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Highlights

Journal of Epidemiology

Volume 30, Issue 9 (September 2020)

Commentary
Professional Commitment to Ethical Discussions Needed From Epidemiologists in the COVID-19 Pandemic
  • COVID-19 pandemic has risen various ethical challenges in public health.
  • We performed a database search of PubMed to identify articles with the constraints of “COVID-19”and “ethics.”
  • Among 424 articles identified, only one article was found to be published in an epidemiological journal.
  • We argue the epidemiologists should commit more to ethical discussions directly concerning epidemiology.
Special Article
Understanding Marginal Structural Models for Time-Varying Exposures: Pitfalls and Tips
  • Marginal structural models (MSMs) should be distinguished from inverse probability weighting.
  • MSM shows prespecified assumptions on causal estimands, while an exposure probability model is an imposed restriction on observed distribution.
  • As MSM and exposure probability model are used for different purposes, misspecification of these models would lead to biases in different ways.
  • Model specifications of MSMs and exposure probability models raise different challenges in real data analysis.
  • G-formula, which shares identifiability assumptions with inverse probability weighting, can be used to fit MSMs only when the models are saturated.
Psychosocial Work Environment Explains the Association of Job Dissatisfaction With Long-term Sickness Absence: A One-Year Prospect Study of Japanese Employees
  • We examined a prospective association of job dissatisfaction with long-term sickness absence obtained from personnel records using survival analysis.
  • Job dissatisfaction was associated with an increased risk of long-term sickness absence, which could be explained by psychosocial work environment.
  • Improving psychosocial work environment may be effective for the prevention of long-term sickness absence.
Cross-Sectional Association Between Employment Status and Self-Rated Health Among Middle-Aged Japanese Women: The Influence of Socioeconomic Conditions and Work-Life Conflict
  • Few studies examining the health effects of employment status among women have taken social and economic conditions as well as work–family conflict into consideration.
  • Among middle-aged Japanese women, non-regular employees and self-employee workers were less likely than regular employees to rate their health as poor.
  • Decreased likelihood of poor self-rated health among non-regular employees compared with regular employees could be explained by reduced work–family conflict.
Statistical Data
Meta-regression Analysis of Sex- and Birth Year-Specific Prevalence of HBsAg and Anti-HCV Among Un-diagnosed Japanese: Data From the First-time Blood Donors, Periodical Health Checkup, and the Comprehensive Health Checkup With Lifestyle Education (Ningen Dock)
  • We estimated the pooled prevalence of HBsAg and anti-HCV based on three large-scaled cohort.
  • Birth year-specific pooled prevalence of HBsAg peaked at 1941 – 1950 birth cohort.
  • That of anti-HCV showed the decreasing trend by birth year.
  • The result of this study can be used reference data of various countermeasure for hepatitis eradication.

Volume 30, Issue 8 (August 2020)

Relative Validity of Starch and Sugar Intake in Japanese Adults as Estimated With Comprehensive and Brief Self-Administered Diet History Questionnaires
  • DHQ and BDHQ reasonably ranked for energy-adjusted intakes of starch and sugars in Japanese adults.
  • Spearman correlations of the first DHQ were acceptable for all variables (0.31-0.67), except for maltose and trehalose in women.
  • The correlations of the first BDHQ were also acceptable (0.32-0.64), except for maltose and galactose.
  • Similar results were observed for the mean of four DHQs and BDHQs.
  • Neither questionnaires satisfactory estimated intakes at the group and individual levels.
Intake of Coffee Associated With Decreased Depressive Symptoms Among Elderly Japanese Women: A Multi-Center Cross-Sectional Study
  • Higher coffee intake was associated with a lower prevalence of depressive symptoms.
  • Caffeine intake was marginally associated with depressive symptoms, but the association was not statistically significant.
  • This cross-sectional study was conducted on 1,992 Japanese women aged 65–94 years.
  • A validated dietary questionnaire and the adjustment for known and putative risk factors for depressive symptoms were used.
  • We investigated using total caffeine intake estimated from BDHQ with foods, coffee and green tea, since there are several sources of caffeine in foods.
Temporal Trends and Geographic Disparity in Hypertension Care in China
  • This study is the first to investigate temporal trends in the geographic variations in diagnosis, treatment and control of hypertension in China.
  • To explore the association between geographic correlates and hypertension care, random effects models were performed, using a nationally longitudinal dataset.
  • This study provided an overview of the progress of China towards effective coverage of hypertension management following health system reform.
  • A nationally strong primary care system and provincially characterized working plans are all needed to achieve the goal of standard hypertension management.
Early SNS-Based Monitoring System for the COVID-19 Outbreak in Japan: A Population-Level Observational Study
  • A chatbot-based healthcare system named COOPERA (COvid-19: Operation for Personalized Empowerment to Render smart prevention And care seeking) was developed in Japan.
  • COOPERA is the first system to monitor epidemiological trends of COVID-19, which provides insights to assist political decisionmaking to tackle the epidemic.
  • No symptoms were reported by 96.93% of participants, but we found a significant 0–3 day gap between the date of onset of self-reported fever and the date of report of polymerase chain reaction test results (confirmed COVID-19), suggesting that the fever reported in COOPERA partially captures the shape of COVID-19 and may be a useful tool to estimate the scale of the COVID-19 epidemic in real time.

