New paper: Increasing income-based inequality in suicide mortality among working-age women and men, Sweden, 1990–2007: is there a point of trend change?

We published a new paper from Journal of Epidemiology and Community Health.

Income inequalities have risen from the 1990s to 2000s, following the economic recession in 1994, but little research has investigated socioeconomic inequalities in suicide mortality for working-age men and women (aged between 30 and 64 years) over the time using longitudinal data in Sweden.

Using Swedish national register data between 1990 and 2007 as a series of repeated cohort studies with a 3-year follow-up (sample sizes were approximately 3.7 to 4.0 million in each year), relative and slope indices of inequality (RII and SII respectively) based on quintiles of individual disposable income were calculated and tested for temporal trends.

SII for the risk of suicide mortality ranged from 27.6 (95% CI 19.5 to 35.8) to 44.5 (36.3 to 52.6) in men and 5.2 (0.2 to 10.4) to 16.6 (10.7 to 22.4) in women (per 100 000 population). In men, temporal trends in suicide inequalities were stable in SII but increasing in RII by 3% each year (p=0.002). In women, inequalities tended to increase in both RII and SII, especially after the late-1990s, with 10% increment in RII per year (p<0.001).

Despite universal social security and generous welfare provision, income inequalities in suicide were considerable and have widened, especially in women. The steeper rise in women may be partially related to higher job insecurity and poorer working conditions in the female dominated public sector after the recession. To reduce health consequences following an economic crisis and widened income inequalities, additional measures may be necessary in proportion to the levels of financial vulnerability.

Hiyoshi, A., Kondo, N., & Rostila, M. (2018). Increasing income-based inequality in suicide mortality among working-age women and men, Sweden, 1990–2007: is there a point of trend change?. J Epidemiol Community Health, jech-2018.

We published a press release (August 9th, 2018).

New paper: Social Support and Access to Health Care Among Older People in Japan: Japan Gerontological Evaluation Study (JAGES)

We published a new paper from Asia Pacific Journal of Public Health.

We investigated cross-sectional associations between social support and access to health care among older Japanese people. From larger cohort datasets of community-dwelling people aged 65 years or older, 23 079 respondents were extracted. We summarized patterns of social support by gender and age group, then analyzed associations between social support and the experience of unmet health care needs, as a negative indicator of access. Adjusting for socioeconomic factors, multiple logistic regression identified that respondents who received instrumental support were less likely to experience unmet health care needs except males aged 65 to 69 years. The effect of receiving instrumental social support was larger than for household income and similar to anxiety about unexpected expenses. In the low-income group, these findings were highlighted among females aged 65 to 69 years and males aged 70 years and older. In addition to redistribution of financial resources, facilitating suitable social support may contribute to alleviating the access gap among older people.

Michiyo Higuchi, Kayo Suzuki, Toyo Ashida, Naoki Kondo, and Katsunori Kondo. “Social Support and Access to Health Care Among Older People in Japan: Japan Gerontological Evaluation Study (JAGES).” Asia Pacific Journal of Public Health (2018)

New paper: Universal school lunch programme closes a socioeconomic gap in fruit and vegetable intakes among school children in Japan

We published a new paper from European Journal of Public Health.

Universal school lunch programmes are expected to cover all children equally, compared with selective programmes that may stigmatize socially vulnerable children. However, the effectiveness of universal programmes in closing dietary disparity has not been empirically proven. We evaluated whether Japan’s universal school lunch programmes contribute to a reduction in the socioeconomic status (SES)-related gradient in fruit and vegetable intakes.

We analyzed data for 719 school children aged 6–12 years in a population-based survey conducted in the greater Tokyo metropolitan area. We measured dietary intakes using a validated self-administered brief diet history questionnaire for young children (BDHQ-10 y). We assessed parental education, annual household income and maternal employment status as SES indicators of children. We used multiple regression to estimate mean fruit and vegetable intakes by parental education and household income, and the contribution of school lunch to reducing the SES-related gradient in fruit and vegetable intakes.

