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Introduction Despite having very high life expectancy, Japan has relatively poor self-rated health, compared to other high-income countries. We studied trends and socioeconomic inequalities in self-rated health in Japan using nationally representative data. Methods The Comprehensive Survey of Living Conditions was analyzed, every 3 years (n ≈ 0.6–0.8 million/year) from 1986 to 2016. Whereas previous studies dichotomized self-rated health as an outcome, we used four categories: very good, good, fair, and bad/very bad. Proportional odds ordinal logistic regression models are used, with ordinal scale self-rated health as an outcome, and age category, survey year and occupational class or educational level as independent variables. Results In 2016, the age-adjusted percentages for self-rated health categorized as very good, good, fair, and bad/very bad, were 24.0, 17.1, 48.7, and 10.2% among working-age men, and 21.6, 17.5, 49.4, and 11.5% among working-age women, respectively. With 1986 as the reference year, the odds ratios (ORs) of less good self-rated health were lowest in 1995 (0.69; 95% Confidence Interval [95% CI]: 0.66–0.71 of working-age men), and highest in 2010 (1.23 [95% CI: 1.19–1.27]). The ORs of male, lower non-manual workers (compared to upper non-manual) increased from 1.12 (95% CI: 1.07–1.17) in 2010 to 1.20 (95% CI: 1.15–1.26) in 2016. Between 2010 and 2016, the ORs of working-age men with middle and low levels of education (compared to a high level of education) increased from 1.22 (95% CI: 1.18–1.27) to 1.34 (95% CI: 1.29–1.38), and from 1.47 (95% CI: 1.39–1.56) to 1.75 (95% CI: 1.63–1.88), respectively. The ORs of working-age women with middle and low levels of education also increased from 1.22 (95% CI: 1.17–1.28) to 1.32 (95% CI: 1.26–1.37), and from 1.74 (95% CI: 1.61–1.88) to 2.03 (95% CI: 1.87–2.21) during the same period. Conclusion Japan has the unique feature that approximately 50% of the survey respondents rated their self-rated health as fair, but with important variations over time and between socioeconomic groups. In-depth studies of the role of socioeconomic conditions may shed light on the reasons for the high prevalence of poor self-rated health in Japan.

Background Fertility treatments help many infertile couples to have children. However, disparities exist in access to fertility tests and treatments. We investigated the association between household income and medical help-seeking for fertility in Japan. Methods We conducted a cross-sectional study using nationally representative data from the National Fertility Survey 2015. Respondents were 6598 married women younger than 50 years old. The primary outcome was medical help-seeking for fertility among those who experienced fertility problems. Multiple logistic regression models were used to assess the association between household income and medical help-seeking, adjusting for age, length of marriage, educational level, employment status, number of children, childbearing desires, living with parents, and region of residence. Results Among 2253 (34%) women who experienced fertility problems, 1154 (51%) sought medical help. The proportion of help-seekers increased linearly from 43% in the low-income group (, Plain Language Summary Fertility treatments have helped millions of people to have a child. Although financial factors are known to play an important role in the decision to use fertility treatments, no previous studies have investigated how socioeconomic factors affect medical help-seeking for fertility in Japan. Therefore, we assessed the association between household income and medical help-seeking among couples with fertility problems in Japan, using nationally representative data from the National Fertility Survey 2015. Of the 6598 respondents (married women under 50 years old), one-third (2253) reported worrying about fertility problems, and half of those women (1154) sought medical help for fertility-related issues. The proportion of help-seekers was highest (59%) among those with high household income and lowest (43%) among those with low household income with a significant linear trend. Even after accounting for age, length of marriage, educational level, employment status, and other possibly related factors, those with higher household income were more likely to seek medical help for fertility tests and treatments. Japan provides various sources of financial support for fertility-related care, such as health insurance coverage for tests and early-stage treatments and partial subsidies for assisted reproductive technology treatments. However, the results indicate that further policy discussion about additional financial support and further studies focusing on barriers to care in Japan could help improve the situations for those with fertility problems. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01212-w.

AIM Due to the lack of national perinatal registries, population-wide descriptive statistics on cesarean deliveries in Japan are unknown. We aim to describe cesarean deliveries for overall and multiple pregnancies using the Japan National Database of health insurance claims. METHODS We calculated the national and prefectural cesarean delivery rates for overall and multiple pregnancies in 2014. We described maternal morbidities (e.g., blood transfusion) and the place and type of the institutions providing prenatal and perinatal care. RESULTS The national cesarean delivery rates were 18.6% overall and 82.7% for women with multiple pregnancies. Prefectural cesarean delivery rates for overall and multiple pregnancies varied from 12.5% to 24.2% and from 49.2% to 100%, respectively, showing a moderate positive correlation (r = 0.59, p

Poor medication adherence of osteoporosis patients is a major global medical problem because of its negative impact on health outcomes and quality of life. The aim of this study was to evaluate how differences in dosing regimens influence adherence to oral bisphosphonates using data from a large health insurance provider in Japan. This was a retrospective observational study using claims data obtained between October 2012 and January 2018, from the community-based National Health Insurance program of a large city in Japan. The data included in the analysis were obtained from women 60 to 74 years old whose oral bisphosphonate prescription was detected between April 2013 and February 2017. Treatment adherence was monitored from the initial prescription for one year, i.e., up to January 2018. Primary comparisons among the daily-dosing, weekly-dosing, and monthly-dosing groups were based on the mean medication possession ratio (MPR). Data from a total of 3,958 patients were analyzed. The numbers of patients aged 60-64, 65-69, and 70-74 were 425, 1,400, and 2,133, respectively. The highest mean MPR was 69.4% for the monthly-dosing of bisphosphonates, followed by the weekly-dosing at 63.5%, and daily-dosing at 57.2%. Using the Kruskal-Wallis test with Dunn-Bonferroni correction, there were significant differences in mean MPR for daily versus weekly (p < 0.01), daily versus monthly (p < 0.001), and weekly versus monthly dosing regimens (p < 0.05). These results suggest significantly more patients adhere to a monthly or weekly regimen of bisphosphonates in the treatment of osteoporosis than to a daily regimen.

There have been few prospective studies on the relationship between oral health conditions and the development of metabolic syndrome (MetS). This prospective cohort study was performed at a Japanese company over one year. Routine medical health examinations, oral health examinations, and a questionnaire pertaining to education, job type, and health behaviors was administered. Participants aged ≥35 years who had no MetS components at baseline were re-examined after one year. Modified Poisson regression analyses were performed to calculate the relative risks (RRs) associated with oral health variables, including periodontitis, decayed and missing teeth, and decayed, missing, and filled teeth (DMFT) in relation to the development of MetS. Of 152 eligible participants, 136 were re-examined after one year; 30 exhibited one or more newly developed MetS components upon re-examination. Decayed teeth at baseline were significantly associated with development of at least one MetS component (adjusted RR 3.25, 95% confidence interval 1.59-6.63). There were no associations between periodontitis, missing teeth, or DMFT and the development of MetS. The association between decayed teeth and MetS was independent of other risk factors, including age and body mass index; therefore, decayed teeth may be associated with the development of MetS.