Volume 30, Issue 7 (July 2020)

Cohort Profile of the NEIGE Study in Tokamachi City, Japan
  • The NEIGE (The Neuron to Environmental Impact across Generation) study has been launched to elucidate social determinants of health in rural older adults in Tokamachi city, Japan. A total of 527 older Japanese adults participated in the study with an average age of 73.5 ± 5.6 years, and 47.3% were male.
  • Baseline characteristics were not significantly different between mountain and downtown except that educational attainment was longer in downtown residents than in mountain residents.
  • Muscle mass and grip strength were markedly higher among mountain residents, as well as physical activity.
  • Walking speed and balance were better among downtown residents than among mountain residents.
Prospective Study on the Association Between Adherence to Healthy Lifestyles and Depressive Symptoms Among Japanese Employees: The Furukawa Nutrition and Health Study
  • We prospectively investigated the association between combined healthy lifestyles and depressive symptoms in a Japanese working population.
  • Adherence to multiple healthy lifestyle factors was significantly associated with a lower risk of depressive symptom.
  • Sleep duration, alcohol intake, BMI, leisure-time physical activity, and smoking status were the important contributors of the association between the Healthy Lifestyle Index and depressive symptoms.
Factors Influencing the Proportion of Non-examinees in the Fukushima Health Management Survey for Childhood and Adolescent Thyroid Cancer: Results From the Baseline Survey
  • The baseline survey of thyroid ultrasound examination was conducted in 2011-2013 in Fukushima Prefecture.
  • Factors influencing the proportion of non-examinees for the survey was assessed.
  • The proportion of non-examinees was lower among girls than among boys.
  • There were more non-examinees among populations that moved after the nuclear power plant accident.
Short Communication
Alcohol Drinking and Bladder Cancer Risk From a Pooled Analysis of Ten Cohort Studies in Japan
  • This pooled analysis included the data of ten population-based prospective cohort studies in Japan.
  • No evidence of significant association between alcohol drinking and bladder cancer incidence was observed for both sexes.
  • The present null result may emphasize on future studies with information on the polymorphisms of alcohol-metabolizing enzymes in East Asians.

Volume 30, Issue 6 (June 2020)

Help-Seeking Behavior and Psychological Distress by Age in a Nationally Representative Sample of Japanese Employees
  • We examined the association between the presence/absence of help-seeking behavior and psychological distress among private and public employees by age group using a nationally representative sample of the Japanese population.
  • Data from the 2016 Comprehensive Survey of Living Conditions, a nationwide cross-sectional survey, were analyzed.
  • Among 78,284 private and public employees aged 20 to 59 years not using any mental health services for mental disorders, 9% and 6% reported severe psychological distress in those aged 20-39 and 40-59, respectively.
  • The proportion of participants without help-seeking behavior was significantly higher among older participants compared to younger participants.
  • After adjusting for sociodemographic and job/life-related variables, participants without help-seeking behavior were more likely to have severe psychological distress regardless of age group, and this trend appeared to be slightly stronger among those aged 20-39.
Proteinuria and Reduced Estimated Glomerular Filtration Rate are Independently Associated With Lower Cognitive Abilities in Apparently Healthy Community-Dwelling Elderly Men in Japan: A Cross-sectional Study
  • Association of proteinuria and low eGFR with cognition warrants further clarification.
  • Multivariable adjusted cognitive score was computed by proteinuria and eGFR status.
  • Proteinuria and low eGFR were independently associated with lower cognition.
  • Coexistence of these conditions showed the lowest cognitive score.
  • Proteinuria or low eGFR even in moderate stage may lead to low cognition.
The Value of a Cystatin C-based Estimated Glomerular Filtration Rate for Cardiovascular Assessment in a General Japanese Population: Results From the Iwate Tohoku Medical Megabank Project
  • The present study investigated the comparison between the cystatin C-based estimated glomerular filtration rate (GFRcys) and creatinine-based GFR (GFRcr) to determine whether these measurements are associated with elevated cardiovascular disease (CVD) risk in a general Japanese population (n = 29,375).
  • Multiple variable analyses after adjusting for baseline characteristics showed that GFRcys was associated CV biomarkers of high-sensitive cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP).
  • The area under the receiver operating characteristic curve for identifying individuals with a high Suita score was higher for the GFRcys than it was for the GFRcr.
  • The GFRcys provided reclassification improvement for detection of participants with estimated high CVD risk compared with the GFRcr.
  • In conclusions, the GFRcys is more closely associated with CV biomarkers and high Suita scores than the GFRcr, and it provides additional value in the detection of individuals with high CV risk.
Statistical Data
Characteristics of Sports-Related Emergency Transport: A Population-Based Descriptive Study in Osaka City
  • In Osaka City, characteristics of cases that required sports-related emergency transport widely varied by the type of sports.
  • The 10 sports with the highest number of cases were baseball, soccer, futsal, basketball, rugby, softball, long-distance running, volleyball, tennis, and judo.
  • The leading diagnosis of injury was fracture/bone contusion and that of illness was heatstroke/dehydration.
  • Half of sudden cardiac arrests occurred during long-distance running.

