Department of Social Epidemiology
Graduate School of Medicine and School of Public Health, Kyoto University
A new paper has been published from Journal of International Health.
Morita Naomi, Kanamori Mariko, Nochi Masahiro, and Kondo Naoki. A mixed methods study on specifying the inhibitory factors to access medical services and effective support for foreign residents living in Japan. Kokusai Hoken Iryo (Journal of International Health) 36(3), 107-121, 2021
https://www.jstage.jst.go.jp/article/jaih/36/3/36_107/_article/-char/ja/
A project led by Kondo, entitled “Hybrid Care Network with ‘Anywhere Door’ for Local Communities,” has been selected by the Research Institute of Science and Technology for Society (RISTEX).
JST press release in Japanese
https://www.jst.go.jp/pr/info/info1535/index.html
Ojima, T., Hosokawa, R., Myojin, T., Aida, J., Kondo, K., & Kondo, N. (2021). Descriptive study of healthy life expectancy in all secondary medical areas in Japan. International Journal of Epidemiology, 50(Supplement_1), dyab168-507.
https://doi.org/10.1093/ije/dyab168.507
Healthy life expectancy (HLE) is an index combined with mortality and morbidity. Monitoring HLE is useful to assess and stimulate health promotion policies/programmes. Though HLE in national or prefectural areas have often been observed, further data in smaller areas are required. The aim of the study is to reveal descriptive features of HLE in secondary medical areas, that is almost same as public health centre jurisdictions and median of population is 214 thousand, in Japan.
HLE by gender in all 341 secondary medical areas were calculated using Sullivan method. Population data was used from resident registry. Mortality data was from vital statistics of total death in 2016-2018. Data of proportions of unhealthy people was from long-term care insurance data in 2017 using proportion of people with care level 2 (almost bed ridden level) or more severe. Finally, maps of HLE of all of Japan were drawn.
Means (standard deviations, maximums, minimums, means of ranges of 95% confidence intervals) of HLE at birth are 79.21 (0.86, 81.36, 76.90, 0.92) and 83.75 (0.62, 85.45, 81.99, 0.80) years for males and females, respectively. Areas with short HLE were prevalent in Tohoku region (northern part), while that with long HLE in Chubu region (central part).
Descriptive features of HLE in smaller areas of all of Japan can be firstly clarified.
Monitoring HLE in local areas would be feasible and useful in some countries. Precision of HLE of areas of these population size would be acceptable.
A new paper has been published by the International Journal of Epidemiology.
Ito, Y., Fukui, K., Kondo, N., Katanoda, K., Nakaya, T., & Sobue, T. (2021). Trends in area-level socioeconomic inequalities of lung cancer mortality by age group in Japan: 1995-2014. International Journal of Epidemiology, 50(Supplement_1), dyab168-314.
https://doi.org/10.1093/ije/dyab168.314
During the long-term economic recession, health inequalities have been concerned in Japan. Among cancer mortality rates, the widest socioeconomic inequalities of municipal mortality was observed in lung cancer. Our aim was to examine the trends in the inequality by sex and age group.
We used the areal deprivation index (ADI) to determine area-level socio-economic position at the municipality level. We calculated age-standardised lung cancer mortality rate by sex, age group (<60/60-74/75+) and ADI quintile group using the vital statistics data. Joinpoint regression models were applied to estimate the average annual percentage changes for the last five years. We also calculated absolute index and relative index of inequalities.
Among men, a clear socioeconomic gradient in lung cancer mortality was observed for all age groups, but among women, ‘J-shape’ gradients in which Q2 or Q3 had the lowest mortality were observed. For women aged 60-74 years, increasing trends of mortality were observed in more deprived groups (Q3-Q5). Men over 75 years showed noticeably decreasing trends in mortality, while women showed no decrease. Absolute inequalities in women were smaller than those in men, but relative inequalities showed widening trends for all age groups.
We identified widening area-level gaps in all age groups and stable/increasing trends in lung cancer mortality of the 60-74 year age group.
It is important to monitor mortality trends and their gaps of lung cancer mortality among deprivation groups to identify vulnerable subpopulations in order to help tackle the health inequalities.
We published a new paper from PLoS One.
Shimoda A, Li Y, Hayashi H, Kondo N. Dementia risks identified by vocal features via telephone conversations: A novel machine learning prediction model. PLoS One. 2021 Jul 14;16(7):e0253988. doi: 10.1371/journal.pone.0253988. PMID: 34260593.
Due to difficulty in early diagnosis of Alzheimer’s disease (AD) related to cost and differentiated capability, it is necessary to identify low-cost, accessible, and reliable tools for identifying AD risk in the preclinical stage. We hypothesized that cognitive ability, as expressed in the vocal features in daily conversation, is associated with AD progression. Thus, we have developed a novel machine learning prediction model to identify AD risk by using the rich voice data collected from daily conversations, and evaluated its predictive performance in comparison with a classification method based on the Japanese version of the Telephone Interview for Cognitive Status (TICS-J). We used 1,465 audio data files from 99 Healthy controls (HC) and 151 audio data files recorded from 24 AD patients derived from a dementia prevention program conducted by Hachioji City, Tokyo, between March and May 2020. After extracting vocal features from each audio file, we developed machine-learning models based on extreme gradient boosting (XGBoost), random forest (RF), and logistic regression (LR), using each audio file as one observation. We evaluated the predictive performance of the developed models by describing the receiver operating characteristic (ROC) curve, calculating the areas under the curve (AUCs), sensitivity, and specificity. Further, we conducted classifications by considering each participant as one observation, computing the average of their audio files’ predictive value, and making comparisons with the predictive performance of the TICS-J based questionnaire. Of 1,616 audio files in total, 1,308 (81.0%) were randomly allocated to the training data and 308 (19.1%) to the validation data. For audio file-based prediction, the AUCs for XGboost, RF, and LR were 0.863 (95% confidence interval [CI]: 0.794-0.931), 0.882 (95% CI: 0.840-0.924), and 0.893 (95%CI: 0.832-0.954), respectively. For participant-based prediction, the AUC for XGboost, RF, LR, and TICS-J were 1.000 (95%CI: 1.000-1.000), 1.000 (95%CI: 1.000-1.000), 0.972 (95%CI: 0.918-1.000) and 0.917 (95%CI: 0.918-1.000), respectively. There was difference in predictive accuracy of XGBoost and TICS-J with almost approached significance (p = 0.065). Our novel prediction model using the vocal features of daily conversations demonstrated the potential to be useful for the AD risk assessment.
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Hakuhodo DY Holdings Inc.’s health management support program “Kenkisen Sen®”, for which our field is conducting joint research, has won the Silver Award in the “Inner Promotion Planning” category at the 19th JPM Planning Solution Awards.
The 19th JPM Planning Solution Awards 2021 Award Winning Entries!
https://jpm-inc.jp/news/planning-sa/2021-08-30-3392/
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.
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.
A new paper was published from Nihon Koshu Eisei Zasshi.
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.