the COVID-19 state of emergency on changes in smoking behavior, as determinants of both increased smoking and quitting.
  • In our dataset of 5,120 smokers, 32.1% reported having increased the number of cigarettes they smoked and 11.9% reported quitting smoking after the declaration of a state of emergency in Japan.
  • The smokers who changed from cigarettes to heated tobacco products were significantly less likely to quit smoking than smokers who did not change tobacco type.
  • People working from home or living alone were associated with increased smoking.
Short Communication
Mobility Change and COVID-19 in Japan: Mobile Data Analysis of Locations of Infection
  • Mobility in working, nightlife, and residential places had changed before the state-of-emergency declaration due to COVID-19.
  • Mobility reduction in nightlife places was particularly high during the state of emergency.
  • Mobility change in nightlife places was more strongly associated with the outbreak of COVID-19 compared to that in working and residential places.
Study Profile
The Korean Pregnancy Outcome Study (KPOS): Study Design and Participants
  • The KPOS research aims to investigate the risk factors and distribution of adverse pregnancy outcomes.
  • This cohort study included 4195 Korean pregnant women and the main outcome was gestational diabetes mellitus, gestational hypertension, and screening positive for peripartum depression.
  • Among 3565 pregnancy outcomes, 30 miscarriages, 16 stillbirths, and 3519 deliveries reported.
  • The prevalence of GDM, hypertensive disorders, and screening positive of depression during pregnancy and postpartum was 7.0%, 1.4%, 27.8%, and 16.6%, respectively.
  • Future studies on the KPOS data will provide information on determinants of pregnancy-related disorders, and this improve maternal health among Korean pregnant women.

Volume 31, Issue 5 (May 2021)

Does Laughter Predict Onset of Functional Disability and Mortality Among Older Japanese Adults? The JAGES Prospective Cohort Study
  • The link between laughter and functional disability and all-cause mortality was prospectively studied in community-dwelling Japanese older adults.
  • After adjustment for 13 potential confounders, low frequency of laughter was associated with increased risks of functional disability.
  • The inverse association between the frequency of laughter and the risk of all-cause mortality was insignificant after adjusting for all covariates.
  • Frequency of laughter is potentially considered an early indicator of functional disability later on in life.
Higher Participation Rate for Specific Health Checkups Concerning Simultaneous Ophthalmic Checkups
  • It had not been shown whether simultaneous ophthalmic checkups influence the specific health checkups’ participation rate.
  • This study showed the significant positive association between the specific health checkups’ participation rate and simultaneous ophthalmic checkups.
  • In this study, fundus photos and ophthalmology consultation, when offered to all applicants, were associated with a higher specific health checkups’ participation rate.
Prevalence and Mortality of Sarcopenia in a Community-dwelling Older Japanese Population: The Hisayama Study
  • The prevalence of sarcopenia defined by the Asian Working Group for Sarcopenia definition was approximately 7% in a community-dwelling older Japanese population.
  • Older subjects and subjects with ADL disability, less regular exercise, and less total energy intake were more likely to have sarcopenia.
  • Sarcopenia was associated with a significant, 2-fold increment in mortality risk after adjusting for potential confounders.
Increase in Body Weight Following Residential Displacement: 5-year Follow-up After the 2011 Great East Japan Earthquake and Tsunami
  • We compared body weight change between survivors relocated to temporary housing and other types of accommodation for up to 5 years after the disaster.
  • The people in temporary housing group experienced significant increases in body weight compared with the people in non-temporary housing group.
  • The significant differences remained after the adjustment for several confounding factors.
  • Living in temporary housing was independently associated with weight gain after the Great East Japan Earthquake irrespective of baseline obesity.
  • The people living in temporary housing should appropriately control body weight to prevent from obesity related diseases in a future disaster.
Trends in Energy Imbalance Gap and Body Weight Status in the Japanese Adult Population: A System Dynamics Approach
  • In Japan, the overall energy imbalance gap (EIG) increased in males over time with a peak around year 1990, but for females it continuously decreased over the past four decades.
  • The overall EIG was small but remained positive for males in 2015, indicating that the prevalence of overweight and obesity will continue to increase at a slower pace.
  • The overall EIG for females started to show a negative value in 2013, indicating that the prevalence of overweight and obesity started to decrease.
  • The dynamics of the EIG were different not only between the sexes, but also among BMI classes.
Older Adults’ Daily Step Counts and Time in Sedentary Behavior and Different Intensities of Physical Activity
  • We examined how daily step count related to device-based time spent in activity behaviors among older Japanese adults.
  • The co-dependence of activity behaviors was taken into account.
  • Daily step count was related to the relative proportion of time spent in moderate-to-vigorous physical activity.
  • Daily step count was also related to the ratio between light-intensity physical activity and sedentary behavior.
  • Findings are helpful for better aligning pedometer-based data with accelerometer-based data.
Short Communication
Epidemiology of Food Choking Deaths in Japan: Time Trends and Regional Variations
  • Increasing age globally makes people more vulnerable to food choking.
  • We investigated the characteristics of food choking deaths in all Japan, with its regional variations on national level, and its time trends.
  • The number of deaths due to food suffocation was highest on New Year’s Day, frequently occurred at home, and among people aged over 75 years.
  • The total number of cases was around 4000 each year, but the incidence proportion among people over 75 years old has been decreasing recently.
  • Regional variations between prefectures existed: highest in Niigata and lowest in Kyoto (standardized mortality ratio 1.38 and 0.60, respectively).

