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Although social participation has been reported to be associated with significantly lower risks of mortality and disability, to our knowledge, no study has estimated its impact on disability-free life expectancy (DFLE). Therefore, this study aimed to investigate the association between social participation and DFLE in community-dwelling older people.We analyzed 11-year follow-up data from a cohort study of 11,982 Japanese older adults (age ≥65 years) in 2006. We collected information on the number of social participations using a questionnaire. Using this information, we categorized the participants into four groups. DFLE was defined as the average number of years a person could expect to live without disability. The multistate life table method using a Markov model was employed for calculating DFLE.The results revealed that DFLE according to the number of social participations was 17.8 years (95% confidence interval [CI], 17.3-18.2) for no activities, 20.9 (95% CI, 20.4-21.5) for one activity, 21.5 (95% CI, 20.9-22.0) for two activities, and 22.7 (95% CI, 22.1-23.2) for three activities in men, and 21.8 (95% CI, 21.5-22.2), 25.1 (95% CI, 24.6-25.6), 25.3 (95% CI, 24.7-25.9), and 26.7 years (95% CI, 26.1-27.4), respectively, in women. This difference in DFLE did not change after the participants were stratified for smoking, body mass index, physical activity, and depression.Social participation is associated with longer DFLE among Japanese older people; therefore, encouraging social participation at the population level could increase life-years lived in good health.

AIMS/INTRODUCTION Fat mass and fat-free mass affect glycated hemoglobin A1c (HbA1c) levels and blood glucose levels, respectively. The aim of the present study was to examine the association between fat mass index and fat-free mass index with HbA1c. MATERIALS AND METHODS We conducted a cross-sectional study that included 3,731 men and 9,191 women aged 20 years or older, living in Miyagi Prefecture, Japan, who were not treated for diabetes. The fat mass index and fat-free mass index were calculated as fat mass and fat-free mass divided by the height squared, respectively. The indices were classified into sex-specific quartiles and combined into 16 groups. An ANCOVA was used to assess associations between the combined fat mass index and fat-free mass index with HbA1c adjusted for potential confounder. The linear trend test was conducted by stratifying the fat mass index and fat free mass index, entering the number as a continuous term in the regression model. RESULTS In multivariable models, a higher fat mass index was related to higher HbA1c levels in men and women in all fat-free mass index subgroups (P

The association between alcohol intake and stomach cancer risk remains controversial. We undertook a pooled analysis of data from six large‐scale Japanese cohort studies with 256 478 participants on this topic. Alcohol intake as ethanol was estimated using a validated questionnaire. The participants were followed for incidence of stomach cancer. We calculated study‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) for stomach cancer according to alcohol intake using a Cox regression model. Summary HRs were estimated by pooling the study‐specific HRs using a random‐effects model. During 4 265 551 person‐years of follow‐up, 8586 stomach cancer cases were identified. In men, the multivariate‐adjusted HRs (95% CIs) of stomach cancer were 1.00 (0.87‐1.15) for occasional drinkers, and 1.00 (0.91‐1.11) for, Alcohol intake increased stomach cancer risk in men, and heavy drinkers showed a greater point estimate of risk for proximal cancer than for distal cancer.

Background Accumulating evidence suggests that consuming coffee may lower the risk of death, but evidence regarding tea consumption in Asians is limited. We examined the association between coffee and tea consumption and mortality in Asian populations. Methods We used data from 12 prospective cohort studies including 248 050 men and 280 454 women from the Asia Cohort Consortium conducted in China, Japan, Korea and Singapore. We estimated the study-specific association of coffee, green tea and black tea consumption with mortality using Cox proportional-hazards regression models and the pooled study-specific hazard ratios (HRs) using a random-effects model. Results In total, 94 744 deaths were identified during the follow-up, which ranged from an average of 6.5 to 22.7 years. Compared with coffee non-drinkers, men and women who drank at least five cups of coffee per day had a 24% [95% confidence interval (CI) 17%, 29%] and a 28% (95% CI 19%, 37%) lower risk of all-cause mortality, respectively. Similarly, we found inverse associations for coffee consumption with cardiovascular disease (CVD)-specific and cancer-specific mortality among both men and women. Green tea consumption was associated with lower risk of mortality from all causes, CVD and other causes but not from cancer. The association of drinking green tea with CVD-specific mortality was particularly strong, with HRs (95% CIs) of 0.79 (0.68, 0.91) for men and 0.78 (0.68, 0.90) for women who drank at least five cups per day of green tea compared with non-drinkers. The association between black tea consumption and mortality was weak, with no clear trends noted across the categories of consumption. Conclusions In Asian populations, coffee consumption is associated with a lower risk of death overall and with lower risks of death from CVD and cancer. Green tea consumption is associated with lower risks of death from all causes and CVD.

Recently, a high urinary sodium-to-potassium (Na/K) ratio and reduced sleep efficiency, in addition to conventional risk factors (obesity and excess alcohol intake), have been identified as risk factors for hypertension. We estimated the population attributable fraction (PAF) for home hypertension due to these risk factors in a general Japanese population. We conducted a cross-sectional study including 1384 participants (393 men and 991 women) to estimate the odds ratio (OR) and 95% confidence interval (CI) for the presence of any of the conventional risk factors using multivariable logistic regression analyses. The models were adjusted for sex, age, smoking status, and log-transformed average daily steps. We also estimated the OR and 95% CI for the presence of any of the overall risk factors. Furthermore, we calculated the PAF due to these risk factors. The results showed that the prevalence of home hypertension was 39.0% (540/1384). The presence of any of the conventional risk factors, as well as any of the overall risk factors, was significantly associated with an increased prevalence of hypertension (OR 2.80, 95% CI 2.15–3.65; OR 2.50, 95% CI 1.93–3.22, respectively). The PAF for hypertension due to the presence of any of the conventional risk factors and the PAF due to the presence of any of the overall risk factors were 30.2% and 39.0%, respectively. In conclusion, the impact of the overall risk factors, including the urinary Na/K ratio and sleep efficiency, on home hypertension was higher than that of conventional risk factors alone. The management of the urinary Na/K ratio and sleep efficiency as well as conventional risk factors might be important in the management of blood pressure.

Background Little is known about the time course of mortality reduction following smoking cessation in Asians who have smoking behaviours distinct from their Western counterparts. We evaluated the level of reduction in all-cause, cardiovascular disease (CVD) and lung cancer mortality by years since quitting smoking, in Asia. Methods Using Cox regression, we analysed individual participant data (n = 709 151) from 16 prospective cohorts conducted in China, Japan, Korea/Singapore, and India/Bangladesh, separately by cohorts. Cohort-specific hazard ratios (HRs) were combined using a random-effects meta-analysis. Results During a mean follow-up of 12.0 years, 108 287 deaths were ascertained—35 658 from CVD and 7546 from lung cancer. Among Asian men, a dose-response relationship of risk reduction in deaths from all causes, CVD and lung cancer was observed with an increase in years after smoking cessation. Compared with never smokers, however, all-cause and CVD mortality among former smokers remained elevated 10–14 years after quitting [multivariable-adjusted HR (95% confidence interval (CI) = 1.25 (1.13–1.37) and 1.20 (1.02–1.41), respectively]. Lung cancer mortality stayed almost 2-fold higher than among never smokers 15–19 years after smoking cessation [1.97 (1.41–2.73)], particularly among former heavy smokers [2.62 (1.71–4.00)]. Women who quitted for ≥5 years retained a significantly elevated mortality from all causes, CVD and lung cancer. Overall patterns of the cessation-mortality associations were similar across countries. Conclusions Our findings suggest that adverse effects of tobacco smoking persist for an extended time period, even for more than two decades, which is beyond the time windows defined in current clinical guidelines for risk assessment of lung cancer and CVD.