Volume 30, Issue 5 (May 2020)

Combined Associations of Body Mass Index and Metabolic Health Status on Medical and Dental Care Days and Costs in Japanese Male Employees: A 4-Year Follow-Up Study
  • The combinations of BMI levels and metabolic health status were associated with the adjusted mean and median medical outpatient days and costs.
  • The BMI levels and metabolic health combinations were associated with the median dental outpatient days and costs.　
  • The highest costs were shown in the obesity/unhealthy phenotype for medical and underweight/unhealthy phenotype for dental.
  • The underweight/unhealthy subjects had higher medical inpatient days and costs than obesity/healthy subjects.
  • Obesity phenotypes identified by both BMI levels and metabolic status may more precisely predict healthcare costs compared with either factor alone.　
Higher Numbers of Pregnancies Associated With an Increased Prevalence of Gestational Diabetes Mellitus: Results From the Healthy Baby Cohort Study
  • This is the first study to investigate the association between number of pregnancy and gestational diabetes mellitus.
  • In an analysis of 7008 pregnant women in China in 2012–2014, ≥ 3 pregnancies was associated with a higher risk of gestational diabetes after adjustment for potential confounders, the associations between number of pregnancy and gestational diabetes were more evident in women who were ≥ 30 year old or with pre-pregnancy BMI < 24 Kg/m2.
  • Our study suggested that number of pregnancy should be taken into consideration when assessing gestational diabetes risk, especially among women who were ≥ 30 year old or with pre-pregnancy BMI < 24 Kg/m2.
Incidence of Metabolic Syndrome in Young Japanese Adults in a 6-Year Cohort Study: The Uguisudani Preventive Health Large-Scale Cohort Study (UPHLS)
  • In 20s and 30s Japanese, the incidences of metabolic syndrome (MS) per 1,000 person-years with the Japanese criteria were 2.2, 5.5 in the female groups and 26.3, 40.5 in the male groups.
  • Compared with the 40s group, the hazard ratios of MS in the young adults account for about 20 to 50% for females and 50 to 70% for males.
  • Smoking, eating speed, physical activity, and alcohol intake are likely to be risks in young adults. These findings suggest that early lifestyle intervention for MS is necessary in young adults.

Volume 30, Issue 4 (April 2020)