Volume 31, Issue 4 (April 2021)

Determinant Factors on Differences in Survival for Gastric Cancer Between the United States and Japan Using Nationwide Databases
  • Large differences in five-year relative survival of surgically treated gastric cancer between two countries: 81.0% in Japan and 45.0% in the US.
  • Wide gap can be explained by earlier stage at diagnosis in Japan due to screening and awareness of gastric cancer.
  • Differences in number of lymph nodes examined also play a key role in the wide gap in survival between two countries.
The Effect of Smoking and Sex on the Association Between Long-term Alcohol Consumption and Metabolic Syndrome in a Middle-aged and Older Population
  • This is the first prospective study to examine how smoking status affects the relation of long-term alcohol consumption on risk of MetS and its components by the amount of alcohol after adjustment for various lifestyle factors including diet in prospective design.
  • Light to moderate long-term alcohol consumption was associated with beneficial and associations on MetS and its components whereas heavy alcohol intake appeared detrimental.
  • Smoking status strongly affected the relationship of long-term alcohol consumption with MetS components, particularly hypertriglyceridemia.
Disparities in Bystander Cardiopulmonary Resuscitation Performed by a Family Member and a Non-family Member
  • We assessed who actually performed bystander cardiopulmonary resuscitation (BCPR).
  • We analyzed the population-based out-of-hospital cardiac arrest (OHCA) registry in Niigata City, Japan.
  • OHCA patients witnessed by family were less likely to receive BCPR compared to those witnessed by non-family members.
  • Among the witnessed patients, the proportion of BCPR actually performed by a family member was lower than that performed by a non-family member.
  • Further efforts will be needed to overcome the barriers for family to perform BCPR.
Role of Social Support in the Relationship Between Financial Strain and Frequency of Exercise Among Older Japanese: A 19-year Longitudinal Study
  • We investigated the association between financial strain and frequency of exercise among Japanese older people.
  • We also tested the role of social support in buffering this relationship.
  • Greater financial strain was associated with less frequency of exercise.
  • As financial strain increased, people with more instrumental support engaged in less exercise than people with less support.
  • These associations were observed among females, but not among males.
Population Attributable Fractions of Modifiable Risk Factors for Nonsyndromic Orofacial Clefts: A Prospective Cohort Study From the Japan Environment and Children’s Study
  • This study reported the population attributable fractions (PAFs) of modifiable risk factors for nonsyndromic orofacial clefts in Japan.
  • Among cleft lip with or without cleft palate (CL±P) cases, non-use of a folic acid supplement had the highest PAF, followed by maternal active and passive smoking.
  • We failed to show a significant association between variables. However, the current results of CL±P support the previous evidence.
Associations of Education With Overall Diet Quality Are Explained by Different Food Groups in Middle-aged and Old Japanese Women
  • We found positive associations of education with a diet quality score consisting of selected seven components in middle-aged and older Japanese women.
  • The associations were mainly explained by different foods, namely ‘milk’ in middle-aged women and ‘sodium from seasonings’ in older women.
  • The associations were independent of lifestyle and neighborhood variables in both groups.
  • The present finding may help inform the development of a public health policy to reduce disparity of diet quality by education.
Short Communication
Association of Eating Alone With Depression Among Older Adults Living Alone: Role of Poor Social Networks
  • We hypothesise that the known association of eating alone with depression may be confounded by social network size.
  • Eating alone and poor social network were independently associated with greater depression in older adults living with others.
  • Poor social network was associated with greater depression symptoms irrespective of eating style in older adults living alone.
  • Even when eating and living alone, older adults with decent social networks are more likely to be mentally healthy.