Prior studies reported the association of reproductive factors with breast cancer (BC), but the evidence is inconsistent. We conducted a pooled analysis of nine cohort studies in Japan to evaluate the impact of six reproductive factors (age at menarche/age at first birth/number of births/age at menopause/use of female hormones/breastfeeding) on BC incidence. We conducted analyses according to menopausal status at the baseline or at the diagnosis. Hazard ratio (HR) and 95% confidence interval (CI) were estimated by applying Cox proportional‐hazards model in each study. These hazard ratios were integrated using a random‐effects model. Among 187,999 women (premenopausal: 61,113, postmenopausal: 126,886), we observed 873 premenopausal and 1,456 postmenopausal cases. Among premenopausal women, use of female hormones significantly increased BC incidence (HR: 1.53 [1.04–2.25]). Although P value for trend was not significant for age at first birth and number of births (P for trend: 0.15 and 0.30, respectively), women giving first birth at ages ≥36 experienced significantly higher BC incidence than at ages 21–25 years, and women who had ≥2 births experienced significantly lower BC incidence than nulliparous women. Among postmenopausal women, more births significantly decreased BC incidence (P for trend: 0.03). Although P value for trend was not significant for age at first birth and age at menopause (P for trend: 0.30 and 0.37, respectively), women giving first birth at ages 26–35 years experienced significantly higher BC incidence than at ages 21–25 years, and women with age at menopause: ≥50 years experienced significantly higher BC incidence than age at menopause: ≤44 years. BC incidence was similar according to age at menarche or breastfeeding history among both premenopausal and postmenopausal women. In conclusion, among Japanese women, use of female hormones increased BC incidence in premenopausal women, and more births decreased BC incidence in postmenopausal women.

Although alcohol consumption is reported to increase the incidence of breast cancer in European studies, evidence for an association between alcohol and breast cancer in Asian populations is insufficient. We conducted a pooled analysis of eight large-scale population-based prospective cohort studies in Japan to evaluate the association between alcohol (both frequency and amount) and breast cancer risk with categorization by menopausal status at baseline and at diagnosis. Estimated hazard ratios (HR) and 95% confidence intervals were calculated in the individual cohorts and combined using random-effects models. Among 158 164 subjects with 2 369 252 person-years of follow-up, 2208 breast cancer cases were newly diagnosed. Alcohol consumption had a significant association with a higher risk of breast cancer in both women who were premenopausal at baseline (regular drinker compared to nondrinker: HR 1.37, 1.04-1.81, ≥23 g/d compared to 0 g/d: HR 1.74, 1.25-2.43, P for trend per frequency category: P = .017) and those who were premenopausal at diagnosis (≥23 g/d compared to 0 g/d: HR 1.89, 1.04-3.43, P for trend per frequency category: P = .032). In contrast, no significant association was seen in women who were postmenopausal at baseline or at diagnosis, despite a substantial number of subjects and long follow-up period. Our results revealed that frequent and high alcohol consumption are both risk factors for Asian premenopausal breast cancer, similarly to previous studies in Western countries. The lack of a clear association in postmenopausal women in our study warrants larger investigation in Asia.

The nature of the recovery process of posttraumatic stress disorder (PTSD) symptoms is multifactorial. The Massive Parallel Limitless-Arity Multiple-testing Procedure (MP-LAMP), which was developed to detect significant combinational risk factors comprehensively, was utilized to reveal hidden combinational risk factors to explain the long-term trajectory of the PTSD symptoms. In 624 population-based subjects severely affected by the Great East Japan Earthquake, 61 potential risk factors encompassing sociodemographics, lifestyle, and traumatic experiences were analyzed by MP-LAMP regarding combinational associations with the trajectory of PTSD symptoms, as evaluated by the Impact of Event Scale-Revised score after eight years adjusted by the baseline score. The comprehensive combinational analysis detected 56 significant combinational risk factors, including 15 independent variables, although the conventional bivariate analysis between single risk factors and the trajectory detected no significant risk factors. The strongest association was observed with the combination of short resting time, short walking time, unemployment, and evacuation without preparation (adjusted P value = 2.2 × 10−4, and raw P value = 3.1 × 10−9). Although short resting time had no association with the poor trajectory, it had a significant interaction with short walking time (P value = 1.2 × 10−3), which was further strengthened by the other two components (P value = 9.7 × 10−5). Likewise, components that were not associated with a poor trajectory in bivariate analysis were included in every observed significant risk combination due to their interactions with other components. Comprehensive combination detection by MP-LAMP is essential for explaining multifactorial psychiatric symptoms by revealing the hidden combinations of risk factors.

Sleep duration is emerging as an important modifiable risk factor for morbidity and mortality. We assessed the association between sleep duration and cancer incidence and mortality among Japanese adults using data from six population-based cohorts with 271 694 participants. During a total follow-up period of about 5.9 million person-years, we identified 40 751 incident cancer cases and 18 323 cancer deaths. We computed study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression models and pooled the estimates using random-effects meta-analysis. Sleep duration of ≥10 hours (vs 7 hours) was associated with increased risk of cancer incidence among women (HR 1.19, 95% CI 1.02-1.38), but not men, and increased risk of cancer mortality among men (HR 1.18, 95% CI 1.00-1.39) and women (HR 1.44, 95% CI 1.20-1.73). Sleep duration of ≤5 hours (vs 7 hours) was not associated with cancer incidence and mortality. However, among postmenopausal women, sleep durations of both ≤5 and ≥10 hours (vs 7 hours) were associated with an increased risk of cancer mortality. Among Japanese adults, sleep duration of ≥10 hours is associated with increased risk of cancer incidence and mortality among women and cancer mortality among men.

Background The physical and psychological health impacts on victims of the Great East Japan Earthquake (GEJE) have lasted for a long time. Some cross-sectional studies have reported a relationship between social networks and/or social support and mental health among victims. Previous studies were cross-sectional observations at one time point after a disaster, it remains unclear whether the lack of social trust soon after the GEJE predicts long-term mental health outcomes among the victims. The objective of the present study was to examine prospectively the association between social trust soon after the GEJE and trends in sleep disorders up to 6 years after the GEJE. Methods We conducted a health survey on residents living in two areas affected by the GEJE. We analyzed data from 1293 adults (aged ≥18 years) who had participated in an initial health survey. The participants responded to a self-administrated questionnaire composed of items on health condition, mental health, including sleep disorders (based on the Athens Insomnia Scale [AIS]), and social trust. We classified the participants into two categories (high or low) based on the level of social trust at the first health survey. A linear mixed model was used to estimate trends in AIS scores in relation to social trust at the first health survey. Results The AIS scores of participants in the low social trust group were significantly higher than those in the high social trust group throughout the 6 years after the GEJE (P Conclusion Social trust at 3 to 5 months after the GEJE predicted AIS scores at 6 years after the GEJE among victims. This finding suggests that it may be possible to identify people who have a lower potential for mental resilience from disaster damage over the long term. Further, health interventions for this high-risk group could help promote resilience after a disaster.

Purpose This study aimed to investigate the relationship between the bilateral maximum occlusal force (MOF) of full dental arches and all-cause mortality in a group of community-dwelling older males and females in Japan. Methods This 13-year prospective cohort study was conducted among 815 older adults (395 male and 420 female) aged 70 years or over (mean age ± standard deviation: 75.1 ± 4.5 years). Bilateral MOF in the intercuspal position was recorded with horseshoe-shaped pressure-sensitive film. Participants were grouped by gender into tertiles according to MOF. Demographic variables, chronicity, comorbidity, physical status, cognitive and psychological status, social functioning, and blood chemistry data were also assessed. Information regarding all-cause mortality and migration was obtained from the Sendai Municipal Authority. Cox proportional hazard modeling was performed to assess all-cause mortality during the follow-up period. Results In total, 159 male and 109 female participants died over a median 12.9-year follow-up period, and the cumulative mortality significantly increased with lower MOF in both males and females. The multivariate Cox proportional hazard model demonstrated a significant increase in the risk of all-cause mortality associated with lower tertiles of MOF, relative to the upper tertile in males (hazard ratio: 1.62; 95% confidence interval: 1.05–2.51) and females (hazard ratio: 1.94; 95% confidence interval: 1.10–3.56). Conclusions There was a significant and independent association of bilateral MOF with all-cause mortality in community-dwelling elderly males and females in Japan. These findings suggested that maintenance of oral functioning contributes to general health.

