New paper: Community social networks, individual social participation and dietary behavior among older Japanese adults: Examining mediation using nonlinear structural equation models for three-wave longitudinal data

We published a paper from Preventive Medicine.

M. Nishio, D. Takagi, T. Shinozaki, et al., Community social networks, individual social participation and dietary behavior among older Japanese adults: Examining mediation using nonlinear structural equation models for three-wave longitudinal data, Preventive Medicine (2021), https://doi.org/10.1016/j.ypmed.2021.106613

Abstract

Community social networks positively affect older adults’ dietary behavior, but the underlying mechanisms remain uncertain. This study investigated if the relationship between community social networks and dietary behavior is mediated by social participation, and whether the influence of community social networks differs across sociodemographic groups. We conducted a cross-lagged panel mediation analysis employing nonlinear structural equation modeling using panel data from the Japan Gerontological Evaluation Study (JAGES), a longitudinal study of Japanese older adults in 2010, 2013, and 2016, which included 11,347 men and 14,105 women aged over 65. Monodirectional relationships in community social networks, individual social participation, and fruit/vegetable intake were examined. Community social networks were associated with social participation regardless of sociodemographic conditions. Individual social participation was in turn, positively associated with fruit/vegetable intake, with this association being stronger among those living alone. Analyses further showed that individuals’ social participation positively mediated the relationship between community social networks and fruit/vegetable intake. For both genders, the mediating effects were stronger among people living alone than in those living with someone. However, community networks could also directly and negatively affect fruit/vegetable intake among men who live alone unless they participated in community activities. Community social networks may promote social participation, thereby facilitating healthier dietary behavior regardless of sociodemographic status. Social participation in turn may positively contribute to the dietary health of people living alone. Community-based interventions to encourage people living alone to participate in social activities may help reduce inequality in dietary behavior related to cohabitation status.

New paper: Single-parenthood and health conditions among children receiving public assistance in Japan: a cohort study

We published a paper from BMC Pediatrics.

Nishioka D, Saito J, Ueno K, Kondo N. Single-parenthood and health conditions among children receiving public assistance in Japan: a cohort study. BMC Pediatr. 2021 May 3;21(1):214. doi: 10.1186/s12887-021-02682-4. PMID: 33941113.

Abstract

Background: Children’s healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social support. Single-parenthood is a health risk factor for children owing to low-income-associated food insecurity and stress. No study has investigated the association between single-parenthood and health status in children from families receiving public assistance. This study aimed to examine the association between single-parent households and children’s health among public assistance recipients in Japan by using linkage data of two municipal public assistance databases and administrative medical assistance data.

Methods: We performed a retrospective cohort study. Public assistance for households below the poverty line ensures income security and medical care. The study population included all children aged 15 or younger availing public assistance in January 2016. We extracted recipients’ sociodemographic factors from January 2016 and identified the incidence of childhood diseases’ diagnosis until December 2016 as the outcome, including 1) acute upper respiratory infections; 2) influenza and pneumonia; 3) injuries, including fractures; 4) intestinal infectious diseases; 5) conjunctivitis; 6) asthma; 7) allergic rhinitis; 8) dermatitis and eczema, including atopic dermatitis; and 9) diseases of the oral cavities, salivary glands, and jaws, such as tooth decay or dental caries.

Results: Among the 573 children, 383 (66.8%) lived in single-parent households. A multivariable Poisson regression, with a robust standard error estimator, showed that single-parenthood is associated with a higher prevalence of asthma (incidence ratio [IR] = 1.62; 95% confidence interval [CI], 1.16-2.26), allergic rhinitis (IR = 1.41; 95% CI, 1.07-1.86), dermatitis and eczema (IR = 1.81; 95% CI, 1.21-2.70), and dental diseases (IR = 1.79; 95% CI, 1.33-2.42) compared to non-single parent households, whereas little association was found between single-parenthood and children’s acute health conditions.

Conclusions: Among public assistance recipients, living in single-parent households may be a risk factor for children’s chronic diseases. The Japanese public assistance system should provide additional social care for single-parent households. Further investigations are necessary using more detailed longitudinal data, including environmental factors, the severity of children’s health conditions, contents of medical treatments, and broader socioeconomic factors.