Volume 31, Issue 3 (March 2021)

A Prospective Cohort Study of Bedroom Warming With a Heating System and Its Association With Common Infectious Diseases in Children During Winter in Japan
  • The use of a heating system in the bedroom is strongly associated with a decrease in the frequency of catching cold in children.
  • Children who did not use a heating system in the bedroom are more likely to take sick leave from school or nursery.
  • Relationship exists between a heated bedroom and number of hospital visits due to cold.
  • Children who did use a heater in the bedroom had significantly lower odds of being infected with influenza and having diarrhea with vomiting.
Differential Effect of Polymorphisms on Body Mass Index Across the Life Course of Japanese: The Japan Multi-Institutional Collaborative Cohort Study
  • There was a significant association between three body mass index (BMI) traits and polymorphisms in or near FTO, BDNF, TMEM18, HS6ST3, and BORCS7.
  • The BMI-related loci discovered in European ethnicities also have significant association in Japanese population.
  • The loci of association with current BMI and BMI change were similar, in contrast, unique associated loci were identified in BMI at 20 years old.
  • Our study indicated that the genetic effects on BMI by these BMI-associated loci may vary across the life course via different pathways.
The Impact of Hypertension Definition Based on Two-visit Strategy on Estimate of Hypertension Burden: Results From the China Health and Nutrition Survey 1989–2011
  • Based on the measurements from the China Health and Nutrition Survey (CHNS1989–2011), one-visit and two-visit strategies were respectively applied to investigate the incidence of hypertension in a cohort study.
  • In addition, by these two strategies, a cross-sectional study based on CHNS 2006 and CHNS 2006–2009/2011 was used to investigate the prevalence of hypertension.
  • If the two-visit strategy was applied to China hypertension survey, the hypertension burden was predicted to be overestimated by 25.5%–47.8% (based on JNC 7) and 23.5%–48.2% (based on the 2017 ACC/AHA), respectively.
Heated Tobacco Products Have Reached Younger or More Affluent People in Japan
  • New tobacco products are being diffused worldwide, and heated tobacco products (HTPs) have become widely available.
  • The spread of HTPs and the characteristics of their users must be studied to monitor tobacco control efforts.
  • This study examined the sociodemographic characteristics of HTPs users in Japan.
  • HTPs were accepted by younger or more affluent people.
Adherence to the Japanese Physical Activity Guideline During Early Childhood Among Rural Preschoolers: A Cross-sectional Study
  • Two-thirds of the preschoolers (66.2%) adhered to the levels of physical activity recommended by the Japanese guideline.
  • Boys (70.2%) had higher proportions of adherence to the Japanese physical activity guideline as compared to girls (61.2%).
  • Adherence to the Japanese physical activity guideline varied considerably among the 20 enrolled preschools (14–100%).
  • There were no significant differences in the proportions of adherence to the physical activity guideline among different preschool grades.
Intakes of Specific Categories of Vegetables and Fruits Are Inversely Associated With Depressive Symptoms Among Adults
  • Current evidence between different types of vegetables or fruits intakes and depressive symptoms in the general population is completely unknown.
  • Tomatoes and tomato mixtures, dark-green, and other vegetables intakes were inversely related to depressive symptoms in the general population.
  • Berries and dried fruits intakes were inversely related to depressive symptoms in the general population.
  • An L-shaped relationship was observed between intake of total vegetables and depressive symptoms in the general population.
  • Intake of total fruits and depressive symptoms presented a linear inverse trend in the general population.
Review Article
Economic Evaluations of Gestational Diabetes Mellitus Screening: A Systematic Review
  • GDM screening generally found to be cost-effective, though uncertainties remain due to many factors.
  • The 1-step GDM screening, with more cases detected, is more likely to be cost-effective than the 2-step GDM screening.
  • Universal screening is more likely to be cost-effective than screening targeting the high-risk population.
Statistical Data
Clinical Trajectories of Suicide Attempts and Self-harm in Patients Admitted to Acute-care Hospitals in Japan: A Nationwide Inpatient Database Study
  • We described patient characteristics and clinical management for suicide attempts and self-harm among patients admitted to acute-care hospitals in Japan.
  • Of 17,881 patients admitted to acute-care hospitals in Japan with suicide attempts/self-harm during the study period, 2,639 (15%) completed suicide.
  • Among patients discharged to home, 51% did not receive psychiatric intervention.
  • In 468 (54%) acute-care hospitals, no psychiatric intervention was provided for suicide attempters during the study period.
  • Half of acute-care hospitals did not provide hospital-based psychiatric care for patients with suicide attempts or self-harm.