Background Little is known about occupational disparities in bladder cancer survival. Methods Using data from a population‐based cancer registry (1970‐2016), we identified 3593 patients with incident bladder cancer diagnosed during 1970‐2011 who completed occupational information. The patients were followed for 5 years (median follow‐up time 5.0 years). Their longest‐held occupations at incident bladder cancer diagnosis were classified according to a national standardized classification. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall death were estimated by Cox proportional hazard model, adjusted for age, sex, and year of diagnosis. Clerical workers served as the reference group. Results Overall prognosis was fair in this population (5‐year overall survival, 61.9%). Compared with patients in clerical jobs, survival was poorer for those in professional and managerial jobs (mortality HR 1.36; 95% CI 1.09‐1.69), sales and service jobs (HR 1.25, 95% CI 1.01‐1.56), construction jobs (HR 1.83, 95% CI 1.40‐2.38), and manufacturing jobs (HR 1.32, 95% CI 1.05‐1.66), as well as those not actively employed (HR 1.27, 95% CI 1.02‐1.58). A similar pattern was observed in the subgroup analyses restricted to male patients as well as additional analyses adjusted for potential prognostic variables (eg, stage) with multiple imputation. Conclusion We documented occupational disparities in bladder cancer survival in Japan. However, the pattern of disparity did not favor highest occupational groups., We documented occupational disparities in bladder cancer survival in Japan. However, the pattern of disparity did not favor highest occupational groups.

Aims and Objectives Dipeptidyl peptidase‐4 inhibitor (DPP4i) is widely used for the treatment of type 2 diabetes (T2DM) in several countries such as Japan, whereas biguanide (BG; mostly metformin) is recommended as a first‐line antidiabetic medication in many countries according to evidence mainly from Western countries. Although previous studies reported that DPP4i may be more efficacious for East Asians, direct comparisons of effectiveness and cost between DPP4i and BG have never been conducted in East Asia. Methods We extracted claims and medical check‐up data (observation period from January 2010 to March 2016) of adult patients under 70 years old with T2DM who received DPP4i or BG as first‐line antidiabetic drugs. Changes in HbA1c and BMI before and 2 years after the first prescription and annual cost of antidiabetic medication during the second year were compared between the DPP4i and BG groups. Results We extracted 1034 patients who received DPP4i and 365 patients who received BG as the first antidiabetic medication (male sex, 83.0% and 84.9%; HbA1c (mean [SD]), 7.7 [1.4]% and 7.9 [1.4]%; BMI, 26.6 [4.5] kg/m2 and 28.1 [4.3] kg/m2). After propensity score matching, changes in HbA1c and BMI were not significantly different between the groups (HbA1c, −0.67% vs −0.80% [P = .28]; BMI, −0.3 kg/m2 vs −0.4 kg/m2 [P = .42]). Annual cost of antidiabetic drugs was significantly higher in the DPP4i group (US $458.7 vs 273.3 [P

AIMS/INTRODUCTION To identify factors associated with worsening glycemic control after discontinuing diabetes care among patients with type 2 diabetes. MATERIALS AND METHODS This retrospective cohort study combined medical claims and health checkup data between January 2005 and April 2018. Adult Japanese workers with type 2 diabetes who had dropped out from diabetes care for ≥4 months after receiving ≥18 months of non-intermittent care and had health checkup information both before and after the dropout were included. Factors associated with changes in HbA1c during the dropout period were identified using multiple linear regression analyses and depicting restricted cubic spline (RCS) curves. RESULTS A total of 1,125 patients (mean age: 51.2 years, baseline HbA1c: 6.8%, and number of males: 93.7%) whose follow-up HbA1c increased to 7.6% after a mean 9.3-month dropout period were included. Deterioration in HbA1c was associated with higher baseline HbA1c and sulfonylurea or insulin use. The RCS curves illustrated that patients without antidiabetic medication had small changes in HbA1c (+0.5% from a baseline HbA1c of 7.0%), whereas those using sulfonylureas or insulin had an approximately 2% or more increase in HbA1c even when maintaining reasonable glycemic control before dropping out. CONCLUSIONS Overall in this study, glycemic control worsened during treatment interruptions among patients who were mainly male employees. However, changes in HbA1c greatly varied based on baseline HbA1c and antidiabetic medication type. Caring for patients at risk of worsening glycemic control due to treatment dropout, especially those using sulfonylurea and insulin, is imperative.

Background: Japan is one of the world’s largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times. Methods: We analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every 3 years (n ≈ 700,000 per year) in Japan, during 2001–2016. Age-standardized smoking prevalence was computed based on occupational class and educational level. We calculated smoking prevalence difference (PD) and ratio (PR) of (a) manual workers versus upper non-manual workers and (b) low versus high educational level. The slope index of inequality (SII) and relative index inequality (RII) by educational level were used as inequality measures. Results: Overall smoking prevalence (25–64 years) decreased from 56.0% to 38.4% among men and from 17.0% to 13.0% among women during 2001–2016. The PD between manual and upper non-manual workers (25–64 years) increased from 11.9% (95% confidence interval [CI], 11.0–12.9%) to 14.6% (95% CI, 13.5–15.6%) during 2001–2016. In 2016, smoking prevalence (25–64 years) for low, middle, and highly educated individuals were 57.8%, 43.9%, and 27.8% for men, and 34.7%, 15.9%, and 5.6% for women, respectively. SII and RII by educational level increased among both sexes. Larger socioeconomic differences in smoking prevalence were observed in younger generations, which suggests that socioeconomic inequalities in smoking evolve in a cohort pattern. Conclusions: Socioeconomic inequalities in smoking widened between 2001 and 2016 in Japan, which indicates that health inequalities will continue to exist in near future.

Background and Aim Screening for tuberculosis before treating with biologic agents is recommended in patients with immune‐mediated inflammatory diseases (IMIDs). We conducted this study to identify adherence to the recommended practice in a real‐world setting in Japan. Methods We used a community‐based insurance claims database in a city in the Greater Tokyo Area in Japan. Between July 2012 and January 2019, we enrolled patients with IMIDs in the age range 15 to 74 years who had initiated biologic therapy. Tuberculosis screening was defined as (a) interferon‐γ release assay and/or a tuberculin skin test (IGRA/TST) and (b) IGRA/TST and X‐ray and/or CT scan (X‐ray/CT) within 2 months before starting biologic agents. We analyzed the proportions of patients who underwent tuberculosis screening and their association with the patient‐ and treatment‐related factors and treatment for latent tuberculosis infection (LTBI). Results Of 421 patients presumed to have initiated biologic therapy, 202 (48%) underwent IGRA/TST and 169 (40%) underwent IGRA/TST and X‐ray/CT. Patients aged 65 to 74 years were more likely to undergo tuberculosis screening than those aged 45 to 64 years. Compared to infliximab, IGRA/TST was less frequently performed in patients treated with etanercept, adalimumab, golimumab, abatacept, and tocilizumab. Treatment for LTBI was provided to 67 (16%) patients. Proportions of patients receiving LTBI treatment did not significantly differ according to the screening status. Conclusion There was low adherence to the recommendations for tuberculosis screening and prophylactic treatment before biologic therapy. It is necessary to continue alerting clinical practitioners to the importance of screening for tuberculosis and treatment for LTBI.

