Complex multimorbidity and mortality in Japan: a prospective propensity-matched cohort study.

We published a study from BMJ Open.

Kato D, Kawachi I, Saito J, Kondo N. Complex multimorbidity and mortality in Japan: a prospective propensity-matched cohort study. BMJ Open. 2021 Aug 2;11(8):e046749. DOI: 10.1136/bmjopen-2020-046749 PMID: 34341044.


    Objectives: There are limitations to defining multimorbidity (MM) based on a simple count of diseases. To address these limitations, the concept of complex MM (CMM) focuses on how many body systems are affected in a single patient, rather than counting comorbid conditions. This study compared the prediction of mortality among older Japanese adults between CMM and conventional MM.

    Design: A population-based prospective cohort study.

    Setting: The Japan Gerontological Evaluation Study, a nationwide longitudinal cohort study, which ran from 2010 to 2016.

    Participants: Functionally independent individuals who were older than 65 and had complete illness data at the time of baseline survey were eligible.

    Outcomes measure: CMM was defined as the coexistence of 3 or more body system disorders at baseline. We calculated the propensity for each individual to develop CMM based on a wide array of characteristics, including socioeconomic status and health behaviours. Individuals with and without CMM were then matched on their propensity scores before we estimated overall survival using a log-rank test.

    Results: Our 6-year follow-up included 38 889 older adults: 20 233 (52.0%) and 7565 (19.5%) adults with MM and CMM, respectively. In the MM-matched cohort (n=15 666 pairs), the presence of MM was significantly associated with increased mortality (HR 1.07; 95% CI 1.01 to 1.14; p=0.02 by the log-rank test). A similar mortality association was found in the CMM-matched cohort (n=7524 pairs, HR, 1.07; 95% CI 0.99 to 1.16; p=0.08 by the log-rank test).

    Conclusion: This is the first study to report the association between CMM and mortality among older adults in Japan. MM and CMM predict mortality in older adults to a similar degree. This finding needs to be replicated with more precision in larger samples.

    Keywords: epidemiology; geriatric medicine; multimorbidity; social medicine.

    Large-Scale Fandom-based Gamification Intervention to Increase Physical Activity: A Quasi-experimental Study.

    A new paper was published from Sci Sports Exerc.

    Kamada M, Hayashi H, Shiba K, Taguri M, Kondo N, Lee IM, Kawachi I. Large-Scale Fandom-based Gamification Intervention to Increase Physical Activity: A Quasi-experimental Study. Med Sci Sports Exerc. 2021 Aug. DOI: 10.1249/MSS.0000000000002770 Epub ahead of print. PMID: 34366420.


    Purpose: Gamification, the use of game design elements in nongame contexts, in combination with insights from behavioral economics has been applied increasingly to behavior change interventions. However, little is known about the effectiveness or scalability of this approach, especially in the long term. We tested a large-scale smartphone-based intervention to encourage physical activity among Japanese baseball fans using gamification techniques that leveraged fandom and inter-team competition inherent in sports.

    Methods: A quasi-experimental study was conducted among fans of the Japanese Pacific League. The app, Pa-League Walk, included gamification elements, such as competition between opposing teams’ fans based on total daily step counts on game days (>60,000 free downloads since March 2016). We analyzed daily steps of 20,052 app users, supplemented by online survey data of 274 users and 613 matched controls. Difference-in-differences estimators evaluated change in daily steps before and after app installation in users versus matched controls.

    Results: Users’ daily steps increased by 574 (95% confidence interval: 83, 1064) steps three months after installation, compared to controls. The increase was maintained for up to nine months (559 [99, 1018] more steps per day versus baseline), attenuating over a longer follow-up. Positive effect modification was found by high frequency of the app use (P < 0.001) but not by other covariables (P ≥ 0.14) such as education or income. Days with 10,000 steps achievement increased from 24.4% to 27.5% after the additional introduction of incentives (digital player photos) (P < 0.001).

    Conclusion: Using existing fandom and solidarity, the gamification app increased physical activity at scale among baseball fans, including people with lower socioeconomic status under-represented in traditional health programs.

    Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data

    A new paper was published from Nihon Koshu Eisei Zasshi.

    Saito M, Tsuji T, Fujita K, Kondo N, Aida J, Ojima T, Kondo K. [Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data]. Nihon Koshu Eisei Zasshi. 2021 Aug 6. Japanese. DOI: 10.11236/jph.21-056 Epub ahead of print. PMID: 34373427.


    Objectives This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3) higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

    Keywords: leading indicator; long-term care benefit; long-term care prevention; long-term care receipt data; older adults; risk assessment scales for incident functional disability.

    Article Publication: Possibility of “Social Prescription” in Psychiatry (Nishioka)

    Research Fellow Daisuke Nishioka’s paper has been published in “Psychiatry”.

    Daisuke Nishioka, Naoki Kondo. Possibility of “social prescription” in psychiatry. Psychiatry 39(1) 64 – 70
    Available at:

    Media Coverage: Isolation and Loneliness are a Matter of Life: The Challenge of “Social Prescription” to Invite Patients into the Circle of People in the Community, and Whether “Social Prescription” Will Become a System to Heal Loneliness and Isolation: Trials Starting in Japan (Naoki Kondo)

    An article by Naoki Kondo (Professor) was published on Buzzfeed.

    1. Isolation and loneliness are a matter of life. The challenge of “social prescription” that invites patients into the circle of people in the community Published on July 17, 2021

    2. Will “Social Prescription” Become a System to Heal Loneliness and Isolation? A Trial Started in Japan Published on July 18, 2021

    News: [Collaboration] McCann Health Japan obtains evidence for the world’s first “dementia prediction model using voice data of daily conversation.”

    A paper (co-authored by Kondo Laboratory and McCann Health Japan) was published in a peer-reviewed academic journal in PR TIMES.

    A Shimoda, L Yue, H Hayashi, N Kondo. Dementia risks identified by vocal features via telephone conversatons: a novel machine learning prediction model. PLOS ONE. 2021;16(7):e0253988. DOI:

    News: Joint research agreement signed with Kitanihon Computer Service Co., Ltd.

    We have signed a joint research agreement with Kitanihon Computer Service Co., Ltd.
    We will conduct research on the “Development of a Health Management Support System for Welfare Recipients”.

    Kitanihon Computer Service Co., Ltd.

    Special Research Student Mariko Kanamori’s paper was published in several newspapers.

    Special research student Mariko Kanamori’s paper has been published in several newspapers.

    Newly published papers: Saga Shimbun, Ryukyu Shimpo, Chukoku Shimbun SELECT, Shimono Shimbun, Kahoku Shimpo, Chubu Keizai Shimbun

    Ms. Mariko Kanamori, a veterinarian and a graduate student at the University of Tokyo Graduate School of Medicine, who is a member of the team, said, “Farming is a job that requires a lot of mutual help in the community. If there are few peers in the community, it may be difficult to help each other, which may affect mental health. I think it is necessary to enhance the system to help each other across the region.

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    メディア掲載:農家のうつリスク研究 地域越える助け合い必要(特別研究学生 金森)