Background To provide updates on clinical practice of acute pancreatitis (AP) in Japan, we conducted a nationwide epidemiological survey. Methods This study consisted of a two-staged survey; the number of AP patients was estimated by the first-stage survey and their clinical features were examined by the second-stage survey. We surveyed AP patients who had visited hospitals in 2016. Results The estimated number of AP patients in 2016 was 78,450, with an overall incidence of 61.8 per 100,000 persons. We obtained detailed clinical information of 2994 AP patients, including 706 (23.6%) severe cases classified according to the Japanese severity criteria. The male-to-female sex ratio was 2.0, and the mean age at onset was 59.9 years in males and 66.5 years in females. Alcohol was the most common etiology (42.8%) in males and gallstones in females (37.7%). The AP-associated mortality was 6.1% in severe AP cases, which was decreased by 40% compared to the 2011 survey. Antibiotics were administered to most cases, with carbapenem being frequently used. Enteral nutrition was given in 31.8% of severe cases, but majority cases received after 48 h. Among the 107 patients who received intervention for walled-off necrosis, five patients received surgery-first approach, 66 received endoscopic ultrasound-guided transluminal drainage, and 19 underwent step-up approach. Conclusions We clarified the current status of AP in Japan including the significant reduction of mortality in severe cases, shift to endoscopic approaches for walled-off necrosis, and poor compliance of the recommendations in the guidelines including management of enteral nutrition and antibiotic administration.

Objective To investigate the efficacy of prophylactic administration of low-dose landiolol on postoperative atrial fibrillation (POAF) in patients after cardiovascular surgery. Methods Consecutive 150 patients over 70 years of age who underwent cardiovascular surgery for valvular, ischemic heart, and aortic diseases were enrolled in this single-center prospective randomized control study from 2010 to 2014. They were assigned to three treatment groups: 1γ group (landiolol at 1 μg/kg/min), 2γ group (landiolol at 2 μg/kg/min), or control group (no landiolol). In the two landiolol groups, landiolol hydrochloride was intravenously administered for a period of 4 days postoperatively. Electrocardiography was continuously monitored during the study period, and cardiologists eventually assessed whether POAF occurred or not. Results POAF occurred in 24.4% of patients in the control group, 18.2% in 1γ group, and 11.1% in 2γ group (p = 0.256). Multivariate logistic regression analysis showed that the incidence of POAF tended to decrease depending on the dose of landiolol (trend-p = 0.120; 1γ group: OR = 0.786, 95% CI 0.257–2.404; 2γ group: OR = 0.379, 95% CI 0.112–1.287). Subgroup analysis showed a significant dose-dependent reduction in POAF among categories of female sex, non-use of angiotensin II receptor blockers (ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and 0.004). Conclusions These findings indicate that prophylactic administration of low-dose landiolol may not be effective for preventing the occurrence of POAF in overall patients after cardiovascular surgery, but the administration could be beneficial to female patients, patients not using ARBs preoperatively, and those after valvular surgery.

To investigate the association of smoking status and years since smoking cessation with the risk of incident dementia among elderly Japanese. We conducted a longitudinal analysis of smoking status and smoking cessation with dementia in prospective cohort study of 12,489 Japanese individuals aged ≥ 65 years who were followed up for 5.7 years. Information on smoking status and other lifestyle factors was collected via a questionnaire in 2006. Data on incident dementia were retrieved from the public Long-term Care Insurance Database. The Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident dementia. During 61,613 person-years of follow-up, 1110 cases (8.9%) of incident dementia were documented. Compared with individuals who had never smoked, current smokers showed a higher risk of dementia (HR 1.46, 95% CI 1.17, 1.80). Among ex-smokers, the risk for those who had stopped smoking for ≤ 2 years was still high (HR 1.39, 95% CI 0.96, 2.01), however, quitting smoking for 3 years or longer mitigated the increased risk incurred by smokers; the multivariable HRs (95% CIs) were 1.03 (0.70, 1.53) for those who had stopped smoking for 3–5 years, 1.04 (0.74, 1.45) for 6–10 years, 1.19 (0.84, 1.69) for 11–15 years, and 0.92 (0.73, 1.15) for > 15 years. Our study suggests that the risk of incident dementia among ex-smokers becomes the same level as that of never smokers if they maintain abstinence from smoking for at least 3 years. Electronic supplementary material The online version of this article (10.1007/s10654-020-00612-9) contains supplementary material, which is available to authorized users.

Summary Background & aims Although it has been suggested that the Japanese diet contributes to the longevity of the Japanese population, no study has examined the association between the Japanese diet and survival time. The present study investigated the association between the Japanese diet and survival time. Methods We analyzed 20-year follow-up data from a cohort study of 14,764 Japanese men and women aged 40–79 years. At the baseline survey in 1994, we collected dietary information using a validated 40-item food frequency questionnaire. Adherence to a Japanese diet consisting of nine components (rice, miso soup, seaweeds, pickles, green and yellow vegetables, fish, green tea, beef and pork, and coffee) was assessed in terms of a Japanese dietary index (JDI) score, the total score ranging from 0 to 9. Cox proportional hazards model and Laplace regression analysis were used to estimate the hazard ratios (HRs) and differences in median age at death (50th percentile differences – PDs in age at death) with 95% confidence intervals (CIs) according to the quartiles of the JDI score. Results During the follow-up period, we documented 4,619 deaths. We observed that a higher JDI score was associated with a lower risk of mortality and longer survival time: In comparison to participants in the lowest JDI score quartile (0–4), the multivariate-adjusted HR (95% CI) of all-cause mortality was 0.91 (0.83–0.99) and the multivariate-adjusted 50th PD in age at death (95% CI) was 10.2 (3.2–17.2) months longer for those in the highest quartile (7–9). Conclusions Adherence to a Japanese diet is associated with a longer survival time.

With population aging, an increasing attention has been paid to quality of life rather than mere longevity. Now, it is urgently needed to clarify predictors of well-being in later life, i.e., "successful aging (SA)." The aim of this study is to investigate whether the number of remaining teeth impacts on maintenance of SA among Japanese older people. The present study was conducted in Tsurugaya district, a suburban area of Sendai, in northern Japan, and included older people aged ≥ 70 years who had met the criteria for SA at a 2003 baseline survey. At the baseline survey, dentists obtained data for the number of remaining teeth. We obtained information about Long-term Care Insurance certification, including the dates of incident functional disability and death between 2003 and 2012. Data pertaining to health-related quality of life (HRQOL) were collected at the 2003 baseline survey and the 2012 follow-up survey. Maintenance of SA was defined in terms of survival, disability-free status and high HRQOL in both 2003 and 2012. Among 450 participants, 108 (24.0%) were considered to have maintained a state of SA. When participants were classified into three groups according to previous studies, in comparison with participants who retained 0-9 teeth, the multivariate prevalence ratios (95% confidence intervals) were 1.39 (0.81-2.36) for those who retained 10-19 teeth and 1.58 (1.002-2.50) for those who retained ≥ 20 teeth (p trend = 0.046). The present results suggest that retaining ≥ 20 teeth is associated with maintenance of SA among Japanese older people.

In developed countries, the relationship between education level, wealth, and healthy aging have been found to be mediated by modifiable risk factors, such as obesity, physical activities, and smoking status. The present study was to investigate the association between education level, monthly per-capita expenditure (PCE), and healthy aging in the older Indonesian population, and to clarify modifiable risk factors that mediate this association. A 7-year prospective longitudinal study (2007-2014) was conducted on 696 older Indonesian individuals (≥ 50 years) living in 13 different provinces in Indonesia during the survey periods. Data on educational level, PCE, and modifiable risk factors were collected in 2007. Information on healthy aging was obtained in both 2007 and 2014. A multivariate-adjusted logistic regression model was used to estimate the odds ratio (ORs) and 95% confidence intervals (CIs) for healthy aging by education level and PCE. The mediating effects were estimated using a four-way effect decomposition. Out of 696 eligible subjects, 206 (29.6%) were judged as healthy aging in 2014. The OR (95% CI) for healthy aging for participants with a higher education level was 1.81 (1.23-2.65) compared with those with a lower education level, and no significant association was observed between PCE and healthy aging. An association was thus observed between education level and healthy aging, but not PCE. Importantly, the association between education level, PCE, and healthy aging does not appear to be mediated by the modifiable risk factors. Priorities in making health policy would be different between developed countries and developing countries.