Volume 31, Issue 2 (February 2021)

The Major Source of Antioxidants Intake From Typical Diet Among Rural Farmers in North-eastern Japan in the 1990s
  • This is the first study to clarify the total antioxidant intake reflecting the foods commonly consumed in a Japanese population.
  • We constructed an antioxidant database of foods representative of the typical Japanese diet using 12-day dietary records from Japanese.
  • To consider the effects of peroxyl radical-scavenging activities, our database measured hydrophilic- and lipophilic antioxidant values on standardized methods.
  • We found that Japanese diet included rice and seafood, is a desirable diet with high in antioxidants, especially high in lipophilic antioxidants.
The Association Between Habitual Sleep Duration and Mortality According to Sex and Age: The Japan Public Health Center-based Prospective Study
  • Sleep durations ≥8 hours are associated with mortality from all-cause, CVD, and other causes in the Japanese general population.
  • Sex does not appear to be an effect modifier for the association between sleep duration and mortality outcomes.
  • Age with a cut-off at 50 years may be an effect modifier for the association between sleep duration and the risk of other-cause mortality in women.
Longitudinal Trends in Blood Pressure Associated With the Frequency of Laughter: The Circulatory Risk in Communities Study (CIRCS), a Longitudinal Study of the Japanese General Population
  • The frequency of laughter has known to been associated with cardiovascular disease and related biomarkers.
  • Although various mechanisms have accounted for the association between laughter and cardiovascular disease and related biomarkers, no previous studies have examined the association between laughter and changes in blood pressure levels.
  • Middle-aged men with low frequency of laughter had significantly increased systolic and diastolic blood pressure levels over the four-year period.
  • The changes in blood pressure associated with infrequent laughter were more evident in men without antihypertensive medication use over four years and men with a current drinking status at the baseline.
Seasonal Variation in Epidemiology of Kawasaki Disease-Related Coronary Artery Abnormalities in Japan, 1999–2017
  • The interaction between patient age and sex influences the development of Kawasaki disease (KD)-related coronary artery abnormalities (CAAs).
  • KD occurrence in summer/autumn was higher in younger than in older participants.
  • The lowest age group (<6 months) showed an inverse summer/autumn to winter/spring ratio (>1.0).
  • Female (<6 months) and male patients (≥5 years) have high risk for KD-related CAAs.
Estimated Prevalence of Cronkhite-Canada Syndrome, Chronic Enteropathy Associated With SLCO2A1 Gene, and Intestinal Behçet’s Disease in Japan in 2017: A Nationwide Survey
  • Cronkhite–Canada syndrome (CCS), chronic enteropathy associated with SLCO2A1 gene (CEAS), and intestinal Behçet’s disease (BD) are rare intractable intestinal disorders.
  • We conducted the first nationwide survey of these three diseases to estimate the prevalence of patients in Japan.
  • The estimated prevalence rates per 1,000,000 population of patients with CCS, CEAS, and intestinal BD were 3.7, 3.1, and 24.8, respectively, and found to be higher than those previously reported.
Statistical Data
Excess mortality from suicide during the early COVID-19 pandemic period in Japan: a time-series modeling before the pandemic
  • Excess mortality from suicide was discussed to assess the impact of the COVID-19 pandemic in Japan.
  • Excess mortality during the pandemic period was estimated using a time series model based on the number of suicides before the pandemic.
  • No significant excess mortality was observed through the early pandemic period; instead, a downward trend in suicides for both sexes was visible.
  • Our results suggest that various changes in the early period of the COVID-19 pandemic induced a decrease in suicides in Japan.