Compared with children with high maternal education (>15 years), those with low maternal education (<13 years) had less vegetable intake by 22.3 g/1000 kcal (95% confidence interval = 12.5, 32.2) and less fruit intake by 7.5 g/1000 kcal (95% confidence interval = −2.4, 17.3). However, fruit and vegetable intakes from school lunch did not vary by SES, indicating that school lunch intake alleviated the SES-related gradient of total vegetable intake by 9.9% and that of fruit intake by 3.4%.

Universal school lunch programmes can partially contribute to a reduction in the SES-related gradient in dietary intakes.

Mai Yamaguchi, Naoki Kondo, Hideki Hashimoto. Universal school lunch programme closes a socioeconomic gap in fruit and vegetable intakes among school children in Japan. European Journal of Public Health, 2018 Mar 26. doi: 10.1093/eurpub/cky041.

New paper: Exploring 2.5-Year Trajectories of Functional Decline in Older Adults by Applying a Growth Mixture Model and Frequency of Outings as a Predictor: A 2010–2013 JAGES Longitudinal Study

We published a new paper from Journal of Epidemiology.

Background: We explored the distinct trajectories of functional decline among older adults in Japan, and evaluated whether the frequency of outings, an important indicator of social activity, predicts the identified trajectories.

Methods: We analyzed data on 2,364 adults aged 65 years or older from the Japan Aichi Gerontological Evaluation Study. Participants were initially independent and later developed functional disability during a 31-month follow-up period. We used the level of long-term care needs certified in the public health insurance system as a proxy of functional ability and linked the fully tracked data of changes in the care levels to the baseline data. A low frequency of outings was defined as leaving one’s home less than once per week at baseline. We applied a growth mixture model to identify trajectories in functional decline by sex and then examined the association between the frequency of outings and the identified trajectories using multinomial logistic regression analysis.

Results: Three distinct trajectories were identified: “slowly declining” (64.3% of men and 79.7% of women), “persistently disabled” (4.5% and 3.7%, respectively), and “rapidly declining” (31.3% and 16.6%, respectively). Men with fewer outings had 2.14 times greater odds (95% confidence interval, 1.03–4.41) of being persistently disabled. The association between outing frequency and functional decline trajectory was less clear statistically among women.

Conclusions: While the majority of older adults showed a slow functional decline, some showed persistent moderate disability. Providing more opportunities to go out or assistance in that regard may be important for preventing persistent disability, and such needs might be greater among men.

Saito, J., Kondo, N., Saito, M., Takagi, D., Tani, Y., Haseda, M., Tabuchi, T. & Kondo, K. (2018). Exploring 2.5-Year Trajectories of Functional Decline in Older Adults by Applying a Growth Mixture Model and Frequency of Outings as a Predictor: A 2010–2013 JAGES Longitudinal Study. Journal of Epidemiology, JE20170230.

New paper: increased overweight risks among children living in post-earthquake temporary housing

Our new paper identified the increased overweight risks among elementary school children who have been living in emergency temporary housing after the 2011 Great East Japan Earthquake. After the 2011 disaster, there are many children who are still residing in temporary housing.

Obesity in elementary school children after the Great East Japan Earthquake

Hidenori Moriyama,
Toru Fuchimukai,
Naoki Kondo,
John I Takayama

The paper was published from Pediatrics International.  DOI: 10.1111/ped.13468

New publication: Japan health system review

Asia Pacific Observatory on Health Systems and Policies published Japan health system review.

This is the latest Health in Transition (HiT) report of Japan.

The review can be downloaded for free here.

Japan health system review was written by:
Haruka Sakamoto, The University of Tokyo
Mizanur Rahman, The University of Tokyo
Shuhei Nomura, The University of Tokyo
Etsuji Okamoto, University of Fukuchiyama
Soichi Koike, Jichi Medical University
Hideo Yasunaga, The University of Tokyo
Norito Kawakami, The University of Tokyo
Hideki Hashimoto, The University of Tokyo
Naoki Kondo, The University of Tokyo
Sarah Krull Abe, The University of Tokyo
Matthew Palmer, The University of Tokyo
Cyrus Ghaznavi, The University of Tokyo

and edited by:
Kenji Shibuya, The University of Tokyo
Stuart Gilmour, The University of Tokyo
Kozo Tatara, Japan Public Health Association