Keywords: Chronic health conditions; Japan; Poverty; Public assistance; Single-parenthood.

New paper: Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000-2015: a register-based study.

We published a paper from Addiction.

Stickley A, Baburin A, Jasilionis D, Krumins J, Martikainen P, Kondo N, Leinsalu M. Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000-2015: a register-based study. Addiction. 2021 Apr 28. doi: 10.1111/add.15526. Epub ahead of print. PMID: 33908662.

Abstract

Aim: To estimate whether large macroeconomic fluctuations in the 2000s affected inequalities in alcohol-related mortality in the Baltic countries and Finland.

Design: Longitudinal register-based follow up study.

Setting: Estonia, Latvia, Lithuania and Finland.

Participants: General population in the 35-74 age group.

Measurements: Socioeconomic status was measured by the highest achieved educational level and was categorised using the International Standard Classification of Education 2011 as low (included categories 0-2), middle (3-4), and high (5-8). Educational inequalities in alcohol-related mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 were examined using census-linked longitudinal mortality data. We estimated age-standardised mortality rates and the relative and slope index of inequality.

Findings: Alcohol-related mortality increased in all countries in 2004-2007 except among Estonian women and decreased/remained the same from 2008 onwards except among Latvian men. By 2012-2015 alcohol-related mortality was still higher than in 2000-2003 in Finland, Latvia and Lithuania (women only). Relative inequalities increased across the study period in all countries (significantly in Lithuania and Latvia). The 2004-2007 increase in relative inequalities was mostly driven by a larger mortality increase among the low educated, whereas in 2008-2011 and in 2012-2015 inequalities often increased because of a larger relative mortality decline among the high educated. However, these period changes in relative inequalities and between educational groups were often not statistically significant. Absolute inequalities were larger in 2012-2015 vs. 2000-2003 in all countries except Estonia (decrease).

Conclusion: In Estonia, Latvia, Lithuania and Finland, alcohol-related mortality tended to increase faster among the low educated during a period of economic expansion (2004-2007) and tended to decrease more among the high educated during a period of economic recession (2008-2011).

Keywords: alcohol-related mortality; economic cycles; inequalities; register-based.

New paper: Social participation and mortality according to company size of the longest-held job among older men in Japan: A 6-year follow-up study from the JAGES.

We published a paper from Journal of Occupational Health.

Kanamori S, Kondo N, Takamiya T, Kikuchi H, Inoue S, Tsuji T, Kai Y, Muto G, Kondo K. Social participation and mortality according to company size of the longest-held job among older men in Japan: A 6-year follow-up study from the JAGES. J Occup Health. 2021 Jan;63(1):e12216. doi: 10.1002/1348-9585.12216. PMID: 33792124.

Abstract

Objectives: The purpose of this study was to examine the relationship between social participation (type/pattern) and mortality according to company size of the longest-held job among older men in Japan who have worked in the company.

Methods: Longitudinal data from the Japan Gerontological Evaluation Study were used in this study. Functionally independent individuals aged 65 years and older in Japan were surveyed. Work and community organizations (local community, hobbies, and sports) were used as social participation. A Cox proportional hazards model was used to calculate mortality hazard ratios.

Results: Analysis was carried out on 19 260 participants. A total of 2870 deaths occurred during the 6-year follow-up period. Those in companies with 49 or fewer employees had the highest prevalence of work participation and the lowest participation in any community organization. Regardless of company size, the mortality risk was significantly lower for participants in any social participation (eg, the hazard ratio for participation in a hobby organization among those with a company size of 49 employees or fewer was 0.74, 95% CI: 0.65-0.85) compared to nonparticipants whose company size was 49 or fewer employees.

Conclusions: In Japan, although older men who have worked for small companies may have fewer benefits, their social participation may reduce their mortality risks. To avoid increasing health inequalities, it is necessary to create an environment in which they are more likely to participate in social activities.

Keywords: community participation; health status disparities; leisure activities; social environment; work.

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.