To further clarify the clinico-epidemiological features of autoimmune pancreatitis (AIP) in Japan, we conducted the fourth nationwide epidemiological survey. This study consisted of two stage surveys; the number of AIP patients was estimated by the first survey and their clinical features were assessed by the second survey. We surveyed the AIP patients who had visited hospitals in 2016. The estimated number of AIP patients in 2016 was 13,436, with an overall prevalence rate of 10.1 per 100,000 persons. The estimated number of newly diagnosed patients was 3984, with an annual incidence rate of 3.1 per 100,000 persons. Compared to the 2011 survey, both numbers more than doubled. We obtained detailed clinical information of 1474 AIP patients. The male-to-female sex ratio was 2.94, the mean age was 68.1, and mean age at diagnosis was 64.8. At diagnosis, 63% patients were symptomatic and nearly half of them presented jaundice. Pancreatic cysts were found in 9% of the patients and calcifications in 6%. Histopathological examination was performed in 64%, mainly by endoscopic ultrasonography-guided fine needle aspiration. Extra-pancreatic lesions were detected in 60% of the patients. Eighty-four % patients received the initial steroid therapy, and 85% received maintenance steroid therapy. Kaplan–Meier analysis revealed that the relapsed survival was 14% at 3 years, 25% at 5 years, 40% at 10 years, and 50% at 15 years. Mortality was favorable, but pancreatic cancer accounted for death in one quarter of fatal cases. We clarified the current status of AIP in Japan.

Aims The study aims to evaluate the prognostic significance of impaired glucose tolerance (IGT) with reference to albuminuria in patients with chronic heart failure (CHF). Methods and results We examined 535 CHF patients (mean 66 years, women 25%) in the control arm of our SUPPORT trial, in which we examined additive impact of olmesartan in hypertensive patients with symptomatic CHF treated with β‐blockers and/or angiotensin‐converting enzyme inhibitors. We examined the association between glycaemic abnormality (assessed by 75 g of oral glucose tolerance test) and albuminuria for a composite outcome of all‐cause death, myocardial infarction, stroke, and HF hospitalization. IGT patients (N = 113, mean 67.2 years) were older and more frequently treated with β‐blockers compared with those with normal glucose regulation (N = 142, mean 64.0 years) and those with diabetes mellitus (N = 280, mean 65.7 years). Multivariable Cox proportional hazard models revealed that, as compared with normal glucose regulation (NGR), IGT was associated with increased risk of the outcome when complicated by albuminuria [hazard ratio (HR) 2.25; 95% confidence interval (CI) 1.14–4.42; P = 0.019] but not when uncomplicated by albuminuria (HR 0.76; 95% CI 0.35–1.60, P = 0.47) (P for interaction = 0.041). This was also the case for diabetes mellitus and albuminuria (HR 2.06; 95% CI 1.17–3.61; P = 0.012). Among IGT patients without albuminuria, 21 (29%) developed albuminuria at 1‐year visit, which was again associated with poor prognosis (HR 7.36; 95% CI 1.39–38.98, P = 0.019). Conclusions These results indicate that IGT is associated with poor prognosis when complicated by albuminuria in CHF patients, demonstrating the importance of combined early stages of glucose intolerance and renal dysfunction in the management of CHF.

Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61-70, 71-80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P

Background: Although previous meta-analyses have suggested a dose-response relationship between body mass index (BMI) and thyroid cancer risk, limited evidence has been presented about Asian populations. To assess this association among Asian populations, where underweight is more prevalent than in other regions, a pooled analysis from the Asia Cohort Consortium was conducted.Methods: Baseline height and weight were measured in five cohorts and self-reported in eight cohorts. Thyroid cancer incidence was ascertained by linkage to local cancer registries. Cohorts were treated as a stratum in the Cox proportional hazard model to estimate the pooled hazard ratios (HRs) and corresponding confidence intervals (CIs) from the estimates for each cohort. All analyses were stratified by sex.Results: A total of 538,857 men and women from 13 cohorts from mainland China, Korea, Japan, and Singapore were included in the analysis. During a mean of 15.1 years of follow-up, 1132 thyroid cancer cases were ascertained. Using a BMI of 18.5-22.9 kg/m(2) as a reference, an elevated risk of thyroid cancer was observed for groups with a BMI between 25 and 29.9 kg/m(2) (HR: 1.31, [CI: 0.95-1.80]) and a BMI of 30 kg/m(2) and greater (HR: 1.84, [CI: 0.89-3.81]) in men. Thyroid cancer risk was elevated in women with a BMI of 23-24.9 kg/m(2) (HR: 1.26, [CI: 1.07-1.48]). The HRs for 5-U increment of BMI showed a linear association among men (HR: 1.25, [CI 1.10-1.55]) but not among women (HR: 1.07, [CI: 0.97-1.18]). Although the overall thyroid cancer risk was lower among underweight men and women, the papillary cancer risk may be elevated among underweight men (HR: 2.24, [CI: 0.75-6.66]).Conclusion: While higher BMI is associated with an elevated risk of thyroid cancer in both men and women, the association of underweight BMI may differ by sex and histological subtype.

Background Lifetime risk is an informative estimate for driving lifestyle and behavioral changes especially for young adults. The impact of composite risk factors for cardiovascular disease on lifetime risk stratified by sex has not been investigated in the Japanese population, which has a much lower mortality of coronary heart disease compared with the Western population. We aimed to estimate lifetime risk of death from cardiovascular disease attributable to traditional risk factors. Methods and Results We analyzed pooled individual data from the Evidence for Cardiovascular Prevention from Observational Cohorts in a Japanese cohort study. A modified Kaplan–Meier approach was used to estimate the remaining lifetime risk of cardiovascular death. In total, 41 002 Japanese men and women with 537 126 person‐years of follow‐up were included. The lifetime risk at the index‐age of 45 years for those with optimal risk factors (total cholesterol Conclusions The magnitude and the number of risk factors were progressively associated with increased lifetime risk even in individuals in early adulthood who tend to have low short‐term risk. The degree of established cardiovascular risk factors can be converted into lifetime risk. Our findings may be useful for risk communication in the early detection of future cardiovascular disease risk.

After disasters, people are often forced to reconstruct or move to new residences. This study aimed to reveal the association between the types of reconstructed residences and psychosocial or psychiatric conditions among the population. A total of 1071 adult residents in a coastal town, whose houses were destroyed by the tsunami caused by the Great East Japan Earthquake, enrolled in the study five years after the disaster. The type of reconstructed post-disaster residences (reconstructed on the same site/disaster-recovery public condominium/mass-translocation to higher ground/privately moving to remote areas) and the current psychosocial indicators were investigated. The results revealed that individuals living in public condominiums showed significantly worse scores on the Lubben Social Network Scale-6 (p

An increase in time spent walking is significantly associated with lower risks of mortality and disability. This study aimed to investigate the association between changes in time spent walking and disability-free life expectancy (DFLE) in community-dwelling older people. Thirteen-year follow-up data from a cohort study of 7105 Japanese older adults (age ≥ 65 years) in 2006 were analyzed. Information on time spent walking was collected using questionnaires at two time points (1994 and 2006). Based on this information, the participants were categorized into four groups according to changes in time spent walking: remained inactive, became inactive, became active, and remained active. DFLE was defined as the average number of years a person could expect to live without disability. The multistate life table method using a Markov model was used to calculate DFLE. Of those who were inactive in 1994, DFLE of those who became active in 2006 (20.30 years in men; 24.06 years in women) was longer by about 2 years than of those who remained inactive (17.96 years in men; 21.87 years in women), and it was as long as those who remained active (20.34 years in men; 24.16 years in women). The 2-year difference in DFLE did not change after the participants were stratified by body mass index, motor function, cognitive function, and history of diseases. Increase in time spent walking is associated with longer DFLE in Japanese older people. Encouraging simple physical activity such as walking at the population level could increase life-years lived in good health.