BACKGROUND The incidence of cerebral palsy (CP) is influenced by perinatal medicine and regional medical systems. We investigated the recent incidence of CP and the current problems of children with CP in living at home under an advanced perinatal medical system in Tochigi Prefecture, Japan. METHODS A clinical datasheet survey was performed among 13 hospitals and six rehabilitation facilities treating children with CP born in Tochigi Prefecture to estimate the incidence of CP among children born between 2009 and 2013. The severity of motor and intellectual impairment, presumed causal factors, complications, and provided medical interventions were investigated and compared between preterm and term-born children with CP. RESULTS The incidence of CP was 1.6 per 1000 live births. Shorter gestation period and lower birthweight were associated with a higher incidence of CP. Fifty-one percent of children with CP were non-ambulatory and 55% had severe to profound intellectual impairment. Episodes of neonatal asphyxia and periventricular leukomalacia were the most frequent causal factors; both were significantly more frequent in preterm than in term-born children. Approximately 30% of children with CP had respiratory disorders, dysphagia, or epilepsy; 62% received medical interventions, including medication, mechanical ventilation, oxygen therapy, tube feeding, and intraoral/intranasal suction. CONCLUSION We found the incidence of CP to be lower in comparison to previous Japanese studies. However, the motor and intellectual impairments were severe, and many children with CP and their families were burdened by daily medical care. Public support systems should be developed, as well as the perinatal medical system.

As the medical demand is projected to increase along with the population aging in Japan, the geographical distribution of physicians is a significant concern for society and policymakers. To implement effective measures on geographical physician distribution, this study aimed to describe and compare the distribution of physicians by specialty in 2000, 2010 and 2016 in Japan, and examine whether practice setting was associated with distribution. To quantify the geographical physician distribution by specialty, we calculated the Gini coefficients of physicians working at clinics or hospitals in 2000, 2010, and 2016. We used the basic geographic unit for medical care planning in Japan, a secondary medical area, as the study unit. To show the association between the geographical distribution of physicians in each specialty and their practice setting, we categorized specialties into two groups by the proportion of physicians in that specialty working in hospitals, and showed aggregated Lorenz curves for each category. The overall geographical distribution of physicians appeared to improve during the study period, but varied by specialty. Those in specialties, where at least 90% of physicians work in hospitals such as anesthesiologists and radiologists, were more clustered, as shown by the Lorenz curves and the Gini coefficients. Similar distributional differences were also found even when we excluded physicians working in clinics, meaning that the distributional variation could be explained by other factors than the distribution of hospitals. These results suggest that the nature of practice in each specialty strongly affects the geographical distribution of specialists.

BackgroundWe compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar.MethodsNational register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, Lithuania) covering the period between 1990 and 2015 were collected and harmonised. We calculated age-standardised all-cause and cause-specific mortality among men aged 35–64 by occupational class and measured the magnitude of inequality with rate differences, rate ratios and the average inter-group difference.ResultsClear gradients in mortality were found in all European countries throughout the study period: manual workers had 1.6–2.5 times higher mortality than upper non-manual workers. However, in the most recent time-period, upper non-manual workers had higher mortality than manual workers in Japan and South Korea. This pattern emerged as a result of a rise in mortality among the upper non-manual group in Japan during the late 1990s, and in South Korea during the late 2000s, due to rising mortality from cancer and external causes (including suicide), in addition to strong mortality declines among lower non-manual and manual workers.ConclusionPatterns of mortality by occupational class are remarkably different between European countries and Japan and South Korea. The recently observed patterns in the latter two countries may be related to a larger impact on the higher occupational classes of the economic crisis of the late 1990s and the late 2000s, respectively, and show that a high socioeconomic position does not guarantee better health.

Aim High cesarean section (CS) rates in middle and high-income countries are partly attributable to provider factors, such as staffing patterns and fear of litigation. However, the relationship between CS rates and healthcare resources in the community is poorly understood. Official data on CS rates has been particularly limited in Japan. In this study, we examined nationwide CS statistics and evaluated the association with local resources for perinatal care. Methods We used accumulated data for CS registered in the Japan National Database of health insurance claims in 2013 and calculated crude and age-standardized CS rates at national and prefectural levels. We analyzed the ecological associations with supply of obstetricians and institution and scale of obstetric facilities using multiple regression models. Results There were 190 361 cesarean deliveries in 2013, giving an overall CS rate of 18.5% (elective CS rates 11.0%), which varied by prefecture from 14.0% to 25.6%. In multiple regression analyses, the areal number of obstetricians (standardized regression coefficient [β] = −0.58), the proportion of births at small-scale institutions (β = 0.36) and the number of beds at neonatal intensive care units per birth (β = −0.20) were significantly associated with the age-standardized elective CS rate after adjusting for socioeconomic factors (R2 for the model = 0.40). Conclusions Higher elective CS rates might be associated with limited or unconsolidated medical resources. Policymakers should be aware of regional differences and the possible effects of perinatal care resources on CS rates.

Background Upper-tract urothelial cancer (UTUC), which includes renal pelvic cancer and ureter cancer, is a rare cancer and its prognosis is poor. Smoking and high-risk occupations (e.g., printing and dyestuff working which involves exposure to aniline dyes) are well-known risk factors for UTUC. However, the risk of alcohol consumption in UTUC remains unclear. This study aimed to determine whether alcohol consumption is an independent risk factor for UTUC. Methods The study was a case–control study which used the nationwide clinical inpatient database of the Rosai Hospital group in Japan. We identified 1569 cases and 506,797 controls between 1984 and 2014. We estimated the odds ratio (OR) and 95% confidence interval (95%CI) of alcohol consumption for UTUC – never, up to 15g/day, >15–30g/day, or >30g/day – using unconditional logistic regression. We adjusted for the following covariates: age, sex, study period, hospital, history of smoking, and high-risk occupation. Results The risk of UTUC was significantly higher in ever-drinkers compared with never-drinkers (OR=1.23, 95%CI, 1.08–1.40; P =0.001). Compared with never-drinkers, the risk threshold for UTUC was >15g of alcohol consumption per day (equivalent to 6 ounces of Japanese sake containing 23g of alcohol). A dose-response was observed ( P Conclusion Alcohol consumption may be an independent risk factor for UTUC, with a low-risk threshold of 15g of alcohol per day.

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; ••: ••–••.