Paper published: time preference did not explain the association between education and health behavior much

Educational attainment, time preference, and health-related behaviors: A mediation analysis from the J-SHINE survey Original Research Article
Social Science & Medicine, Volume 153, March 2016, Pages 116-122
Daisuke Takagi, Naoki Kondo, Misato Takada, Hideki Hashimoto


  • We measured time preference using choice-based measurements of time discount rate.
  • We demonstrated the relations of education to smoking, drinking and overweight.
  • However, time discount rate was not associated with binge drinking and overweight.
  • Even for smoking, the mediation effect of time discount rate was quit limited.
  • Interventions for time preference may not close the education-related gap.


Evidence consistently shows that low education is associated with unhealthy behaviors. A recent study in behavioral economics argued that high time preferences ? the tendency to prefer immediate gain to later reward ? explain the limited self-control of individuals in making preventive health-related choices. The aim of this study was to examine the mediating effect of time preference on the associations between education and smoking, binge drinking and overweight in young and middle-aged adults living in a Japanese metropolitan area, using a quantitatively measured time discount rate. A population-based probabilistic sample of residents of 25?50 years of age living in four municipalities within Japanese metropolitan areas where economic disparity is relatively large was obtained from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE). Respondents answered the questionnaire items using a computer-aided personal instrument (CAPI). Data from 3457 respondents were used in this study. Time preferences measured as categorical responses were converted into a continuous number of time discount rates by using the maximum likelihood method. Smoking habit, binge drinking, and body mass index were regressed on educational attainment with demographics and other confounders. The mediating effects of the time discount rate were examined with the bootstrapping method. Results showed that the time discount rate did not mediate the association between education and binge drinking and BMI. Even for smoking, the mediating effect of time discount rate was quite limited, indicating that the proportion of total effect of education mediated was only 4.3% for men and 3.0% for women. The results suggest that modifying time preferences through educational intervention has only limited efficacy in closing disparities in health-related behaviors, and that other mediators fostered by schooling, such as knowledge/skills, group norms and supportive peers/networks, may be more important as modifiable mediators in the link between education and smoking.


Japan; Time preference; Time discount rate; Education; Smoking; Binge drinking; Body mass index

New paper: Correlates of Regular Participation in Sports Groups among Japanese Older Adults: JAGES Cross–Sectional Study

Our paper was published.
Correlates of Regular Participation in Sports Groups among Japanese Older Adults: JAGES Cross-Sectional Study

Mitsuya Yamakita ,Satoru Kanamori,Naoki Kondo,Katsunori Kondo



Participation in a sports group is key for the prevention of incident functional disability. Little is known about the correlates of older adults’ participation in sports groups, although this could assist with the development of effective health strategies. The purpose of this study was to identify the demographic and biological, psychosocial, behavioral, social and cultural, and environmental correlates of sports group participation among Japanese older adults.


Data were obtained from the Japan Gerontological Evaluation study, which was a population?based cohort of people aged ?65 years without disability enrolled from 31 municipalities across Japan (n = 78,002). Poisson regression analysis was used to determine the associations between the factors and participation in sports groups.


Non-regular participation in sports groups was associated with lower educational level, being employed, and working the longest in the agricultural/forestry/fishery industry among the demographic and biological factors and poor self-rated health and depression among the psychosocial factors. Of the behavioral factors, current smoking was negatively associated and current drinking was positively associated with regular participation in sports groups. Among the social and cultural factors, having emotional social support and participating in hobby clubs, senior citizen clubs, or volunteer groups were associated with a high prevalence of participation in sports groups. Perceptions of the presence of parks or sidewalks, good access to shops, and good accessibility to facilities were positively associated with participation in sports groups among the environmental factors.


Our study suggests that the promotion of activities that could increase older adults’ participation in sports groups should consider a broad range of demographic and biological, psychosocial, behavioral, social and cultural, and environmental factors. Although future longitudinal studies to elucidate the causal associations are needed, encouraging participation in community groups through social networks might be effective for participation in sports groups.