Background A higher body fat percentage is associated with hypertension, even in non-obese individuals. The difference in body composition may be related to hypertension. The fat mass index (FMI) and fat-free mass index (FFMI) are proposed indicators of body composition. This study aimed to examine the relationship of a combination of FMI and FFMI with hypertension. Methods We conducted a cross-sectional study of 5,058 men and 11,842 women aged ≥ 20 years in the Miyagi Prefecture, northeastern Japan. The FMI and FFMI were calculated as the fat mass and fat-free mass divided by the height squared, respectively. The indices were classified into quartiles and combined into 16 groups. Hypertension was defined as casual blood pressure ≥ 140/90 mmHg and/or self-reported treatment for hypertension. Multivariable logistic regression models, adjusted for potential confounders, were used to assess the relationship of a combination of FMI and FFMI with hypertension. Results Higher FMI was associated with hypertension in most of the FFMI subgroups. Similarly, a higher FFMI was associated with hypertension in most of FMI subgroups. For men, the association between FFMI and hypertension in the lowest FMI group was not significant. Conclusions Reducing the FMI and FFMI may be important in preventing hypertension. For men, the relationship between the FFMI and hypertension in the lowest FMI group might be weak.

Purpose The association between dairy intake and mortality remains uncertain, and evidence for the Japanese population is scarce. We aimed to investigate the association between dairy intake and all-cause, cancer, and cardiovascular disease (CVD) mortality in Japanese adults. Methods A total of 34,161 participants (16,565 men and 17,596 women) aged 40–64 years without a history of cancer, myocardial infarction, or stroke at baseline were included in the analysis, using data from the Miyagi Cohort Study initiated in 1990. Milk, yogurt, and cheese intake were obtained using a validated food frequency questionnaire. Total dairy intake was calculated as the sum of milk, yogurt, and cheese intake and then categorized by quartile. The outcomes were all-cause, cancer, and CVD mortality. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality risks. Results During 750,016 person-years of follow-up, the total number of deaths was 6498, including 2552 deaths due to cancer and 1693 deaths due to CVD. There was no association between total dairy intake and all-cause, cancer, and CVD mortality for both men and women. We also examined the associations between subgroup dairy products and mortality. For milk and yogurt intake, our results suggest null associations. However, cheese intake was modestly associated with lower all-cause mortality in women; compared with non-consumers, the multivariable HRs (95%CIs) were 0.89 (0.81–0.98) for 1–2 times/month, 0.88 (0.78–1.00) for 1–2 times/week, and 0.89 (0.74–1.07) for 3 times/week or almost daily (p trend = 0.016). Conclusion Dairy intake was not associated with mortality in Japanese adults, except for limited evidence showing a modest association between cheese intake and a lower all-cause mortality risk in women.

Few studies have reported the relationship between reduced sleep efficiency and the prevalence of hypertension independent of sleep duration in Japan. This study aimed to evaluate whether reduced sleep efficiency, measured using an objective device for >1 week, was related to an increased prevalence of hypertension independent of sleep duration in the general Japanese population. We conducted a cross-sectional study of 904 participants aged ≥20 years who lived in Miyagi Prefecture, Japan. Sleep efficiency was measured using a contactless biomotion sleep sensor for 10 continuous days. The participants were classified into two groups according to their sleep efficiency: reduced (

Red meat and processed meat have been suggested to increase risk of colorectal cancer (CRC), especially colon cancer. However, it remains unclear whether these associations differ according to meat subtypes or colon subsites. The present study addressed this issue by undertaking a pooled analysis of large population‐based cohort studies in Japan: 5 studies comprising 232 403 participants (5694 CRC cases) for analysis based on frequency of meat intake, and 2 studies comprising 123 635 participants (3550 CRC cases) for analysis based on intake quantity. Study‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model and then pooled using the random effect model. Comparing the highest vs lowest quartile, beef intake was associated with an increased risk of colon cancer in women (pooled HR 1.20; 95% CI, 1.01‐1.44) and distal colon cancer (DCC) risk in men (pooled HR 1.30; 95% CI, 1.05‐1.61). Frequent intake of pork was associated with an increased risk of distal colon cancer in women (pooled HR 1.44; 95% CI, 1.10‐1.87) for “3 times/wk or more” vs “less than 1 time/wk”. Frequent intake of processed red meat was associated with an increased risk of colon cancer in women (pooled HR 1.39; 95% CI, 0.97‐2.00; P trend = .04) for “almost every day” vs “less than 1 time/wk”. No association was observed for chicken consumption. The present findings support that intake of beef, pork (women only), and processed red meat (women only) might be associated with a higher risk of colon (distal colon) cancer in Japanese.

Summary Background & aims Many studies have suggested that fish intake is associated with protection from risk of atherosclerotic diseases; however, this association with aortic diseases has not been elucidated worldwide. We hypothesized that fish intake is inversely associated with mortality from aortic diseases (aortic dissection and aneurysm). Methods The study was conducted as a pooled analysis of original data from a maximum of 8 cohort studies, comprising a total of 366,048 community-based men and women who had no history of cardiovascular disease or cancer. In each cohort, we used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality from aortic dissection, aneurysm and total aortic disease according to the frequency of fish intake and estimated summary HRs derived from each study. Results Nonlinear inverse associations were found between fish intake and total aortic disease. Compared with persons who ate fish 1–2 times/week, persons who seldom ate fish had higher mortality from total aortic disease (multivariable-adjusted pooled HR = 1.93; 95% CI, 1.13–3.31). Higher mortality was not seen in those who ate fish 1–2 times/month. A similar pattern was observed for aortic dissection. Regarding aortic aneurysm, both persons who seldom ate fish and those who ate fish 1–2 times/month had higher mortality (HR = 1.99; 95% CI, 0.90–4.40 and HR = 1.86; 95% CI, 0.87–3.98, respectively). Conclusions Persons who seldom ate fish had higher mortality from aortic dissection, aneurysm, and total aortic diseases.

BACKGROUND Epidemiologic observations have raised expectations that the Japanese dietary pattern could promote longer disability-free survival (DFS) times among the Japanese population; however, no previous study has examined this issue. OBJECTIVE The aim of this study was to investigate the association between the Japanese dietary pattern and DFS time in the elderly Japanese population. METHODS We analyzed follow-up data covering a 10-y period for 9456 elderly Japanese individuals (aged ≥65 y) participating in a community-based prospective cohort study. Dietary habits were assessed using a food-frequency questionnaire. Based on previous studies, we used 9 food items to calculate the Japanese Diet Index (JDI) score: rice, miso soup, fish and shellfish, green and yellow vegetables, seaweed, pickled vegetables, green tea (1 point for each item if the consumption value was more than or equal to the median, and 0 points otherwise), beef and pork, and coffee (0 points for each item if the consumption value was more than or equal to the median, and 1 point otherwise). Differences in median age at incident disability or death [50th percentile differences (PDs)] according to quartiles (Q1-Q4) of the JDI score were estimated using Laplace regression. RESULTS During the follow-up period, 4233 (44.8%) incident disability or death events occurred. In addition, a higher JDI score was significantly associated with longer DFS time: compared with the lowest quartile of JDI scores (Q1), the multivariate-adjusted 50th PD (95% CI) was 7.1 (1.8, 12.4) mo longer for Q4. Each 1-SD increase of the JDI score was associated with 3.7 (1.7, 5.7) additional months of life without disability (P-trend

Suicide is an important public health issue and previous studies have suggested that social support can one preventive factor. However, the association between emotional and instrumental social support and suicide death has not been investigated in detail. The purpose of this study was to investigate the association between each type of social support and suicide death based on a population-based cohort study. We analyzed follow-up data for 47,223 subjects (aged ≥40 y) participating in a community-based, prospective cohort study. At the baseline, the subjects were asked five questions about social support. The end point of the study was suicide mortality, based on data from the National Vital Statistics. The Cox model was used to estimate the multivariate-adjusted hazard ratios of suicide death. In addition, stratified analysis was conducted to test the interaction of each type of social support with gender (male/female) and age (65/≥65 y) separately. Among 320,880 person-years of follow-up, 90 cases of suicide death were documented. There were significant association between instrumental social support and lower risk of suicide death, and the hazard ratio was 0.60 (95% CI: 0.38-0.94). Emotional social support was also associated with a lower risk of suicide death, but not to a significant degree, and the hazard ratio was 0.70 (95% CI: 0.42-1.17). It is suggested that instrumental social support was significantly associated with a lower risk of suicide death, and emotional social support tended to be associated with a lower risk of suicide death.