Background Higher income population tend to prefer brand-name to generic drugs, which may cause disparity in access to brand-name drugs among income groups. A potential policy that can resolve such disparity is imposing a greater co-payment rate on high-income enrollees. However, the effects of such policy are unknown. We examined how patients’ choice between brand-name and generic drugs are affected by the unique income-based co-payment rates in Japan; 10% for general enrollees and 30% for those with high income among the elderly aged 75 and over. Methods We drew on cross-sectional price variation among commonly prescribed 311 drugs using health insurance claims data from a large prefecture in Japan between October 2013 and September 2014 to identify between-income-group differences in responses to differentiated payments. Results Running 311 multivariate logistic regression models controlling individual demographics, the median estimate indicated that high-income group was 3% (odds ratio = 0.97) less likely to choose a generic drug than the general-income group and the interquartile estimates ranged 0.92–1.02. The multivariate feasible generalized least squares model indicated high-income group’s higher likelihood to choose brand-name drugs than the general-income group without co-payment rate differentiation (p p = 0.027) with an US$1 increase in the difference in additional payment/month for brand-name drugs between income groups — no gap with US$10 additional payment/month. This attenuation was observed in drugs for chronic diseases only, not for acute diseases. Conclusions Income-based co-payment rates appeared to reduce disparity in access to brand-name drugs across income groups, in addition to reducing total medical expenditure among high-income group who shifted from brand-name drugs to generic ones due to larger drug price differences.

ObjectivesTo assess the association between receiving the certified care workers’ home care service, which is provided by non-medical professionals prior to a patients’ death and the probability of a home death.DesignObservational research using the full-time translated number of certified care workers providing home care service per member of the population aged 65 or above, during the year prior to patient’s death per municipality as an instrumental variable.SettingThe certified care workers’ home care service covered by the public long-term care insurance (LTCI) system in Japan.ParticipantsIn total, 1 613 391 LTCI beneficiaries aged 65 or above who passed away, except by an external cause of death, between January 2010 and December 2013 were included in the analysis.Primary outcome measuresDeath at home or death at other places, including hospitals, nursing homes and clinics with beds.ResultsOut of all participants, 173 498 (10.8%) died at home. The number of patients who used the certified care workers’ home care service more than once per each month during 1, 2 or 3 months prior to the month of death numbered 213 848, 176 686 and 155 716, respectively. This was associated with an increased probability of death at home by 9.1% points (95% CI 2.9 to 15.3), 10.5% points (3.3 to 17.6) and 11.4% points (3.6 to 19.2), respectively.ConclusionsThe use of the certified care workers’ home care service prior to death was associated with the increased probability of a home death.

Background and aims In Western countries, sex differences in renal cell carcinoma (RCC) histology and survival have been previously described: compared with men, clear cell subtype is more common but overall prognosis is better among women. The goal of the present study was to examine sex differences in RCC histology and survival in Japan, using a large‐scale population‐based data set. Methods With the use of a population‐based cancer registry in Japan (2004‐2016), patients with primary RCC were followed for 5 years (median follow‐up time 2.1 years). We distinguished histological subtypes of clear cell, papillary, and chromophobe from “others” subtype. Sex‐specific prevalence ratio (PR) for each histological subtype was estimated by Poisson regression with robust variance, adjusted for age and year of diagnosis. Sex‐specific survival rates were estimated by Cox proportional hazard regression, adjusted for age, year of diagnosis, histological subtypes, and other prognostic variables, with multiple imputation. Results The prevalence of clear cell and “others” subtypes was similar between men and women among all the 5265 study subjects during the 12 years of study (clear cell, male 88.6% vs female 87.1%; “others“, male 5.3% vs female 5.3%). However, papillary subtype was less common among women than men (male 4.6% vs female 2.8%; PR = 0.63; 95% CI, 0.45‐0.88), while chromophobe subtype was more common among women (male 1.6% vs female 4.8%; PR = 3.18; 95% CI, 2.26‐4.47). Although “others” subtype (but not papillary/chromophobe subtypes) independently predicted prognosis (HR = 1.74; 95% CI, 1.32‐2.30), no sex differences were observed in RCC survival. Conclusion We did not observe a statistically significant difference in the prevalence of clear cell subtype between men and women in Japan, which differs from the pattern previously described in Western countries. Sex differences in RCC histology may not affect RCC survival in this population.

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.

Study design Population-based retrospective descriptive study. Objective To describe the number and therapeutic profile of patients with spinal stenosis at a large-scale community level using health insurance claims data. Summary of background data A few reports have documented the prevalence of spinal stenosis, and no report has described the therapeutic profile for spinal stenosis in a population base. Methods We studied the claims data of National Health Insurance and Late-stage Elderly Health Insurance in a prefecture in Japan from April 2010 to March 2011. We considered patients to have spinal stenosis if their claims included at least one diagnosis coded as spinal stenosis for at least 1 month during the study period. Disease criteria were based on the International Classification of Diseases, 10th version. We then described the number and the therapeutic profile of the patients with spinal stenosis by age and sex. Results Of 699,723 beneficiaries, 52,889 patients with spinal stenosis were identified. The number of patients with spinal stenosis per 1000 beneficiaries was 76, and those for the subgroups of age ≥ 65 years, ≥ 75 years, and ≥ 85 years were 128, 155, and 152, respectively. The number of patients per 1000 beneficiaries showed unimodal distribution, and the peak for males was 191 between the ages 95 to 99 years and that for females was 160 between the ages 80 to 84 years. Analgesics, prostaglandin E1, or both were prescribed to 40%, 2%, or 20% of patients with spinal stenosis, respectively. Physical therapy, nerve blocks, and surgery were done for 19%, 8%, and 0.4% of the patients, respectively. Approximately, 33% of patients did not receive any treatment. Conclusion There were a large number of patients with spinal stenosis in elderly people. Most of them received nonsurgical treatments. Health insurance claims data could be a useful source of surveillance for such common diseases as spinal stenosis. Level of evidence 4.

We evaluated the nationwide trends in paediatric hospitalisations including non-emergency hospitalisations during the COVID-19 pandemic in Japan. Using inpatient data from 272 acute-care hospitals covering 12.4% of total hospitalisations of all ages, we analysed the number of hospitalisations of children (aged 1–17 years) for weeks 9–21 of 2020 (during the outbreak) versus 2017–2019. Hospitalisation decreased during the outbreak by 38.4% (adjusted incidence rate ratio, 0.60; 95% CI, 0.53 to 0.69). There were reductions in communicable diseases and trauma, possibly through non-pharmaceutical interventions, but not in appendicitis. This study highlights the potential importance of reallocating paediatric care resources during the pandemic.

Background In contemporary Western settings, higher occupational class is associated with lower risk for cardiovascular disease ( CVD ) incidence, including coronary heart disease ( CHD ) and stroke. However, in non‐Western settings (including Japan), the occupational class gradient for cardiovascular disease risk has not been characterized. Methods and Results Using a nationwide, multicenter hospital inpatient data set (1984–2016) in Japan, we conducted a matched hospital case‐control study with ≈1.1 million study subjects. Based on a standard national classification, we coded patients according to their longest‐held occupational class (blue‐collar, service, professional, manager) within each industrial sector (blue‐collar, service, white‐collar). Using blue‐collar workers in blue‐collar industries as the referent group, odds ratios and 95% CI s were estimated by conditional logistic regression with multiple imputation, matched for sex, age, admission date, and admitting hospital. Smoking and drinking were additionally controlled. Higher occupational class (professionals and managers) was associated with excess risk for CHD . Even after controlling for smoking and drinking, the excess odds across all industries remained significantly associated with CHD , being most pronounced among managers employed in service industries (odds ratio, 1.19; 95% CI , 1.08–1.31). On the other hand, the excess CHD risk in higher occupational class was offset by their lower risk for stroke (eg, odds ratio for professionals in blue‐collar industries, 0.77; 95% CI , 0.70–0.85). Conclusions The occupational “gradient” in cardiovascular disease (with lower risk observed in higher status occupations) may not be a universal phenomenon. In contemporary Japanese society, managers and professionals may experience higher risk for CHD .

