New paper: Changes in health-related quality of life among impoverished persons in the Free/Low-Cost Medical Care Program in Japan: Evidence from a prospective cohort study.

We published a paper from Journal of Epidemiology.

Nishioka D, Tamaki C, Furuita N, Nakagawa H, Sasaki E, Uematsu R, Ozaki T, Wakata S, Kondo N. Changes in health-related quality of life among impoverished persons in the Free/Low-Cost Medical Care Program in Japan: Evidence from a prospective cohort study. J Epidemiol. 2021 Mar 27. doi: 10.2188/jea.JE20210005. Epub ahead of print. PMID: 33775974.

Abstract

Background: The Free/Low-Cost Medical Care Program (FLCMC) can subsidize the payment (exempt/lower) in designated institutions in Japan. Given that poverty is a multidimensional concept including social isolation, the FLCMC applicants may need social support over and above financial aid to improve their quality of life. However, there was no data to discuss what services should be provided and to whom. Hence, we aimed to describe the changes in health-related quality of life scores among users of the FLCMC, with respect to their socioeconomic backgrounds.

Methods: This cohort study included patients who newly used FLCMC from July 2018 to April 2019. We used patients’ social work records, obtained at baseline, and self-report questionnaires on the Medical Outcomes Study 8 Items Short Form Health Survey (SF-8), measured both at baseline and six-month-after the application. We used the change in physical and mental health component summary score (PCS-8 and MCS-8) as outcome variables.

Results: Multiple linear regression analyses, adjusting for age, sex, healthcare institute, and baseline PCS-8 and MCS-8, showed that lower income was associated with an increase in PCS-8 (coef. -0.09; 95% CI, -0.15 to, -0.03) and MCS-8 (coef. -0.04; 95% CI, -0.11, to 0.03). Living alone (versus. living with someone) was potentially associated with a decrease in both PCS-8 (coef. -1.58; 95% CI, -7.26 to 4.09) and MCS-8 (coef. -3.62; 95% CI, -9.19 to 1.95).

Conclusions: Among patients using FLCMC, those who live alone may need additional support. Further study testing the generalizability of the findings is required.

Keywords: Free/Low-Cost Medical Care Program; Healthcare access; Japan; Poverty; Social welfare.

New paper: Causal Inference in Studying the Long-term Health Effects of Disasters: Challenges and Potential Solutions.

We published a paper from American Journal of Epidemiology.

Shiba K, Kawahara T, Aida J, Kondo K, Kondo N, James P, Arcaya M, Kawachi I. Causal Inference in Studying the Long-term Health Effects of Disasters: Challenges and Potential Solutions. Am J Epidemiol. 2021 Mar 17:kwab064. doi: 10.1093/aje/kwab064. Epub ahead of print. PMID: 33728430.

Abstract

Two frequently encountered but underrecognized challenges for causal inference in studying the long-term health effects of disasters among survivors include: (a) time-varying effects of disasters on a time-to-event outcome and (b) selection bias due to selective attrition. We review approaches to overcome these challenges and show application of the approaches to a real-world longitudinal data of older adults who were directly impacted by the 2011 earthquake and tsunami (n=4,857). To illustrate the problem of time-varying effects of disasters, we examined the association between degree of damage due to the tsunami and all-cause mortality. We compared results from Cox regression assuming proportional hazards versus adjusted parametric survival curves allowing for time-varying hazard ratios. To illustrate the problem of selection bias, we examined the association between proximity to the coast (a proxy for housing damage from the tsunami) and depressive symptoms. We corrected for selection bias due to attrition in the two post-disaster follow-up surveys (conducted in 2013 and 2016) using multivariable adjustment, inverse probability censoring weighting, and survivor average causal effect estimation. Our results demonstrate that the analytic approaches ignoring time-varying effects on mortality and selection bias due to selective attrition may underestimate the long-term health effects of disasters.

Keywords: causal inference; disaster; inverse probability weighting; selection bias; standardization; survival analysis; survivor average causal effect.

New paper: Neighborhood farm density, types of agriculture, and depressive symptoms among older farmers: a cross-sectional study.

We published a new paper from BMC Public Health.

