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Co-payments help determine how expensive an individual health service is both to payers and to enrollees. The Japanese government had provided its elderly with first dollar coverage, including pharmaceuticals, until January 2001 when it introduced 10% co-payments in an effort to contain costs. We evaluated whether the Japanese increase in co-payments reduced compliance with necessary care, including prescription pharmaceuticals, in elderly patients with chronic illness. Subjects were members of the Health Care System for the Aged (persons age 70 or older) who belonged to a health insurance society located in Fukuoka Prefecture continuously from January 2000 to December 2001. We defined 234 highly compliant patients with hypertension and 35 with diabetes mellitus who visited physicians at least once per month during every month of the 6-month period from January to June 2000. We used time series analyses to compare medical service use during 6 months before and 12 months after the 10% co-payments were introduced. During this study, medical visits were necessary to obtain prescriptions for pharmaceuticals in Japan. Compliance decreased significantly for both hypertension and diabetes mellitus patients after the introduction of 10% co-payments, controlling for the possible impact of secular trends. The impact on necessary pharmaceutical use was likewise affected. However, the impact on costs was not as marked. Co-payments have a major impact on patient compliance and recommended medical service use (but perhaps not on costs), especially in the elderly with chronic diseases.

Despite a close association between adiponectin and both hypertension and type 2 diabetes, the relationship between adiponectin and metabolic syndrome has not yet been well-investigated. To examine and evaluate the association between serum adiponectin levels and metabolic syndrome based on Japanese diagnostic criteria, we analyzed adiponectin and anthropometric parameters in 869 male employees aged 40-59 who belonged to a health insurance society in Fukuoka Prefecture and who underwent annual health check-ups from August 2006 to July 2007. Two hundred and thirty-two of the 869 subjects (26.7%) were diagnosed with metabolic syndrome. The serum adiponectin levels were significantly higher in the non-metabolic syndrome group. In a multiple logistic regression analysis, the subjects in the top quartile of serum adiponectin (adjusted odds ratio:0.36;95% confidence interval:0.21-0.63) and the second (adjusted odds ratio:0.51;95% confidence interval:0.31-0.84) quartile had a significantly decreased risk for metabolic syndrome in comparison to the bottom quartile. The dose-response relationship between serum adiponectin levels and metabolic syndrome was significant (p for trend 0.0001) after adjusting for age, body mass index, smoking status, and drinking status. The current findings suggest that hypoadiponectinemia is inversely correlated with the risk of metabolic syndrome in middle-aged Japanese male workers.

Leptin is a hormone which is predominantly secreted by adipose tissue. Recent studies have shown that leptin increases arterial blood pressure. Although data from available animal studies clearly indicate an association between leptin and hypertension, results of human studies have been less definitive. We conducted a case-control study to examine the association between serum leptin levels and hypertension in 111 hypertensive subjects and 222 male controls, using conditional logistic regression analyses. Mean serum leptin levels were found to be marginally higher in the case subjects than in the control subjects (3.3 ng/ml versus 3.0 ng/ml), however, conditional logistic regression analysis revealed that subjects in the highest quartile had a significantly increased risk of hypertension compared with those in the lowest quartile, even after adjusting for drinking status and diabetes mellitus (adjusted OR, 2.11;95% CI, 1.01-4.39). Our findings suggest that leptin plays an important role in the development of hypertension.