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.

Background Direct-to-consumer information (DTCI) campaign is a new medium to inform and empower patients in their decision-making without directly promoting specific drugs. However, little is known about the impact of DTCI campaigns, expanding rapidly in developed countries, on changes in prescription patterns. We sought to determine whether a DTCI campaign on overactive bladder increases the prescription rate for overactive bladder treatment drugs. Methods We performed a 3-year retrospective cohort study of 1332 participants who were diagnosed overactive bladder but not prescribed treatment drugs prior to the examined DTCI campaign (exposure), using the health insurance claims dataset of the Japan Medical Data Center (November 19, 2010 to November 18, 2013). The DTCI campaign for overactive bladder included television, Internet, and print advertising (November 19, 2011 to December 22, 2011). We divided the study period into Pre-Campaign Year (2010–2011), Year 1 (2011–2012), and Year 2 (2012–2013). Each year began on November 19 and included Period 1 (weeks 1–5) through Period 10 (weeks 46–50). The main outcome was first-time prescription of the treatment drug for each patient, measured by 5-week periods. Using Period 10 in the Pre-Campaign Year as the referent period, we applied the Cox proportional hazard model for each period. Additionally, we performed the interrupted time series analysis (ITSA) for the first-time prescription rate per 5-week period. Results Following the DTCI campaign, patients were about seven times more likely to receive a first prescription of a treatment drug during Period 4 in Year 1 (hazard ratio 7.09; 95% CI, 2.11–23.8; p-value

Background: Cholangiocarcinoma is a relatively rare cancer that is difficult to diagnose and has a poor prognosis. Currently, knowledge concerning its etiology, tumor localization, and pathological features remains limited. The present study aimed to clarify the clinico-epidemiologic nature of cholangiocarcinoma with its clinical subtypes using the largest regional cancer registry in Japan.Methods: Using a regional cancer registry in Kanagawa prefecture, Japan, we estimated three-year and five-year survival rates of cholangiocarcinoma patients, who were classified into two groups: intrahepatic (i-CCA) and extrahepatic cholangiocarcinoma (e-CCA) cases. The hazard ratio for each subtype, including pathological tissue type and tumor site, was calculated.Results: During the period from 1976 to 2013, 14,287 cases of cholangiocarcinoma were identified. The prognosis markedly improved after 2006, when a new type of chemotherapy for cholangiocarcinoma was introduced in Japan. Patients with i-CCA were more likely to be younger, and less likely to undergo surgery than those with e-CCA. The prognosis of cases with i-CCA was poor compared to that of patients with e-CCA.Conclusion: In Japan, i-CCA was more likely to develop in younger people and to have a poor prognosis. The prognosis of both i-CCA and e-CCA cases markedly improved after 2006. The present study describes clinico-epidemiological features of cholangiocarcinoma that may be useful for determining therapeutic strategies for this disease.

Objectives: Our study aimed to clarify the trend of vitamin D deficiency and rickets diagnosed in the past 10 years. Methods: This observational study used health insurance claims data from 2005 to 2014. The number of beneficiaries for 2005 and 2014 were 91 617 and 365 800, respectively. We included children aged 0 to 15 years diagnosed with vitamin D deficiency or vitamin D–deficient rickets; those with congenital/secondary rickets and low-birth-weight infants were excluded. We analyzed the number of patients and the temporal trend of these diseases in Japan. Results: The annual number of patients from 2005 to 2008 was

Although early detection and intervention may improve the outcome of the congenital cytomegalovirus (cCMV) infection, few studies assessed the real-world clinical practice for cCMV patients. We analyzed medical claims data to assess the patterns of diagnoses and medical care for cCMV patients.We used a subset of medical claims database (JMDC Claims Database) in Japan, covering 207,547 newborns between April 2010 and March 2017 and observed for at least 6 months. The diagnosis of cCMV and related symptoms and sequelae and medical care, including essential examinations and antiviral treatment, were identified using standardized codes.Overall, we identified 53 (25.5 per 100,000 newborns) cCMV patients diagnosed within 6 months after birth; of these, 83% were diagnosed within 1 month and 68% had at least 1 cCMV-related symptom at birth. Objective hearing tests and fundus examinations were performed within 6 months in 60% and 30% of patients, respectively. Antivirals were prescribed in 26% of patients. During the observation period (median = 33 months), sensorineural hearing loss (49%) and developmental problems (28%) were commonly identified as cCMV-related sequelae. The proportions of the patients continuously followed up with objective hearing tests up to 36 months were 30% in total and 56% in antiviral-treated patients, respectively.The cCMV patients did not necessarily receive a timely diagnosis nor continuous follow-ups in usual clinical practice. Although the universal screening for cCMV may, if implemented, facilitate early diagnosis, it should be accompanied by strategic follow-up plans to support timely interventions.

Aim The aim of this study was to describe the survival prognosis of children with cerebral palsy (CP) in Okinawa, Japan. Method A cohort study was conducted on all children with CP born between 1988 and 2005 in Okinawa, Japan. Survival proportions were determined with a life table and Kaplan–Meier survival curves were plotted. The effect of each predictor variable was estimated using Cox regression analysis. Results This study included 580 children with CP (332 males, 248 females). In the cohort, 119 (20.5%) children were classified in Gross Motor Function Classification System (GMFCS) level I, 65 (11.2%) were classified in level II, 40 (6.9%) in level III, 189 (32.6%) in level IV, 166 (28.6%) in level V and GMFCS level was unknown for one. Of the 34 children who died, 29 were classified in GMFCS level V and GMFCS level was unknown for one. Mean age at start of follow-up was 24.5 months (SD 2.6mo); mean length of follow-up was 8 years 8 months (standard error of the mean 0.214y). The 5 year- and 18-year survival percentages of the entire cohort were 98% and 89% respectively. In children with CP, significantly lower survival rates were associated with multiple factors, including a birthweight of at least 2500g (p=0.009), a gestational age of at least 37 weeks (p=0.004), and the most severe gross motor limitation, GMFCS level V (p