Kanamori M, Hanazato M, Kondo K, Stickley A, Kondo N. Neighborhood farm density, types of agriculture, and depressive symptoms among older farmers: a cross-sectional study. BMC Public Health. 2021 Mar 4;21(1):440. doi: 10.1186/s12889-021-10469-6. PMID: 33663434.

Abstract

Background: Farmers may have an increased risk for poor mental health. In connection with this, factors specific to the neighborhood environment such as farm density and the type of agriculture, might be important for mental wellbeing. In this study we aimed to clarify the cross-level interaction on depressive symptoms between farm density at the neighborhood level by type of agriculture and the longest occupation of individuals (farmer or non-farmer).

Methods: Data came from the 2016 wave of the Japan Gerontological Evaluation Study (JAGES) that were linked to governmental agricultural data. Information was analyzed from 147,549 respondents aged 65 years or older, residing in 1024 neighborhoods in 39 municipalities. We calculated farm (crop or animal husbandry) density at the neighborhood level, dividing the number of agricultural management entities by the population. Three-level (individual, neighborhood, and municipality) Poisson regression analysis was used to calculate the prevalence rate ratios of depressive symptoms.

Results: The prevalence of depressive symptoms was higher among individuals whose longest occupation was farmer compared to non-farmer. The estimated probability of depressive symptoms by a cross-level interaction analysis showed that among farmers of both genders, those who were residing in neighborhoods where the farm density was low had a higher prevalence of depressive symptoms, regardless of the type of agriculture. The slope of the relationship between depressive symptoms and animal husbandry farm density varied by occupation, with a higher prevalence of depressive symptoms observed in male farmers compared to male non-farmers.

Conclusions: The high prevalence of depressive symptoms among farmers in neighborhoods with a low farm density may reflect a scarcity of formal and informal social support in such communities. The health effects of the neighborhood environment on farmers, such as farm density, which may vary by the type of agriculture, should be further researched.

Keywords: Agriculture; Animal husbandry; Crop; Depression; Farm density; Farmer; Health effect; Japan; Neighborhood; Older adults.

New paper: Changes in work and life patterns associated with depressive symptoms during the COVID-19 pandemic: an observational study of health app (CALO mama) users

We published a paper from Occupational and Environmental Medicine.

Sato K, Sakata R, Murayama C, Yamaguchi M, Matsuoka Y, Kondo N. Changes in work and life patterns associated with depressive symptoms during the COVID-19 pandemic: an observational study of health app (CALO mama) users. Occup Environ Med. 2021 Feb 22:oemed-2020-106945. doi: 10.1136/oemed-2020-106945. Epub ahead of print. PMID: 33619124.

Abstract

Background: During the COVID-19 pandemic, many people refrained from going out, started working from home (WFH), and suspended work or lost their jobs. This study examines how such pandemic-related changes in work and life patterns were associated with depressive symptoms.

Methods: An online survey among participants who use a health app called CALO mama was conducted from 30 April to 8 May 2020 in Japan. Participants consisted of 2846 users (1150 men (mean age=50.3) and 1696 women (mean age=43.0)) who were working prior to the government declaration of a state of emergency (7 April 2020). Their daily steps from 1 January to 13 May 2020 recorded by an accelerometer in their mobile devices were linked to their responses. Depressive symptoms were assessed using the Two-Question Screen.

Results: On average, participants took 1143.8 (95% CI -1557.3 to -730.2) fewer weekday steps during the declaration period (from 7 April to 13 May). Depressive symptoms were positively associated with female gender (OR=1.58, 95% CI 1.34 to 1.87), decreased weekday steps (OR=1.22, 95% CI 1.03 to 1.45) and increased working hours (OR=1.73, 95% CI 1.32 to 2.26). Conversely, starting WFH was negatively associated with depressive symptoms (OR=0.83, 95% CI 0.69 to 0.99).

Conclusions: Decreased weekday steps during the declaration period were associated with increased odds of depressive symptoms, but WFH may mitigate the risk in the short term. Further studies on the longitudinal effects of WFH on health are needed.

Keywords: environment; international occupational health; psychology.

New paper: Predictors of home being the preferred place of death among Japanese older people: JAGES cross-sectional study

We published a new paper from Geriatrics & Gerontology International.