Special Article
Causal Diagrams: Pitfalls and Tips
  • Causal diagrams have been often used among epidemiologists as a tool to describe what is already known about the relevant causal structure.
  • Causal directed acyclic graphs have proven to be a useful tool to clarify our causal thinking if appropriately used.
  • There are many pitfalls to avoid when using causal directed acyclic graphs.
  • Causal diagrams provide an incomparable help at the stages of study design, data collection and analysis, interpretation of study findings, etc.
  • The value of causal diagrams as a pedagogical tool cannot be overlooked in the causal inference literature.
Serum Gamma-Glutamyltransferase, Daily Alcohol Consumption, and the Risk of Chronic Kidney Disease: The Kansai Healthcare Study
  • We prospectively examined whether serum gamma-glutamyltransferase (GGT) related to proteinuria or low estimated glomerular filtration rate (eGFR).
  • Elevated serum GGT was independently associated with the risk of proteinuria.
  • In joint analysis, non-drinkers with the highest tertile of serum GGT had the highest risk of persistent proteinuria.
  • There was no association between serum GGT and low eGFR.
Echocardiographic Parameters and the Risk of Incident Atrial Fibrillation: The Suita Study
  • Association between echocardiographic parameters and the incidence of atrial fibrillation (AF) was investigated in the Suita study.
  • Left atrial diameter (LAD) was associated with increased risk for AF after adjustment for the risk factors of the AF risk score.
  • Among the examined continuous echocardiographic parameters of cardiac structure and function, 1-SD-increase of LAD showed the highest HR for AF.
  • The present study is the first population-based cohort study to show the risk of LAD enlargement for AF incidence in the Asian general population.
  • LAD might be useful for identifying individuals with a high risk of AF in health check-ups of the general population.
Associations of Frequency of Laughter With Risk of All-Cause Mortality and Cardiovascular Disease Incidence in a General Population: Findings From the Yamagata Study
  • This cohort study included 17,152 subjects aged greater than or equal to 40 years who participated in an annual health check-up in Yamagata, Japan.
  • Self-reported daily frequency of laughter was grouped into 3 categories (greater than or equal to 1/week; greater than or equal to 1/month but <1/week; and <1/month).
  • Low frequency of laughter was associated with higher all-cause mortality and cardiovascular disease incidence.
  • This association was significant even after adjustment for possible confounders.
Study Profile
Japan Trial in High-Risk Individuals to Enhance Their Referral to Physicians (J-HARP)—A Nurse-Led, Community-Based Prevention Program of Lifestyle-Related Disease
  • We performed a clustered randomized controlled trial of untreated high-risk individuals aged 40 to 74 years in 43 municipalities around Japan.
  • The intervention group received the theory-based health counselling to accelerate referrals to physicians.
  • A major hypothesis is that high-risk individuals in the intervention group see a physician more than those in the usual care group.
  • We obtained enough number of participants and information to test the effectiveness of health counselling.

Volume 30, Issue 3 (March 2020)

Special Article
Japanese Legacy Cohorts: Six-Prefecture Cohort Study (Hirayama Cohort Study)
  • Late Dr. Takeshi Hirayama and his collaborators conducted a large-scale cohort study in six prefectures in Japan (Miyagi, Aichi, Osaka, Hyogo, Okayama, Kagoshima), which is called the Six-Prefectures Cohort Study or Hirayama Cohort Study.
  • Its baseline survey covered male and female residents aged 40 and over based on the National Census in 1965, of whom 264,118 people (equivalent to 94.8% of the total population) were followed for 17 years until the end of 1982.
  • One of the most important findings obtained from Hirayama Cohort Study was the association between second-hand smoke exposure and lung cancer mortality, which triggered the worldwide spread of smoking ban in indoor public places and workplaces.
  • This special article presented a succinct summary of the main findings obtained from the study, paying respect to the foresight and the leadership of late Dr. Takeshi Hirayama, and his outstanding contributions to improving national and global public health.
Elevated Fasting Blood Glucose Levels Are Associated With Lower Cognitive Function, With a Threshold in Non-Diabetic Individuals: A Population-Based Study
  • Investigated relationships between cognition and fasting blood glucose.
  • Cognitive ability screening instrument (CASI) was used to assess cognition.
  • 3.97-6.20mmol/L glucose associated with highest cognition in men without diabetes.
  • Higher glucose was associated with lower cognition in men with diabetes.
  • Distinct relationships between glucose and cognition by diabetes status were found.
The Association Between Education and Smoking Prevalence, Independent of Occupation: A Nationally Representative Survey in Japan
  • Independent of occupation, lower education level was significantly related to current smoking among the Japanese general population.
  • Educational disparities in smoking were larger among the younger generation than among older people, especially among women aged 20–39 years.
  • Regarding occupation, after adjustment of education and other covariates, significantly higher smoking prevalence in manual workers than in upper non-manual workers was found only in men aged 20–64 years.
  • Among women aged 65 or older, manual workers were less likely to be current smokers than upper non-manual workers, while among women aged 20–64 years, occupation was not associated with smoking.
  • The current study suggests that we should pay attention to social inequality in smoking as well as national smoking prevalence.
Socio-Economic Disparities in Early Childhood Education Enrollment: Japanese Population-Based Study
  • Although studies from other developed countries have shown that the benefits of center-based childcare may be most pronounced among socioeconomically disadvantaged families, such families are less likely to use it.
  • Socio-economic disadvantage (e.g., low income and mother’s low education) were associated with the non-use of center-based childcare.
  • Child’s health and developmental problems (e.g., preterm birth) were also associated with the non-use of center-based childcare.