Background In Japan, the revision of the fee schedules in 2006 introduced a new category of general care ward for more advanced care, with a higher staffing standard, a patient-to-nurse ratio of 7:1. Previous studies have suggested that these changes worsened inequalities in the geographic distribution of nurses, but there have been few quantitative studies evaluating this effect. This study aimed to investigate the association between the distribution of 7:1 beds and the geographic distribution of hospital nursing staffs. Methods We conducted a secondary data analysis of hospital reimbursement reports in 2012 in Japan. The study units were secondary medical areas (SMAs) in Japan, which are roughly comparable to hospital service areas in the United States. The outcome variable was the nurse density per 100,000 population in each SMA. The 7:1 bed density per 100,000 population was the main independent variable. To investigate the association between the nurse density and 7:1 bed density, adjusting for other variables, we applied a multiple linear regression model, with nurse density as an outcome variable, and the bed densities by functional category of inpatient ward as independent variables, adding other variables related to socio-economic status and nurse workforce. To investigate whether 7:1 bed density made the largest contribution to the nurse density, compared to other bed densities, we estimated the standardized regression coefficients. Results There were 344 SMAs in the study period, of which 343 were used because of data availability. There were approximately 553,600 full time equivalent nurses working in inpatient wards in hospitals. The mean (standard deviation) of the full time equivalent nurse density was 426.4 (147.5) and for 7:1 bed density, the figures were 271.9 (185.9). The 7:1 bed density ranged from 0.0 to 1,295.5. After adjusting for the possible confounders, there were more hospital nurses in the areas with higher densities of 7:1 beds (standardized regression coefficient 0.62, 95% confidence interval 0.56–0.68). Conclusion We found that the 7:1 nurse staffing standard made the largest contribution to the geographic distribution of hospital nurses, adjusted for socio-economic status and nurse workforce-related factors. Electronic supplementary material The online version of this article (doi:10.1186/s12912-017-0219-1) contains supplementary material, which is available to authorized users.

Background Prevention and early detection of arterial stiffness are required to avoid severe cardiovascular events. Recently, new noninvasive arterial stiffness indices, the arterial pressure volume index (API) and the arterial velocity pulse index (AVI), have been developed. The purpose of this study was to examine the clinical validity of these new indices by investigating the association between known risk factors of cardiovascular disease (CVD) and API or AVI in a large population. Methods This cross-sectional survey included 7248 adults who underwent an annual medical checkup at a single medical institution. API and AVI were measured using cuff oscillometry by trained nurses. We used correlation coefficients, t-tests, and multiple regression analyses to evaluate associations, and calculated intraclass correlation coefficients (ICC) to examine test-retest reliabilities of these indices. Results Mean age was 45.5 years (SD = 5.8), and 4083 (56.3 %) participants were men, while 3165 were women. Mean values of API and AVI were 25.1 (SD = 7.0) and 16.6 (SD = 5.4), respectively. API was strongly correlated with body mass index (BMI), systolic blood pressure (sBP), and diastolic blood pressure (dBP) (r > 0.3, p 0.3, p

To investigate the changes on self- and parental weight perceptions and parental communication with healthcare professionals (HCPs) in the United States during the mid-2000s period when the terminology changed for classifications of childhood obesity/overweight.A repeated cross-sectional study was conducted with 6799 children aged 8-15 years with the National Health and Nutrition Examination Survey 2005-2014. BMI was calculated from objectively measured heights and weights, and children were classified as normal/underweight, overweight or obese, using the new terminology. Children reported their own weight status. Parents reported their child's weight status and reported how HCPs described their children's weight status. Logistic regressions were used to investigate changes in weight perceptions among overweight/obese children themselves and their parents and parental communication with HCPs about children's overweight/obesity status during the time of the terminology change.The proportion of parents told by HCPs about children's weight status increased for overweight children [6.8% in 2005-2006 to 18.8% in 2013-2014, p for trend (pAlthough the terminology change about childhood obesity/overweight was associated with increased communication about child's weight status by HCPs, the accuracy of weight perceptions among obese/overweight children or their parents did not improve or declined.

Aim Japan lacks a population-based registration system for cerebral palsy (CP), therefore the nationwide prevalence of CP is unknown. Our aim was to estimate the number of children with CP using the National Database of Health Insurance Claims and Specific Health Checkups of Japan, which has been recently developed by the government. Method Study participants were children and adolescents aged below 20 years, who had been assigned CP diagnosis codes more than once in claims issued between June 2012 and May 2013 from all health insurance schemes in Japan, except for Social Welfare and Elderly Health Insurance. Results The number of participants with diagnosed CP was 44 381. The number of males with CP (25 237) was greater than the number of females (19 144). Peak CP prevalence per 1000 population was 2.39 at age 4 years, and this gradually declined with age. The prevalence of CP per 1000 population was 2.27 at age 5 to 9 years. The numbers of inpatients and outpatients with CP were 9126 (20.6%) and 35 255 (79.4%) respectively. Interpretation Our estimation of CP prevalence per 1000 population at age 5 to 9 years lay in the higher range of figures from previous studies in Japan, and was close to figures reported by European countries.

Although insufficient sleep or poor sleep quality has been reported to be associated with the development of type 2 diabetes, the relation of type 2 diabetes with nonrestorative sleep (NRS), a subjective feeling, has been overlooked. We used a large-scale medical checkup database to investigate whether there is a cross-sectional association between NRS and type 2 diabetes risk in Japanese individuals. We extracted data for 14,476 individuals who were not receiving therapeutic drugs for diabetes. About 36.8% of individuals were identified as having NRS. In a multiple logistic regression analysis, NRS was significantly associated with the risk of developing diabetes. Thus, this line of research may have implications for diabetes prevention.

Objective: This study aimed to investigate the association between periodontal disease and peptic ulcers in a working population. Methods: Self-administered questionnaires were distributed to all employees of a large insurance company in Japan. The questionnaire asked about their health status and lifestyle habits. Peptic ulcer was defined as either stomach ulcer, duodenal ulcer, or both. For the evaluation of periodontal disease, three indices were used: (a) loss of five or more teeth, (b) having been told of having periodontitis, and (c) periodontal risk score. Results: Of the eligible 28 765 subjects analyzed, peptic ulcer was present in 397 (1.4%). The results of bivariate analyses showed that a significantly higher proportion of subjects with peptic ulcer reported that they lost five or more teeth (35.3 vs. 17.4%, p

Background:Background: Within total health expenditure, the share of out-of-pocket health expenditure by individuals has increased in the past 25 years in China, from 20% in 1980 to 49% in 2006, with a peak of 59% in 2000. Medical issues have become a larger concern than any other issue for households. Abstract: Objective:Objective: To estimate the determinants of individual out-of-pocket health expenditure in China. Abstract: Methods:Methods: We used a subsample of 9860 adults aged ≥18 years from the 2004 China Health and Nutrition Survey. To control for potential sample selection bias, the Heckman selection model was used to analyse individuals' health expenditure decisions, which is based on a sample that excludes individuals who do not report paying for healthcare. Abstract: Results:Results: Of the sampled population, 24.6% reported recent illness, 80.6% of whom sought care; 82.3% of those who sought care reported the amount of health spending. The average out-of-pocket health expenditure was Chinese Yuan (Y) 502 (Y100 - &dollar;US12.2 in 2004). Illness perceived as 'quite serious' and self-reported poor health status had the highest coefficients (2.012 &lsqb;p < 0.01&rsqb; and 3.351 &lsqb;p < 0.01&rsqb;, respectively). People spent more on healthcare with increasing age, especially over the age of 65 years, with a coefficient of 1.171 (p < 0.01). Those who had chronic disease, earned higher incomes, resided in urban areas, lived in the middle or eastern region, or lived in a household with a head having a middle school or higher education paid more for healthcare. In the model examining disaggregated effects of insurance programmes, the coefficients were positive, except for commercial insurance, and the coefficient for labour insurance was significant. Abstract: Conclusion:Conclusion: Perceived severity of illness and self-reported health status are the most important factors when determining out-of-pocket health expenditure. The effect of aging is substantial. China should develop appropriate medical relief policies for the elderly to help them gain access to necessary healthcare services. Certain types of insurance programmes tend to increase out-of-pocket health expenditures, which highlights the need to continuously monitor and rigorously evaluate the impact of ongoing health insurance reform in China.