Previous studies have suggested that a healthy lifestyle (HL) may prolong the years of life spent in good health. However, the impact of HL on disability-free survival (DFS) among the elderly is still uncertain. To investigate the relationship between HL and DFS in the general elderly population. Prospective cohort study with a 10-year follow-up (2006–2016). 9910 community-dwelling elderly people (≥ 65 years). A HL index derived by summing the number of HL behaviors. Data on incident disability were retrieved from the public Long-term Care Insurance database. Multivariate-adjusted 50th percentile differences (PDs) in age at disability or death (months) and their 95% CIs were estimated with the Laplace regression model. During the 10 years, 4562 disability or death events occurred. Participants who adhered to all three HL behaviors lived 17.1 (95% CI 12.7, 21.5) months longer without disability than those who adhered to zero or one. Each 1-point increase of the index score conferred 8.8 months additional life without disability. The tendency for the 50th PDs to increase with a higher HL index score did not differ according to age (

BACKGROUND The relationship between body mass index (BMI) and disability-free survival (DFS) remains unclear. METHODS We conducted a 10-year prospective cohort study of 12,666 Japanese individuals aged ≥ 65 y. Information on BMI and lifestyle factors was collected via a questionnaire in 2006. Functional disability data were retrieved from the public Long-term Care Insurance database. Subjects were divided into seven groups according to BMI (

Aim A thorough analysis of multiple primary cancers (MPC) could provide important information as to the pathogenesis of human malignancies. Analysis of MPC using clinical databases has been performed, but little has been done using autopsy cases. Therefore, in this study, we first retrospectively analyzed MPC associated with endometrial and ovarian cancers using the Japan Autopsy Annual Database. Methods The Japan Autopsy Annual Database from 2002 to 2010 was established by the Japanese Society of Pathology, Tokyo, Japan. Among the 164 211 autopsy cases registered, 9142 were cases of primary cancers. Results The patients with endometrial cancer-associated MPC did have a lower risk of harboring colorectal cancer (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.45-0.89) but had a higher risk of ovarian cancer (OR, 3.15; 95% CI, 2.11-4.71). Those with ovarian cancer-associated MPC had a lower risk of harboring gallbladder cancer including bile ductal cancer (OR, 0.47; 95% CI, 0.27-0.80) but a higher risk of harboring breast (OR, 1.69; 95% CI, 1.20-2.38) and endometrial cancers (OR, 3.48; 95% CI, 2.33-5.20). Conclusion Both endogenous and exogenous factors are associated with the incidence of MPC. Results of our present study based on Japanese Autopsy Base first demonstrated that female hormones had a strong influence on the incidence of MPC. This study also demonstrated that the analysis of MPC using an autopsy database could have advantages over clinical database analysis.

Background A growing number of epidemiology studies have shown that poor oral health is associated with an increased incidence of functional disability. However, there are few studies in which the confounding bias is adjusted appropriately. In this study, we examined whether dental status is associated with functional disability in elderly Japanese using a 13-year prospective cohort study after elimination of confounding factors with propensity score matching. Methods Participants were community-dwelling Japanese aged 70 years or older who lived in the Tsurugaya district of Sendai (n = 838). The number of remaining teeth (over 20 teeth vs 0-19 teeth) was defined as the exposure variable. The outcome was the incidence of functional disability, defined as the first certification of long-term care insurance (LTCI) in Japan. The variables that were used to determine propensity score matching were age, sex, body mass index (BMI), medical history (stroke, hypertension, myocardial infarction, cancer, and diabetes), smoking, alcohol consumption, educational attainment, depression symptoms, cognitive impairment, physical function, social support, and marital status. Results As a result of the propensity score matching, 574 participants were selected. Participants with 0-19 teeth were more likely to develop functional disability than those with 20 or more teeth (hazard ratio 1.33; 95% confidence interval, 1.01-1.75). Conclusions In this prospective cohort study targeting community-dwelling older adults in Japan, having less than 20 teeth was confirmed to be an independent risk factor for functional disability even after conducting propensity score matching. This study supports previous publications showing that oral health is associated with functional disability.

It has been noted that not only adverse psychosocial health effects but also mortality might increase for a person living with a spouse with cancer. This study examined the association between a partner's cancer diagnosis and mortality among a Japanese population.In December 2006, a survey was conducted on participants aged 40 years or older who were residing in northeastern Japan. We identified couples using municipality-specific household ID numbers by searching public records and confirmed partner's cancer diagnosis after the baseline measurement using regional cancer registration information. After following up for a maximum of 4.0 years with the participants regarding mortality and emigration by reviewing the Residential Registry Record, we used Cox's proportional hazards regression to estimate the hazard ratio (HR) of all-cause mortality.We identified 25,938 participants (12,969 pairs) and included them in the analyses. A total of 1,308 (5.0%) participants had partners with a cancer diagnosis after baseline. The study found no association between a partner's cancer diagnosis and all-cause mortality; multivariable HRs of all-cause mortality for individuals in exposed subjects compared with those in unexposed subjects were 1.35 (95% confidence interval [CI] = 0.99-1.83; p = .055). Contrarily, sensitivity analyses of mortality attributed to having partners diagnosed with cancer based on the time since entry showed that all-cause mortality significantly increased only within one year from spouse cancer diagnosis; HR = 2.18 (95% CI = 1.44-3.30; p .01).Our findings reveal that the mortality rate from partner's cancer diagnosis was significantly high during the early period of diagnosis and multidisciplinary teams for cancer treatment might be important for preventing death among the partner.

Background: Although lower household economic status is known to be a risk factor for obesity among school-age children, such an association among toddlers remains unclear. The present study investigated the association between household economic status and obesity in toddlers. Design: We conducted a cross-sectional study of children aged 4 years attending daycare centers in Japan. Information on subjective household economic status [“affluent”, “neither”, “less affluent”, or “non-affluent”] was collected via questionnaire from the children’s guardians in 2015. Based on measured values of height and weight, obesity was defined using the International Obesity Task Force cut-offs of overweight (BMI ≥17.47 for boys and ≥17.19 for girls). We used the logistic regression model to investigate the association between household economic status and obesity. Results: Among 1,848 respondents, the prevalence of obesity was 6.8%. Non-affluent household economic status was associated with a significantly higher probability of obesity in toddlers; the multivariate adjusted odds ratio for “non-affluent” households was 2.31 (95% confidence interval, 1.23–4.33) compared with “affluent” households. Conclusion: Perception of non-affluent economic status by the guardian was associated with a higher probability of toddler obesity. This result suggests that non-affluent household economic status is associated with obesity in toddlers.

Objectives To our knowledge, the overall nutritional quality of the Japanese diet has not been assessed previously. The aim of this study was to investigate the relationship between adhering to a Japanese diet and nutrient intake. Methods We conducted a cross-sectional study of 1129 Japanese persons ≥70 y of age. Dietary habits were assessed using a food frequency questionnaire. The primary outcome was nutrient intake (12 components of NRF9.3 index). The overall nutrient adequacy (ONA) score was applied for assessing the potential of nutrient density. Correlation analysis was performed to compare the Japanese Diet Index (JDI) and nutrient intake, and multiple regression analysis was used to simulate the modified JDI (MJDI). Results The JDI was positively correlated with all nine beneficial nutrients, and negatively correlated with two nutrients (saturated fat and sugar). The JDI was significantly correlated with the ONA score (Spearman's coefficient = 0.248). The MJDI, which was defined by the coefficients for seven food items, was significantly correlated with the ONA score (Spearman's coefficient = 0.515). However, the JDI and MJDI were correlated with higher sodium intake. Conclusions The present findings suggest that adhering to a Japanese diet defined by the JDI score is associated with better nutrient intake. However, this dietary pattern also appears to be associated with high sodium intake.