Volume 30, Issue 2 (February 2020)

Utility of a Specific Health Checkup Database Containing Lifestyle Behaviors and Lifestyle Diseases for Employee Health Insurance in Japan
  • Lifestyle and associated diseases were examined by the Specific Health Checkup (SHC).
  • Results were compared with data from the National Health and Nutrition Survey.
  • SHC subjects were younger, had better lifestyle behaviors.
  • SHC subjects had lower prevalence of metabolic syndrome, diabetes and hypertension.
  • Developing health policies would benefit from selection of an appropriate database.
Sociodemographic Factors Influenced Response to the 2015 National Nutrition Survey on Preschool Children: Results From Linkage With the Comprehensive Survey of Living Conditions
  • Overall response rate to the 2015 National Nutrition Survey on Preschool Children (NNSPC) was 64.1%.
  • Response rates varied according to sociodemographic factors such as residential area, family structure, economic status, and maternal characteristics.
  • Some bias, mostly small, was seen in survey estimates of the 2015 NNSPC.
Dental Status is Associated With Incident Functional Disability in Community-Dwelling Older Japanese: A Prospective Cohort Study Using Propensity Score Matching
  • 13-year prospective cohort study in 574 elderly Japanese to determine the relationship between dental status and functional disability.
  • Reduction of confounding factors in the study population with propensity score matching.
  • Participants with 0-19 teeth have a higher risk to develop functional disability than those with 20 or more teeth.
Incidence and Age Distribution of Hospitalized Presumptive and Possible Abusive Head Trauma of Children Under 12 Months Old in Japan
  • Capturing incidence of abusive head trauma (AHT) is important for evaluating intervention effectiveness.
  • No studies reported the incidence of AHT in Japan.
  • This study revealed similar incidence of possible AHT to other countries.
  • The month-age distribution uniquely showed two peaks for around 2 and 8 months old.
  • Further research is needed to prevent AHT among children in early and late infancy.

Volume 30, Issue 1 (January 2020)

Trends in Serum Lipid Levels of a 10- and 13-Year-Old Population in Fukuroi City, Japan (2007–2017)
  • We investigated trends in serum lipids from 2007 to 2017 in a population of 10- and 13-year-old children in Fukuroi City, Japan.
  • No remarkable changes in the prevalence of adverse LDL-C and HDL-C levels were observed regardless age or sex, while the prevalence of high non-HDL-C increased in boys.
  • Serum LDL-C and HDL-C levels slightly increased in boys and girls aged 10 years, and HDL-C levels slightly increased in girls aged 13 years.
Serum Pepsinogen Values in Japanese Junior High School Students With Reference to Helicobacter Pylori Infection
  • Accurate infection diagnosis was pursued with both serum and urine tests.
  • In the analyses, 171 H. pylori non-infected and 8 infected students were included.
  • Infected students showed higher pepsinogen I and II and lower I to II ratio.
  • The distributions of serum pepsinogen differed clearly from that in adults.
  • In non-infected students, males showed higher pepsinogen values than females.
Association of Vegetable, Fruit, and Okinawan Vegetable Consumption With Incident Stroke and Coronary Heart Disease
  • We aimed to elucidate associations of total Okinawan vegetable consumption as well as total fruit and vegetable consumption with risk of incident stroke and coronary heart disease among participants who lived in Okinawa Prefecture.
  • Total and specific Okinawan vegetable consumption were not statistically significantly associated with risk of stroke and coronary heart disease.
  • Consumption of total vegetable and fruit in Japanese residents of Okinawa was also not associated with risk of incident stroke and coronary heart disease.
Study Profile
The Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT): Study Design and Participants
  • Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT) was launched in 2011 to identify risk factors for lifestyle-related disease, elucidate factors which extend healthy life expectancy, and contribute toward personalized healthcare.
  • Between 2011 and 2016, a baseline survey was conducted at 16 municipalities in 7 prefectures across the country.
  • We have established a population-based cohort of 115,385 persons (Response rate 44.1%), among whom 55,278 (47.9% of participants) have provided blood and urine samples.
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Editor-in-Chief: Keitaro Matsuo