Ishikawa T, Haseda M, Kondo N, Kondo K, Fukui S. Predictors of home being the preferred place of death among Japanese older people: JAGES cross-sectional study. Geriatr Gerontol Int. 2021 Feb 16. doi: 10.1111/ggi.14135. Epub ahead of print. PMID: 33594743.

Abstract

Aim: There is a large discrepancy between people’s preferred and actual place of death in Japan. To manage this discrepancy, this study aimed to identify the variability in preferred places of death and their associated factors among Japanese older people.

Methods: Cross-sectional survey data were collected in 2016 as part of the Japan Gerontological Evaluation Study, in which 20 204 participants were asked about their preferred place of death. Logistic regression analyses were conducted to examine the final determinants for home as the preferred place of death.

Results: Based on survey data, 35.8% of respondents preferred home as the place of death, 42.7% preferred some sort of facility and 21.5% were unsure. Those who preferred to be at home when receiving end-of-life care were more likely to be older in age, live with others, be employed, be homeowners, have lived in their current residence for a longer period, not be vaccinated for influenza in the past year, engage in physical work or intense sports, not have participated in end-of-life discussions regarding preferred place of death, have experienced relatives dying at home, practice norms of reciprocity, have a sense of attachment to their neighborhood, receive instrumental social support, interact with neighbors and live in a rural area.

Conclusions: Factors related to community attachment were associated with choosing home as the preferred place of death. To fulfill the preferences of Japanese older people, a broad range of demographic, health, behavioral, social, cultural and environmental factors should be considered.

Keywords: Japan; cross-sectional studies; preferred place of death.

New paper: Association of pneumococcal and influenza vaccination with patient-physician communication in older adults: A nationwide cross-sectional study from the JAGES 2016

We published a paper from Journal of Epidemiology.

Sato K, Kondo N, Murata C, Shobugawa Y, Saito K, Kondo K. Association of pneumococcal and influenza vaccination with patient-physician communication in older adults: A nationwide cross-sectional study from the JAGES 2016. J Epidemiol. 2021 Feb 6. doi: 10.2188/jea.JE20200505. Epub ahead of print. PMID: 33551389.

Abstract

Background: Increasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient-physician communication and whether this variable was associated with increased odds of vaccination.

Methods: We used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination.

Results: Among the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians’ listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients’ questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination.

Conclusion: The results suggest that promotion of having a family physician, better patient-physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.

Keywords: influenza vaccine; older adults; patient-physician communication; pneumococcal vaccine; shared decision-making.

New paper: Preferences for the forms of co-payment and advance payment in healthcare services; a discrete choice experiment

We published a paper from Asian Pacific Journal of Health Economics and Policy.

Masaki Okuda, Yukinobu Ichida, Keita Yamane, Rika Ohtsuka, Miwa Yamaguchi, Rei Goto, Atsuhiro Yamada, Atsushi Sannabe, Naoki Kondo, Takashi Oshio. Preferences for the forms of co-payment and advance payment in healthcare services; a discrete choice experiment. Asian Pacific Journal of Health Economics and Policy Vol.3 No.2. 【DOI】10.6011/apj.2021.01

Abstract [PDF]

Full text [PDF]

New paper: Childhood adversities, late-life stressors and the onset of depressive symptoms in community-dwelling older adults

We published a paper from Aging & Mental Health.

Inoue Y, Stickley A, Yazawa A, Aida J, Koyanagi A, Kondo N. Childhood adversities, late-life stressors and the onset of depressive symptoms in community-dwelling older adults. Aging Ment Health. 2021 Feb 1:1-6. doi: 10.1080/13607863.2021.1875190. Epub ahead of print. PMID: 33522286.

