Papers

Descriptive study of healthy life expectancy in all secondary medical areas in Japan.

A new paper has been published by the International Journal of Epidemiology.

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

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

Descriptive features of HLE in smaller areas of all of Japan can be firstly clarified.

Key messages

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.

Trends in area-level socioeconomic inequalities of lung cancer mortality by age group in Japan: 1995-2014.

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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Key messages

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.

New paper: Dementia risks identified by vocal features via telephone conversations: A novel machine learning prediction model

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.

Abstract

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.

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.

    Abstract

    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.

    Abstract

    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.

    Abstract

    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: Income Inequality Becomes Health Inequality (Public Assistance Research Quarterly)

    Naoki Kondo and Daisuke Nishioka (visiting researcher) have published an article in the latest issue of the Quarterly Journal of Public Assistance Research.

    Click here for the table of contents of the Quarterly Journal of Public Assistance Research No. 261 (in Japanese).
    Click here to purchase.

    Daisuke Nishioka will continue to write a series of articles.

    Special Feature: Income Inequality Becomes Health Inequality
    Why Health Care Assistance is Necessary: A Perspective from the Concept of Capital
    Naoki Kondo, Graduate School of Kyoto University

    Toward Effective Implementation of Health Management Support Program for Protected Persons
    Daisuke Nishioka, Osaka Medical College Graduate School of Medicine

    Reference
    The Power of Accompaniment: A Survey Study on the Actual Conditions of Medical Service Use by the Needy and the Effectiveness of Accompaniment Support for Medical Consultations（PDF, in Japanese)

    Daisuke Nishioka’s website is here.

    Press Release: Possible Regional Disparities in the “Improvement” of Care Needs

    Airi Amamiya, a visiting researcher, published a paper in International Journal of Environmental Research and Public Health A press release was issued on a paper published in the International Journal of Environmental Research and Public Health.

    The Possibility of Regional Disparities in the “Improvement” of Care Needs(PDF)
    ～Social capital in the community may not be effective for certain people. ～(PDF)

    This study suggests that although men live in areas with strong community ties (social cohesion), they are less likely to improve their care needs if they have a low opinion of those ties. For women, despite living in a community with high civic participation, if they do not participate in the community, they are less likely to improve after needing care. In areas with rich social capital, it is necessary to consider whether anyone is excluded from these connections.

    Reference
    Amemiya A, Saito J, Saito M, Takagi D, Haseda M, Tani Y, Kondo K, Kondo N. Social Capital and the Improvement in Functional Ability among Older People in Japan: A Multilevel Survival Analysis Using JAGES Data. Int J Environ Res Public Health. 2019 Apr 12;16(8):1310. doi: 10.3390/ijerph16081310. PMID: 31013681; PMCID: PMC6518128.

    Press Release: Socioeconomic disparities may exist in “improvement” of care needs

    Airi Amamiya, a visiting researcher, has published a press release on a paper published in BMC Public Health.

    Possible socioeconomic disparities in the “improvement” of care needs
    – Longer education is twice as likely to improve as shorter education – (PDF, in Japanese)

    It is known that there is a possibility of improvement in the condition of the elderly even after they require long-term care. This study found that those who are socioeconomically disadvantaged are less likely to improve their condition after needing care. This suggests that there is a socioeconomic disparity in the improvement of care needs. There is a need to focus on supporting those who are in a socioeconomically disadvantaged position.

    Reference
    Amemiya A, Kondo N, Saito J, Saito M, Takagi D, Haseda M, Tani Y, Kondo K. Socioeconomic status and improvement in functional ability among older adults in Japan: a longitudinal study. BMC Public Health. 2019 Feb 19;19(1):209. doi: 10.1186/s12889-019-6531-9. PMID: 30782149; PMCID: PMC6381753.