Volume 31, Issue 1 (January 2021)

Impact of PSCA Polymorphisms on the Risk of Duodenal Ulcer
  • We evaluated the association between PSCA polymorphisms and risk of duodenal/gastric ulcer and its interaction with environmental factors in a Japanese population.
  • Our study confirms an association between the PSCA rs2294008 C-allele and risk of duodenal ulcer in a large Japanese population.
  • This association was independent of age, sex, study site, smoking habit, drinking habit, and H. pylori status.
Alcohol Consumption and Risk of Gastric Cancer: The Japan Collaborative Cohort Study
  • This is a prospective cohort study examine the sex-specific dose-response association between alcohol consumption and risk of gastric cancer among Japanese men and women.
  • We also evaluated the association between alcohol consumption and the site-specific risk of gastric cancer.
  • This study also discussed the differences from previous studies in Japan.
  • The present study suggested that alcohol consumption increases the risk of gastric cancer among Japanese men, regardless of anatomical sub-site of the cancer.
Infant Mortality Rates for Farming and Unemployed Households in the Japanese Prefectures: An Ecological Time Trend Analysis, 1999–2017
  • Compared to the infant mortality rate of the most privileged occupation type (type II regular worker), overall IMRs during the 1999-2017 period nearly doubled (1.96) among farming households and increased 6.5 times among unemployed households.
  • Inequality in IMRs across household occupations increased during the period of 1999-2017.
  • Inequality tended to be lower in the prefectures where population density was low, or farm density was high.
Hospital Surgical Volume and 3-Year Mortality in Severe Prognosis Cancers: A Population-Based Study Using Cancer Registry Data
  • Three-year mortality was significantly higher at low-volume hospitals (adjusted hazard ratio: 1.5-1.9) than high-volume for esophageal, biliary tract, and pancreatic cancers.
  • Moreover, mortality was significantly higher at middle-volume hospitals showing adjusted hazard ratio of 1.3-1.4 than high-volume for these cancers.
  • In particular localized pancreatic cancer, the impact of hospital surgical volume on 3-year mortality was strong (adjusted hazard ratio: 2.66).
Study Profile
Study Profile of the Tohoku Medical Megabank Community-Based Cohort Study
  • After the Great East Japan Earthquake, TMM CommCohort Study was established and 87,866 residents agreed to be enrolled.
  • Mainly two recruit methods were applied, i.e., health check-up based and assessment center based recruit.
  • The age-adjusted rates of current smoking and higher degrees of psychological distress were greater among residents living in coastal rather than among those in the inland areas.
Study Profile
Adachi Child Health Impact of Living Difficulty (A-CHILD) Study: Research Protocol and Profiles of Participants
  • Describing the purpose and design of the Adachi Child Health Impact and Living Difficulty (A-CHILD) study and the baseline profiles of participants.
  • A-CHILD study has been conducted since 2015 to clarify the associations between socioeconomic factors and child health.
  • The number of households in “living difficulties”, such as low household income or material deprivation, stood at 1,047 (24.5%).
  • This longitudinal study will continue to contribute important information for the development of policies to tackle the issue of child poverty.