The geographical distribution of health professionals reflects behavioral characteristics of such professionals and of the health system in which they work. The spill-over hypothesis asserts that their oversupply leads to a more even geographic distribution. The current surplus of dentists in Japan is a suitable opportunity to observe such situations. This study demonstrates the transition of the geographic distribution of dentists from 1980 to 2000 in comparison with that of physicians. Using data from the Population Census and the Physician, Dentist, and Pharmacist Census, we calculated the ratio of dentists working in clinics and hospitals per population in 1980, 1990, and 2000 and the Gini coefficients according to the municipality boundaries at the end of 2000. We also plotted the municipalities on a graph, which illustrated the ratios of the dentists by population. We did the same analysis with physician data. The number of dentists increased by 71% during the 20 years studied. The ratios of dentists/100,000 population were 44.1, 58.3, and 69.7 in 1980, 1990, and 2000, respectively. The Gini coefficients for dentists by municipality were 0.270, 0.213, and 0.197, excluding the municipalities with a dental university or its hospital. In contrast, the Gini coefficients for physicians barely changed while the number of physicians increased by 60% during the same periods. The graphs for dentists appeared to indicate the ceiling of those ratios (approximately 100 dentists/100,000 population), but such a ceiling was not seen for physicians. The supply of dentists might have reached a level that generated the geographic diffusion and redistribution of dentists in Japan, in contrast with the situation involving physicians. This supports some results from other countries suggesting that saturation of local markets for health professionals may result in geographical redistribution, producing a more equal pattern of provision across the national space.

Background Assessment of the quality of care is a key element in current diabetes care. However, the quality of care for diabetes patients in Japan has rarely been reported. Objectives To assess the quality of diabetes care in two communities in Japan by using National Health Insurance claims data. Methods We analysed claim data of 13 650 beneficiaries of National Health Insurance in two communities in Japan from May 2006 to April 2007. Diabetes cases were identified by using a case detection algorism. Our main outcome measures were three process quality indicators: (1) haemoglobin A1c (HbA1c) testing; (2) annual eye examination; and (3) annual nephropathy screening, recommended in the existing clinical guidelines. We calculated the performance rate of each quality indicator and examined the effects of demographic characteristics and co-morbid conditions. Results We identified 636 diabetes cases. Of these, 97.0% had at least one HbA1c test, and 69.8% had ≥4 tests during the study period. The odds ratios (ORs) for ≥4 HbA1c tests were lower in subgroups aged 75–79 (OR 0.58, 95% confidence interval 0.35–0.96), and aged ≥80 (OR 0.54, 95% confidence interval 0.32–0.88) compared with the subgroup aged

Objective: Little is known about the incidence of secondary neoplasms among survivors of retinoblastoma in Japan. The objective of our study was to analyze the cumulative incidence rate of secondary neoplasms following retinoblastoma and to investigate the risk factors of developing secondary neoplasms. Methods: We conducted a retrospective cohort study of 754 retinoblastoma patients who visited the National Cancer Center Hospital in Tokyo between 1964 and 2007. The cumulative incidence rate curves were drawn using the competing risk method and compared with the Gray’s test. Using competing risk regression analysis, multivariate analysis estimated the subdistribution hazard ratio of factors related to the development of secondary neoplasms. Results: The median length of follow-up was 108 months (0 –5 94 months). Twenty-one (2.8%) patients developed 23 secondary neoplasms in total. The cumulative incidence rates of secondary neoplasms after retinoblastoma treatment were 2.4% at 10 years after diagnosis, 4.3% at 20 years, 6.4% at 30 years and 19.1% at 40 years. Ten patients (1.3%) died and 723 (95.9%) were alive without developing secondary neoplasms. The subdistribution hazard ratios of hereditary retinoblastoma and external beam irradiation were 4.85 (95% confidence interval ¼ 0.74–31.85) and 4.76 (95% confidence interval ¼ 0.69–33.09), respectively. Conclusions: We demonstrated the cumulative incidence rate of secondary neoplasms following retinoblastoma in Japan. The subdistribution hazards ratios of hereditary retinoblastoma and external beam irradiation were high but not significant because of statistical power. The long-term follow-up of retinoblastoma survivors is warranted to understand secondary neoplasm risk.

Both elevated liver enzymes and a family history of diabetes mellitus (FHDM) are independent risk factors for type 2 diabetes. This study evaluates the epidemiological association between elevated liver enzymes and FHDM. Subjects included 3512 women workers without diabetes, hepatitis, a smoking habit, or a history of alcohol intake. Blood samples and personal data were collected from all subjects. Subjects with FHDM had a higher mean body mass index (BMI: 23.9kg/m(2) vs. 23.4kg/m(2); p=0.003). Laboratory testing also revealed higher mean fasting plasma glucose (FPG: 5.67mmol/L vs. 5.22mmol/L; p0.001), asparate aminotransferase (AST: 20.0IU/L vs. 19.2IU/L; p=0.049), alanine aminotransferase (ALT: 18.4IU/L vs. 16.7IU/L; p=0.004), gamma-glutamyltranspeptidase (GGT: 24.1IU/L vs. 20.5IU/L; p0.001), and triglycerides (TG: 1.09mmol/L vs. 1.00mmol/L; p=0.011) for FHDM subjects, when adjusted for age and BMI. Multiple linear regression analysis revealed that FHDM, age, BMI, FPG, and TG were correlated with GGT (p=0.004 for FHDM; p0.001 for age, BMI, FPG, and TG). Elevated liver enzymes were associated with FHDM. In particular, elevated GGT was related to FHDM, independent of the other variables. Elevated liver enzymes, probably due to fat deposition in the liver, may play a role in increasing the risk of diabetes in individuals with FHDM.

Objective The objective of this paper is to describe the frequency of duplicative medication use and to estimate the drug cost associated with duplicative medications in patients who visit multiple medical institutions in Japan. Methods The subjects of this study were insurants of a corporate health insurance society. We examined claims of insurants who received prescriptions from multiple medical institutions in April 2002. We examined characteristics of insurants who received duplicative medications and calculated the cost of duplicated drugs. Results 8.8% received drugs with the same mechanism of action for overlapping administration periods. In terms of comparison among three age groups, 0–19 years old, 20–69 years old, and 70 years old or older, the percentage was higher in 0–19-year-old patients than in the other age groups. The cost of duplicated drugs was found to be 0.7% or 0.5% of the total drug cost, when calculated with higher-priced drugs and lower-priced drugs, respectively. Conclusions This study suggests that pediatric and teenage patients as well as elderly patients require prudent management of medication to avoid duplicative medications and that at least an estimated 5.2–7.2 billion yen may be saved if duplicative medications can be completely eliminated nationwide.