Background and objective Although it has been well known that volunteering is associated with a significantly decreased risk of incident disability among older people, it remains unanswered which subgroups of older people the above association is most remarkable. We aimed to identify such subgroups by conducting subgroup analyses for age, sex, chronic medical condition, and socio-demographic factors. Methods Participants were 826 Japanese community-dwelling people aged ≥70 years who lived in Tsurugaya, Sendai. Volunteering status was assessed with a baseline survey conducted in 2003. Incident functional disability was defined as the first certification of Long-term Care Insurance until 2017. The Cox proportional hazard model was used to estimate the multivariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident functional disability. Subgroup analyses were conducted according to sex, age, medical history, marital status, and educational level. Results The association between current volunteering and the risk of incident functional disability was not significant (HR 0.77, 95% CI 0.56–1.06) compared to non-volunteers. In the subgroup analysis, the association between current volunteering and the risk of incident functional disability was significant among participants who were women (HR 0.52, 95% CI 0.30–0.91), those who were aged 75 years or over (HR 0.57, 95% CI 0.36–0.91), and those living without a spouse (HR 0.47, 95% CI 0.24–0.91). Conclusion The association between volunteering and a decreased risk of incident functional disability was remarkable among vulnerable groups such as women, those aged 75 years or over, those living without a spouse.

Study design A longitudinal panel study. Objective The aim of this study was to examine the occurrence of low back pain (LBP), especially the association of previous LBP with further episodes of LBP, in survivors of the Great East Japan Earthquake (GEJE) during the course of 5 years. Summary of background data LBP is common among survivors of natural disasters, but its long-term course is not clear. Methods A 5-year longitudinal study was conducted among survivors of the GEJE (n = 1821). The presence of LBP was assessed using a self-reported questionnaire at 2, 4, and 7 years after the disaster (termed the first, second, and third time points, respectively). Multiple logistic regression analysis was performed to assess a potential association between LBP at the first and second time points with LBP at the third time point, and the odds ratios (ORs) and 95% confidence intervals (CI) were calculated. Results The prevalence of LBP was 25.3%, 27.3%, and 27.2% at the first, second, and third time points, respectively. The occurrence of LBP at the first time point was significantly associated with LBP at the third time point, and the adjusted odds ratio (OR) (95% confidence interval [CI]) was 5.47 (4.28-6.98). Furthermore, LBP at the first and second time points was significantly associated with LBP at the third time point. Compared to no LBP at the first and second time points, the adjusted OR (95% CIs) for LBP at the third time point was 4.12 (3.14-5.41) in the case of LBP at either of the first or second time points and 10.73 (7.80-14.76) for LBP at both time points (P for trend Conclusion Previous LBP was associated with LBP 5 years later among survivors of the GEJE. Furthermore, the effect on subsequent LBP was stronger with a higher frequency of previous LBP episodes. Level of evidence 3.

Marital status has been shown to be associated with mortality, but evidence in Asian populations is limited.To examine the association of marital status with total and cause-specific mortality.This cohort study included individual participant data from 16 prospective studies in the Asia Cohort Consortium conducted between 1963 and 2015. Asian participants with complete information on marital and vital status were included. Study-specific hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards model and then pooled using a random-effects meta-analysis. The analysis began in February 2021 and ended in August 2021.Marital status.All-cause and cause-specific mortality.Of 623 140 participants (326 397 women [52.4%] and 296 743 men [47.6%]; mean [SD] age, 53.7 [10.2] years; mean [SD] follow-up time, 15.5 [6.1] years), 123 264 deaths were ascertained. Compared with married individuals, those who were unmarried had pooled HRs of 1.15 (95% CI, 1.07-1.24) for total mortality, 1.12 (95% CI, 1.03-1.22) for cerebrovascular disease mortality, 1.20 (95% CI, 1.09-1.31) for coronary heart disease mortality, 1.17 (95% CI, 1.07-1.28) for circulatory system diseases mortality, 1.06 (95% CI, 1.01-1.11) for cancer mortality, 1.14 (95% CI, 1.05-1.23) for respiratory diseases mortality, and 1.19 (95% CI, 1.05-1.34) for external causes of death. Positive associations with total mortality were also observed for those who were single (HR, 1.62; 95% CI, 1.41-1.86), separated (HR, 1.35; 95% CI, 1.13-1.61), divorced (HR, 1.38; 95% CI, 1.13-1.69), and widowed (HR, 1.09; 95% CI, 1.04-1.13). In subgroup analyses, the positive association persisted across baseline health conditions, and the risk of death was more pronounced among men or people younger than 65 years.This large pooled cohort study of individual participant data provides strong evidence that being unmarried, as well as belonging to the unmarried subcategories, was positively associated with total and cause-specific mortality. Investment of targeted social support services might need to be considered in light of the mortality differences between married and unmarried individuals.

The Great East Japan Earthquake devasted the old community in coastal areas characterized by primary industry. The number of unemployed people increased from 150,000 to 190,000 after the earthquake. All of the adult residents of Shichigahama (18 years old or older), located in the coastal area of the Miyagi prefecture, whose houses were totally or majorly damaged, were recruited for a survey conducted in October 2011. All of the residents who responded with written informed consent were included in this study. Among 904 individuals who had a job before the Great East Japan Earthquake, 19% became unemployed. Concerning gender and age, 9% of young men, 34% of elderly men, 21% of young women, and 49% of elderly women became unemployed. Concerning the type of industry, 38%, 15%, and 16% of people who had belonged to the primary, secondary, and tertiary industries, respectively, before the disaster became unemployed. Those who became unemployed exhibited a significantly higher risk of insomnia compared to those who maintained jobs. The study pointed out the severe impact of the Great East Japan Earthquake on populations who had belonged to the primary industry, especially among elderly women, and its effect on sleep conditions.

Summary Background & aims Previous studies have reported that the Japanese diet is associated with a lower risk of dementia; however, whether changes in adherence to the Japanese diet affects incident dementia remains unknown. We aimed to evaluate the association between long-term changes in adherence to the Japanese diet and risk of incident dementia among older Japanese individuals. Methods We collected dietary information from community-dwelling older individuals living in Ohsaki city, Japan using a validated 39-item food frequency questionnaire in 1994 and 2006. Adherence to the Japanese diet was assessed using the 8-item Japanese Diet Index (JDI8) score (range: 0 to 8 points). Changes in adherence to the Japanese diet were defined as changes in the JDI8 score from 1994 to 2006. Next, the participants were classified into five groups: great decrease, moderate decrease, no changes [ref.], moderate increase, or great increase. Then, 3146 Japanese adults aged ≥65 years in 2006 were followed-up for 5.7 years. Incident dementia was retrieved from the long-term care insurance database. The Cox proportional hazards model was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident dementia. Results During 14,336 person-years of follow up, 231 cases of dementia were ascertained. Compared with no changes in the JDI8 score, the multivariable-adjusted HRs (95%CIs) were 1.72 (1.13, 2.62) for great decrease, 1.10 (0.73, 1.66) for moderate decrease, 0.82 (0.54, 1.25) for moderate increase, and 0.62 (0.38, 1.02) for great increase (p-trend Conclusions An increase in adherence to the Japanese diet was associated with a reduced risk of incident dementia, whereas a decrease in adherence was associated with an elevated risk among older Japanese individuals.

