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Supplemental material, sj-docx-1-sjp-10.1177_14034948221092285 for Socioeconomic inequalities in self-rated health in Japan, 32 European countries and the United States: an international comparative study by Hirokazu Tanaka, Wilma J. Nusselder, Yasuki Kobayashi and Johan P. Mackenbach in Scandinavian Journal of Public Health

Supplemental material, sj-docx-1-sjp-10.1177_14034948221092285 for Socioeconomic inequalities in self-rated health in Japan, 32 European countries and the United States: an international comparative study by Hirokazu Tanaka, Wilma J. Nusselder, Yasuki Kobayashi and Johan P. Mackenbach in Scandinavian Journal of Public Health

Intervention for higher-risk participants of health checkups especially with diabetes has been started in Japan to prevent renal replacement therapy (RRT) initiation, but evidence about RRT initiation risk among checkup participants has been scarce. To estimate the incidence by risk factors, we conducted a retrospective cohort study using medical claims and checkup data of a community-based insurance scheme in Japan. Beneficiaries who participated in the checkup in 2012-2013 were included and followed up for about five years. We estimated the incidence of RRT initiation by the subject characteristics, followed by investigation for risk factors in bivariate analyses and multivariable regression analyses with Bayesian prior probability distributions. As a result, among 49,252 participants, 37 initiated dialysis (0.21/1,000 person-years); no kidney transplantation was performed during the period. Baseline estimated glomerular filtration rate was strongly associated with dialysis initiation. No dialysis was initiated among those without baseline hypertension; cumulative incidence by hypertension status was significantly different (p < 0.001). Diabetes was significantly associated with dialysis initiation in bivariate analysis, but the association was not significant in multivariable regression analysis [reference: no diabetes; incidence rate ratio (IRR) for diabetes without medication, 3.30 (95% credible interval, 0.48-15.56); IRR for diabetes with medication, 1.69 (95% credible interval, 0.68-3.47)]. In conclusion, potential risk factors for RRT initiation include male sex, comorbid hypertension, and current smoking status, in addition to advanced chronic kidney disease, proteinuria, and diabetes. New initiatives should consider these factors to increase the efficacy of the programs at the population level.

Aim To assess the temporal changes in the quality indicators pertaining to the process measures of diabetes care during a recent decade in Japan. Methods A five-fold repeated cross-sectional study was conducted using health insurance claims data provided by the Japan Medical Data Center between April 2006 and March 2016. We identified 46,631 outpatients with antidiabetic medication who regularly visited hospitals or clinics at least every three months. We evaluated the quality indicators pertaining to glycemic control monitoring, lipid profile monitoring, retinopathy screening, nephropathy screening, and appropriate medication choice. The proportions of patients who received appropriate examinations/prescriptions, by observation period and either the type of antidiabetic medication or facility type were estimated using generalized estimating equation (GEE) models with multiple covariate adjustments. Results The quality indicator values for appropriate medication choice and nephropathy screening improved between 2007 and 2015, whereas those for glycemic control monitoring and retinopathy screening remained suboptimal. Patients prescribed medications in larger hospitals were likelier to undergo the recommended examinations (e.g. retinopathy screening: 36.1% (95% CI: 35.4–36.7%) for clinic, 40.6% (95% CI: 39.1–42.2%) for smaller hospital, and 46.0% (95% CI: 44.8–47.2%) for larger hospital in 2015). Conclusions Several process measures of diabetes care remained suboptimal in Japan.

Additional file 1. Table S1. Sociodemographic characteristics of participants who had reported current fertility problems according to the status of medical help-seeking. Table S2. Logistic regression analysis for factors associated with medical help-seeking among participants who had reported current fertility problems.

Additional file 1.

Aim The effects of family caregiving, especially long-hours caregiving, on coronary heart disease (CHD) are debatable. We examined the impact of family caregiving on incident non-fatal CHD. Methods We used data from the Longitudinal Survey of Middle-Aged and Elderly Persons from 2005 to 2010, a nationwide panel survey for Japanese people aged 50–59 years in 2005 (baseline). After we excluded non-respondents and people with missing key variables at baseline, 25 121 individuals without CHD, stroke or cancer were followed up for a mean of 4.6 years. The exposure was assessed at baseline by three indicators: (i) family caregiving; (ii) hours spent caregiving; and (iii) kinship type of care recipient. The non-fatal CHD incidence was identified according to questionnaire responses from 2006 to 2010. Results Cox's proportional hazards analysis did not show a statistically significant association between family caregiving and incident non-fatal CHD (hazard ratio [HR] 1.13, 95% confidence interval [CI] 0.92–1.40). Caregivers who spent 20–69 h per week on care showed a statistically significant increased risk for non-fatal CHD (HR 1.78, 95% CI 1.23–2.58) compared with non-caregivers; whereas this increased risk was statistically significant only among women (HR 1.98, 95% CI 1.27–3.08), but not among men (HR 1.35, 95% CI 0.67–2.71). Kinship type of care recipient did not make a significant difference to the effects of family caregiving on incident non-fatal CHD. Conclusions Long-hours family caregiving could be an independent risk factor for incident non-fatal CHD among middle-aged women in Japan. Geriatr Gerontol Int 2017; 17: 2109–2115.

Additional file 3: Table 3. Results for the association between the use of service items of each type of long-term care for home-dwelling recipients and the recipients’ home death, using the Poisson regression analysis with covariates (n = 2,035,657).

Additional file 2: Table 2. Results for the association between the use of types of long-term care service for home-dwelling recipients and the recipients’ home death, using the Poisson regression analysis with covariates (n = 2,035,657).

Additional file 1: Method S1. (Settings detail). Table S1. Upper limits in long-term care insurance (LTCI) coverage for recipients at home by care level before and after the LTCI reform in 2006. Table S2. Effect of the long-term care insurance reform in 2006 on formal and informal care services use: an analysis using the expanded sample. Table S3. Effect of the long-term care insurance reform in 2006 on health outcomes: total sample: an analysis using the expanded sample. Table S4. Effect of the long-term care insurance reform in 2006 on formal and informal care services using samples stratified by gender and age. Table S5. Effect of the long-term care insurance reform in 2006 on health outcomes: stratified by gender and age.

Additional file 1: Table 1. Characteristics of long-term care beneficiaries aged 65 years and above who passed away in Japan between January 2008 and December 2013, by the use of each type of long-term care services for home-dwelling recipients.

Additional file 1. Can income-based co-payment rates improve disparity? The case of the choice between brand-name and generic drugs.

Figure S1. and Table S1. Interrupted time series analysis for different outcomes. (DOCX 224Â kb)

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Numbers of medical schools and student admissions in Japan between 1950 and 2010. (DOCX 17Â kb)