Abstract

Objective: Depression is common in older individuals though many factors associated with its occurrence remain under-researched. We examined whether childhood adversities (CAs) and late-life stressors are associated with the onset of depressive symptoms in adults aged ≥ 65 and if these early- and late-life stressors interact in the prediction of depressive symptoms. Methods: Data came from the 2010 and 2013 waves of the Japan Gerontological Evaluation Study (JAGES) (N = 8701). The Geriatric Depression Scale (GDS-15) was used to assess the presence of depressive symptoms (GDS ≥ 5). A Poisson regression analysis was used to examine associations. Results: Both CAs (1 event: incidence rate ratio [IRR] = 1.59, 95% confidence interval [CI]: 1.41-1.79; ≥ 2 events: IRR = 2.36, 95% CI = 1.80-3.10) and late-life stressful events (1 event: IRR = 1.13, 95% CI: 1.02-1.25; ≥ 2 events: IRR = 1.25, 95% CI = 1.05-1.50) were significantly associated with the onset of depressive symptoms. Borderline significant interactions between CAs and late-life stressors (e.g. ≥ 2 CAs and ≥ 2 late-life events: IRR = 0.61, p = 0.087) suggest that late-life stressors may be important in predicting the onset of depressive symptoms especially among individuals with no or fewer CAs compared to those with ≥ 2 CAs. Conclusions: Stressful events in childhood and late adulthood were independently associated with the onset of depressive symptoms in older adults. In addition, stressful experiences in childhood might affect how individuals respond to stressful events in later life.

Keywords: Depression; adverse events (AE); aging; epidemiology.

New paper: Macroeconomic changes and educational inequalities in traffic fatalities in the Baltic countries and Finland in 2000-2015: a register-based study.

We published a paper from Scientific Reports.

Stickley A, Baburin A, Jasilionis D, Krumins J, Martikainen P, Kondo N, Leinsalu M. Macroeconomic changes and educational inequalities in traffic fatalities in the Baltic countries and Finland in 2000-2015: a register-based study. Sci Rep. 2021 Jan 27;11(1):2397. doi: 10.1038/s41598-021-81135-5. PMID: 33504848.

Abstract

This study examined trends and inequalities in road traffic accident (RTA) mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in relation to large-scale macroeconomic changes in the 2000s. Educational inequalities in RTA mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 among 30-74 year olds were examined using census-linked longitudinal mortality data and by estimating the relative and slope index of inequality. Overall RTA mortality decreased substantially between 2000-2003 and 2012-2015. From 2004-2007 to 2008-2011, the RTA mortality decline accelerated but was larger in the Baltic countries. Among men the RTA mortality decline was mostly driven by a larger fall among the high and middle educated. Among women, the changes in RTA mortality by educational level had no clear pattern. From 2000-2003 to 2012-2015 relative educational inequalities in RTA mortality increased among men, although more in the Baltic countries. Among women the pattern was mixed across countries. Absolute inequalities fell in all countries among both sexes. Educational inequalities in male RTA mortality may be growing because of increasingly less access to safer cars and a more hazardous driving culture among the lower educated.

New paper: Association between frequency of laughter and oral health among community-dwelling older adults: a population-based cross-sectional study in Japan

We published a paper from Quality of Life Research.

Hirosaki M, Ohira T, Shirai K, Kondo N, Aida J, Yamamoto T, Takeuchi K, Kondo K. Association between frequency of laughter and oral health among community-dwelling older adults: a population-based cross-sectional study in Japan. Qual Life Res. 2021 Jan 11. doi: 10.1007/s11136-020-02752-7. Epub ahead of print. PMID: 33432445.

Abstract

Purpose: Oral health has been reported to have an impact on the activities of daily life such as chewing, eating, and laughing, while psychological factors such as depression and loneliness have been reported to affect oral health. Little is known, however, about the association between laughter and oral health in older adults. This study examined the bidirectional association between the frequency of daily laughter and oral health in community-dwelling older Japanese adults.

Methods: Our cross-sectional study employed data from the 2013 Japan Gerontological Evaluation Study’s self-reported survey, which included 11,239 male and 12,799 female community-dwelling independent individuals aged 65 years or older. We defined the oral health status by the number of remaining teeth. The association between the self-reported frequency of laughter (almost every day, 1-5 days per week, 1-3 days per month, or almost never) and oral health was examined using logistic regression analysis.

Results: The participants with 10 or more teeth were significantly more likely to laugh compared with the edentulous participants, after adjusting for all covariates. Compared with those who almost never laughed, those who laughed 1-5 days per week were significantly less likely to be edentulous. After stratifying by sex, similar results were found only in the men for both analyses.

Conclusion: There was a significant bidirectional association between frequency of laughter and oral health that was independent of socioeconomic and lifestyle factors among older adults.

Keywords: Cross-sectional study; Frequency of laughter; Number of remaining teeth; Older adults.