We examined the usefulness of the combined use of fasting plasma glucose (FPG) and hemoglobin Alc (HbA1c) levels to predict the progression of diabetes in a Japanese population.A retrospective cohort study was conducted from 1995 to 2002 among 449 non-diabetic Japanese workers, ages 23-65, in whom baseline FPG levels and HbA1c were measured. Subjects were classified into six groups according to their baseline FPG level: low normal fasting glucose (NFG) (5.55 mmol/l); high NFG (5.55-6.09 mmol/l); or impaired fasting glucose (IFG) (6.10-6.99 mmol/l), in combination with baseline HbA1c level: low HbA1c (5.8%) and high HbA1c (or =5.8%). The cumulative incidence of diabetes in 2002, as defined by the 1997 American Diabetes Association (ADA) diagnostic criteria, was compared between groups.The overall cumulative incidence of diabetes was 3.8% (17/449). The cumulative incidence of diabetes was 0.6% (2/339) in those with low NFG/normal HbA1c; 0% (0/24) with low NFG/high HbA1c; 6.4% (3/47) with high NFG/normal HbA1c; 23.1% (3/13) with high NFG/high HbA1c; 17.6% (3/17) with IFG/normal HbA1c; and 66.7% (9/17) with IFG/high HbA1c. The odds ratios for diabetes, adjusted for age, sex, body mass index (BMI) and family history of diabetes, were 5.3 (95% CI, 3.0-9.3) and 3.0 (1.7-5.3), per 0.56 mmol/l increase in FPG and 0.5% increase in HbA1c, respectively.The combined use of FPG and HbA1c levels predicts the progression to diabetes in individuals with no apparent risk. In particular, the combination is recommended for individuals with a FPGor =5.55 mmol/l.

This study aimed to describe trends in CP prevalence among children born between 1988 and 2007 in Okinawa, Japan.This study was conducted during two time periods, Period I (from 1988 to 1997) and Period II (from 1998 to 2007), using data from the local CP registration system. We assessed cerebral palsy gestational age and birth weight specific trends in prevalence and analyzed these with Poisson regression analysis.Overall crude CP prevalence was 1.88 per 1000 live births. Approximately 70% of children with CP were born preterm or with low birth weight (LBW). Overall CP prevalence increased in Period I and decreased significantly in Period II (P0.05). Additionally, CP prevalence among children born with a birth weight between 1000 and 1999g increased in Period I and decreased significantly in Period II (P0.05). A significant decrease was found among the children born between 1995 and 2007 with a gestational age between 28 and 31weeks (P0.01).There was a decrease in CP prevalence from 1998 to 2007, especially among LBW children and preterm infants. The high CP proportions among LBW and preterm infants are unique features of the population of Okinawa, Japan.

Introduction: Recent studies have shown that the results of vascular function tests, such as pulse wave velocity or cardio-ankle vascular index (CAVI), were associated with pulmonary function in children or hypertensive patients, and increased CAVI might be correlated with progression of chronic obstructive pulmonary disease. However, the association between vascular function and pulmonary function remains unclear, especially in healthy adult people. Arterial velocity index (AVI) is a novel arterial stiffness index that can be measured more easily than previous methods. The aim of this study was to investigate the association between AVI and pulmonary function test results in the healthy adult population. Methods: We conducted a cross-sectional survey of healthy adults aged 20 years or older at a single large medical center in Hachinohe, Japan between April 2014 and March 2015. We measured AVI using cuff oscillometry. AVI means the characteristics of pulse waves at higher cuff pressure than systolic BP. The outcome measure was forced expiratory volume in one second (FEV1), which was measured with spirometry. We used log-transformed values of AVI and FEV1, as the distributions of these values were skewed. We calculated a correlation coefficient between AVI and FEV1, and performed multiple linear regression analyses to adjust for effects of age, sex, height, and smoking status. Results: In total, 777 men and 530 women participated in this study. The mean age of total participants was 44.9 years (SD = 5.9), and the percentage of current smokers was 32.0 % (418 out of 1,307). The mean AVI was 15.6 (SD = 4.9), and the mean FEV1 was 3.13 L (SD = 0.65). AVI was negatively correlated with FEV1 (r = –0.21, p < 0.001). In fully-adjusted models, AVI was independently associated with FEV1 (β = –0.03, p = 0.017, 95 % CI = –0.06 to –0.01). Conclusions: Our study showed that an increase of arterial stiffness as assessed via AVI was independently associated with a decrease in FEV1 in the healthy Japanese population. Further study is warranted to confirm these findings in cohort studies.

To assess the effects of environmental exposures to trace metals on the incidence of preeclampsia, concentrations of lead (Pb), antimony (Sb), manganese (Mn), mercury, cadmium, cobalt and zinc in umbilical cord blood (UCB) and mother whole blood (MWB) were measured in 396 postpartum women without occupational exposure to metals in Tehran, Iran, using inductively coupled plasma mass spectrometry. Mother's ages ranged from 15 to 49 (mean 27) years. Preeclampsia was diagnosed in 31 subjects (7.8%). Levels of Pb, Sb and Mn in UCB were significantly higher in preeclampsia cases [mean+/-SD of 4.30+/-2.49 microg/dl, 4.16+/-2.73 and 46.87+/-15.03 microg/l, respectively] than in controls [3.52+/-2.09 microg/dl, 3.17+/-2.68 and 40.32+/-15.19 microg/l, respectively] (P

This study was aimed to examine the association of periodontitis with white blood cell (WBC) count and blood pressure (BP). In 2002, 424 subjects (manufacturing workers) were investigated for periodontitis by a general dentist. All were Japanese. Among them, 364 subjects (269 men and 95 women) who also attended the next year's (2003) screening were enrolled for this study. Of the 364 subjects, 55 (15.1%) had periodontitis. We also measured the BP and WBC count in periodontitis and non-periodontitis subjects at baseline and 1-year later follow-up. The WBC count higher in subjects with periodontitis than in subjects without periodontitis, both at baseline [mean +/- standard error (SE) 6.6 x 10(3) +/- 0.2 x 10(3)/ml vs 5.8 +/- 0.3 x 10(3)/ml; p0.001] and follow-up (7.0 +/- 0.3(3)/ml vs 6.5 +/- 0.1(3)/ml; p = 0.003). The systolic BP was higher in subjects with periodontitis than in subjects without periodontitis, both at the baseline (128 +/- 2.1 mmHg vs 120.8 +/- 0.8 mmHg; p0.001) and follow-up (129.2 +/- 2.3 mmHg vs 123.0 +/- 0.8 mmHg; p = 0.011), and so was the diastolic BP both at baseline (76 +/- 1.5 mmHg vs 71.2 +/- 0.6 mmHg; p = 0.003) and follow-up (80.5 +/- 1.7 mmHg vs 75.4 +/- 0.7 mmHg; p = 0.004). Periodontitis is associated with increased BP and WBC count. This finding may provide one underlying pathway linking periodontitis and cardiovascular disease.