Papers

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.

    New Paper: Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries

    We published a paper from Scientific Reports.

    Oh J, Lee HY, Khuong QL, Markuns JF, Bullen C, Barrios OEA, Hwang SS, Suh YS, McCool J, Kachur SP, Chan CC, Kwon S, Kondo N, Hoang VM, Moon JR, Rostila M, Norheim OF, You M, Withers M, Li M, Lee EJ, Benski C, Park S, Nam EW, Gottschalk K, Kavanagh MM, Tran TGH, Lee JK, Subramanian SV, McKee M, Gostin LO. Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries. Sci Rep. 2021 Jul 2;11(1):13717. doi: 10.1038/s41598-021-92766-z. PMID: 34215764.

    Abstract

    Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country’s 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective ‘pool’ in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic.

    New Paper: Disability and psychological distress in nine countries of the former Soviet Union

    We published a paper from J Affect Disord.

    Stickley A, Kondo N, Roberts B, Kizilova K, Waldman K, Oh H, Inoue Y, Shin JI, Shakespeare T, McKee M. Disability and psychological distress in nine countries of the former Soviet Union. J Affect Disord. 2021 Jun 2;292:782-787. doi: 10.1016/j.jad.2021.05.061. Epub ahead of print. PMID: 34175591.

    Abstract

    Background: People with disabilities (PWD) are at increased risk of poor mental health. However, this association and the pathways involved remain under-researched in many parts of the world. This study examined the association between disability and psychological distress in nine countries of the former Soviet Union (FSU).

    Methods: Data were analysed from 18,000 adults aged ≥18 years collected during the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2010 and 2011. Information was obtained on disability status, the severity of the disability and psychological distress. Logistic regression analysis was used to estimate associations.

    Results: In a fully adjusted combined country analysis, disability was associated with over two times higher odds for psychological distress (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.86-2.58). The strength of the association varied across the individual countries. Among PWD more severe disability was associated with significantly higher odds for psychological distress (OR: 2.12, 95%CI: 1.26-3.55).

    Limitations: The data were cross-sectional and disability status was self-reported, possibly resulting in underreporting.

    Conclusions: Disability is associated with worse psychological health in FSU countries, especially among those with more severe disabilities. As poor mental health may also increase the risk of negative outcomes in PWD, this finding highlights the importance of the early detection and treatment of mental disorders in PWD in these countries.

    New paper: Disability and loneliness in nine countries of the former Soviet Union

    We published a paper from Disabil Health J.

    Stickley A, Kondo N, Richardson E, Leinsalu M, Waldman K, Oh H, Inoue Y, Shakespeare T, McKee M. Disability and loneliness in nine countries of the former Soviet Union. Disabil Health J. 2021 May 28:101123. doi: 10.1016/j.dhjo.2021.101123. Epub ahead of print. PMID: 34147415.

    Abstract

    Background: People with disabilities (PWD) often face structural and other barriers to community involvement and may therefore be at risk of loneliness. Yet, so far, this issue has received little attention.

    Objective: This cross-sectional study aimed to examine the association between disability and loneliness in nine countries of the former Soviet Union (FSU).

    Methods: Data were analyzed from 18000 respondents aged ≥18 that came from the Health in Times of Transition (HITT) survey that was undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2010/11. Respondents reported on whether they had a disability (no/yes) and its severity. A single-item question was used to assess loneliness. Logistic regression analysis was used to examine the associations.

    Results: Across the countries, 6.8% of respondents reported being disabled. In a fully adjusted combined country analysis, disability was associated with higher odds for loneliness (odds ratio: 1.30, 95% confidence interval: 1.06-1.60). In an analysis restricted to PWD, individuals in the most severe disability category (Group 1) had over two times higher odds for loneliness when compared to those in the least severe disability category (Group 3).

    Conclusions: Disability is associated with higher odds for reporting loneliness in the FSU countries and this association is especially strong among those who are more severely disabled. An increased focus on the relationship between disability and loneliness is now warranted given the increasing recognition of loneliness as a serious public health problem that is associated with a number of detrimental outcomes.

    Keywords: Adult population; Disabled; HITT survey; Lonely.