In 2011, Minamisanriku Town lost all of its medical facilities during the Great East Japan Earthquake. Using 10,459 anonymized disaster medical records of affected people in Minamisanriku Town, we assessed the prevalence and risk factors of sleep disturbance, which is known to exacerbate non-communicable diseases (NCDs) and anxiety disorder. Because sleep disturbance is a part of mental health issues, we divided the patients into two groups: patients (n = 492) with mental health issues other than sleep disturbance and the remaining (n = 9,967) with other comorbidities. Out of 492 patients with mental health issues, 295 patients (60.0%, 114 male, 158 female and 23 unknown) had sleep disturbance who might have required specific treatments. Out of the remaining 9,967 patients, 1,203 patients (12.1%, 361 male and 769 female and 73 unknown) had sleep disturbance. Univariate and multivariate analyses of the 9,967 patients revealed that the odds ratio (OR) of sleep disturbance was higher for female (OR 1.95), elderly persons over 60 (OR 16.15) and residing in evacuation centers (OR 1.36). Patients with two or more NCD had higher risk (OR 1.42). Importantly, sleep disturbance affects younger patients without NCD residing in evacuation center. Emergency medical teams most frequently prescribed benzodiazepines both for sleep induction and anxiolysis. In addition to high risk groups (female, older, with other mental health issues, residing in evacuation center), it is important to survey sleep disturbance in younger and healthier populations especially in evacuation centers and to provide psychosocial and medical support for them.

To provide updated clinico-epidemiological information on chronic pancreatitis (CP) in Japan.We conducted a two-stage nationwide epidemiological survey; the number of CP patients was estimated in the first-stage survey, and their clinical features were examined in the second-stage survey. We surveyed patients with CP who had visited hospitals in 2016 and were diagnosed according to the Japanese diagnostic criteria 2009 (DC2009). Furthermore, we validated the new Japanese diagnostic criteria (DC2019) in patients with early CP diagnosed according to DC2009.The number of patients with definite/probable CP in 2016 was 56,520 (prevalence, 44.5 per 100,000 persons), and that of early CP was 4470 (prevalence, 3.5 per 100,000 persons). We obtained detailed clinical information of 2150 patients with definite/probable CP and 249 patients with early CP. Compared with the early CP cases, the definite/probable CP cases had higher proportions of male (4.8 vs. 1.3), alcohol-related etiology (72.0% vs. 45.8%), smoking history (69.6% vs. 41.0%), diabetes mellitus (42.3% vs. 19.3%), and past history of acute pancreatitis (AP) (50.4% vs. 22.1%). Among the patients with early CP diagnosed according to DC2009, 93 (37.3%) were diagnosed with early CP according to DC2019, but the diagnosis of the remaining 156 (62.7%) patients was downgraded. Alcohol-related etiology, smoking history, early disease onset, and past history of AP were associated with the maintenance of early CP diagnosis in DC2019.We clarified the current status of CP in Japan. Further validation studies are warranted to clarify the diagnostic utility of DC2019.

It is already known that adult height is a factor associated with an increased risk of colon cancer and postmenopausal breast cancer, pancreatic cancer, premenopausal breast cancer, and ovarian cancer. However, the association between adult height and lung cancer incidence remains unclear. The purpose of the present study was to examine the association between adult height and the risk of lung cancer incidence in the Japanese population. We analyzed data for 43,743 men and women who were 40-64 years old at the baseline in 1990. We divided the participants into quintiles based on height at the baseline. Cox proportional hazards analysis was used to estimate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of lung cancer according to adult height, after adjustment for potential confounders. We identified 1,101 incident case of lung cancer during 24.5 years of follow-up. The multivariate HRs and 95% CIs for the highest category relative to the lowest were 1.48 (1.15-1.91) in men and 1.35 (0.91-1.99) in women. Furthermore, the association between adult height and the incidence of lung cancer was found the significant increased risk among ever smokers in men, but not never smokers. We also observed that adult height tend to be associated with an increased risk of small cell lung cancer and squamous cell carcinoma. This prospective cohort study has demonstrated a positive association between adult height and the risk of lung cancer incidence among men, especially those who have ever smoked.

Musculoskeletal pain is a major problem among survivors of natural disasters. Functional disabilities in older adults increase after disasters and can lead to musculoskeletal pain. However, the effects of poor physical function on musculoskeletal pain after natural disasters remain unclear. This study aimed to elucidate the association of poor physical function with new-onset musculoskeletal pain among older survivors after the Great East Japan Earthquake (GEJE). Survivors aged ≥ 65 years, 3 years after the GEJE, were assessed longitudinally for 1 year (n = 646). Musculoskeletal pain was assessed using a self-reported questionnaire, and new-onset musculoskeletal pain was defined as absence and presence of pain at 3 years and 4 years, respectively, after the disaster. Physical function at 3 years after the disaster was assessed using the Kihon Checklist physical function score, which consists of 5 yes/no questions, and poor physical function was defined as a score of ≥ 3/5. Multivariate logistic regression analyses were used to assess the association of poor physical function with new-onset musculoskeletal pain. The incidence of new-onset musculoskeletal pain was 22.4%. Participants with poor physical function had a significantly higher rate of new-onset musculoskeletal pain. Compared with high physical function, the adjusted odds ratio (95% confidence interval) for new-onset musculoskeletal pain was 2.25 (1.37-3.69) in poor physical function (P = 0.001). Preceding poor physical function was associated with new-onset musculoskeletal pain among older survivors after the GEJE. There is need to focus on the maintenance of physical function to prevent musculoskeletal pain after natural disasters.

Background Low back pain (LBP) is a common health problem experienced after natural disasters. LBP is often concurrent with other musculoskeletal pain; however, the effects of preexisting musculoskeletal pain on the development of LBP are not clear. The purpose of this study was to elucidate the association of musculoskeletal pain in other body sites with new-onset LBP among survivors of the Great East Japan Earthquake (GEJE). Methods A longitudinal study was conducted with survivors of the GEJE. The survivors who did not have LBP at the 3 year time period after the GEJE were followed up 1 year later (n = 1782). Musculoskeletal pain, such as low back, hand and/or foot, knee, shoulder, and neck pain, were assessed with self-reported questionnaires. The outcome of interest was new-onset LBP, which was defined as LBP absent at 3 years but present at 4 years after the disaster. The main predictor was musculoskeletal pain in other body sites 3 years after the GEJE, which was categorized according to the number of pain sites (0, 1, ≥ 2). Multiple regression analyses were performed to calculate the odds ratio (OR) and 95% confidence interval (CI) for new-onset LBP due to musculoskeletal pain in other body sites. Results The incidence of new-onset LBP was 14.1% (251/1782). Musculoskeletal pain in other body sites was significantly associated with new-onset LBP. Including people without other musculoskeletal pain as a reference, the adjusted OR and 95% CI for new-onset LBP were 1.73 (1.16–2.57) for people with one musculoskeletal pain site and 3.20 (2.01–5.09) for people with ≥ 2 sites (p Conclusions Preexisting musculoskeletal pain in other body sites was associated with new-onset LBP among survivors in the recovery period after the GEJE.

Smoking has been consistently associated with the risk of colorectal cancer (CRC) in Western populations; however, evidence is limited and inconsistent in Asian people. To assess the association of smoking status, smoking intensity and smoking cessation with colorectal risk in the Japanese population, we performed a pooled analysis of 10 population-based cohort studies. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox's proportional hazards model and then pooled using a random-effects model. Among 363 409 participants followed up for 2 666 004 person-years, 9232 incident CRCs were identified. In men, compared with never smokers, ever smokers showed higher risk of CRC. The HRs (95% CI) were 1.19 (1.10-1.29) for CRC, 1.19 (1.09-1.30) for colon cancer, 1.28 (1.13-1.46) for distal colon cancer and 1.21 (1.07-1.36) for rectal cancer. Smoking was associated with risk of CRC in a dose-response manner. In women, compared with never smokers, ever smokers showed increased risk of distal colon cancer (1.47 [1.19-1.82]). There was no evidence of a significant gender difference in the association of smoking and CRC risk. Our results confirm that smoking is associated with an increased risk of CRC, both overall and subsites, in Japanese men and distal colon cancer in Japanese women.