Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3233/JAD-220200

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DOI： 10.1111/jgs.18068

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

目的
2011年度より第三者提供が開始されたレセプト情報・特定健診等情報データベース（NDB）の研究利用が不十分な状況にある．学術研究を加速化させ，エビデンスに基づいた医療政策を推進するためには，NDBの活用可能性を高めていく必要がある．本研究の目的は，臨床疫学研究および医療経済研究を行うのに有用性が高く，かつ，データ容量の効率性が高いNDB解析用データセットを構築することである．
方法
2009年4月から2016年12月の間の医科入院レセプトおよびDPCレセプトにおいて1度でも出現したことのある解析用患者IDを全データから無作為に25%分を抽出し，当該解析用患者IDの全期間における全診療行為情報を含む全レセプトデータを格納したNDBを用いた．臨床疫学研究および医療経済研究を行うのに有用性の高い解析用データセットテーブルに必要な変数について検討した．また，医科レセプトにおいては退院年月日情報が含まれていないことから，レセプトデータを用いた補完的な退院年月日を付加する方法について検討した．本検討では，退院年月日情報が含まれるDPCレセプトを用いて，入院年月日と診療実日数を用いる場合と，診療行為発生日を用いる場合のそれぞれの方法で退院年月日を算出し，実際のDPCレセプトに記載されている退院年月日との一致状況について検証した．
結果
NDBに含まれるレコード識別情報を有機的に連結させた解析用データセットテーブルとして，以下の11テーブルを開発した：患者（KAN），レセプト（REC），傷病名（SYO），診療行為（SIN），薬剤（IYA），特定器材（TOK），調剤（TYO），調剤加算料等（TKA），DPC診断群分類（BUD），医療機関（IRK），入院（ADM）．医療機関（IRK）を除く各テーブルは解析用患者IDによって相互に突合することができる．また，医科レセプトにおける補完退院年月日は，診療行為（SI），医薬品（IY），特定器材（TO），コーディングデータ（CD）の各レコードにおける診療行為年月日の最終日情報を用いることで，99.83%の入院症例において正しい退院年月日を付加することができた．
結論
本研究において開発した解析用データセットテーブルを用いることで，NDBを用いた臨床疫学研究および医療経済研究を即座に実施可能な環境をもたらすことができる．

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

背景：
医療政策に費用対効果の視点を導入する議論は，感染制御領域においても例外ではない．しかしながら，費用対効果の検証に不可欠な，我が国における疾病費用に関する検証は十分に実施されていない．本研究の目的は胃手術の実施症例に対する手術部位感染（SSI）発生による追加的医療資源を推定することである．
方法：
2007年7月から2010年12月の間に6病院において胃手術を実施した症例を解析対象に定めた．使用データは，JANISデータとDPCデータを突合して構築したJANIS/DPC統合データベースである．推定には，従属変数を術後在院日数および術後医療費（出来高換算）に定め，曝露変数をSSIの有無および深さに定めた一般化線形モデルを用いた．
結果：
解析対象症例数は857症例であり，感染者数は42症例であった．SSI発生による術後在院日数の延長および術後医療費の増加は，表層切開創SSIでは6.6日および206千円，深部切開創SSIでは12.8日および398千円，臓器/体腔SSIでは18.3日および1,021千円と推定された．
結論：
本研究は，JANISデータとDPCデータという既存データを突合するJANIS/DPC統合データベースを構築するとともに，6施設を対象に胃手術症例におけるSSI発生による追加的医療資源を推定した．本推定値は，感染制御方策の費用対効果の検証に活用可能である．

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

Although previous studies have shown no increased mortality risk after the primary series of COVID-19 mRNA vaccines, reports on booster doses are lacking. This study aimed to evaluate mortality risk after the mRNA vaccine boosters in addition to the primary series. This nested case-control study included two age-specific cohorts (18-64 and ≥65 years as of February 1, 2021) in two municipalities. All deaths were identified and matched five controls for each case at each date of death (index date) with risk set sampling according to municipality, age, and sex. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for mRNA vaccines (first to fifth doses) were estimated by comparing with no vaccination within 21 and 42 days before the index date using a conditional logistic regression model. The 18-64-years cohort comprised 431 cases (mean age, 57.0 years; men, 58.2%) and 2,155 controls (mean age, 56.0; men, 58.2%), whereas the ≥65-years cohort comprised 12,166 cases (84.0; 50.2%) and 60,830 controls (84.0, 50.2%). The aORs (95% CI) in 0-21 days after the third and fourth doses in the 18-64-years cohort were 0.62 (0.24, 1.62) and 0.38 (0.08, 1.84), respectively. The aORs (95% CI) after the third to fifth doses in the ≥65 years cohort were 0.36 (0.31, 0.43), 0.30 (0.25, 0.37), and 0.26 (0.20, 0.33), respectively. In conclusion, booster doses of mRNA vaccines do not increase mortality risk. These findings could help subsequent vaccine campaigns and alleviate vaccine hesitancy.

DOI： 10.1080/21645515.2024.2350091

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Authorship：Last author  

Authorship：Last author,　Corresponding author  

Authorship：Last author  

Authorship：Last author,　Corresponding author  

Authorship：Last author  

Authorship：Last author  

Language：English   Publisher：Journal of Infection and Public Health  

Background: Evaluating the selective pressure of antimicrobials on bacteria is important for promoting antimicrobial stewardship programs (ASPs). The aim of this study was to assess the selective pressure of antimicrobials by evaluating their use (carbapenem [CBP] and CBP-sparing therapy) over time and the detection status of CBP-resistant organisms using multicenter data. Methods: Among the facilities whose data were registered in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology from 2017 to 2020, those that had data on the use of CBP and CBP-sparing therapy (fluoroquinolones [FQs], cefmetazole [CMZ], piperacillin–tazobactam [PIP/TAZ], ampicillin–sulbactam [ABPC/SBT], ceftriaxone/cefotaxime [CTRX/CTX], CAZ (ceftazidime), cefepime [CFPM], and aminoglycosides [AGs]) as well as on CBP-resistant Enterobacterales (CRE) and CBP-resistant Pseudomonas aeruginosa (CRPA) detection were included. Alcohol-based hand rubbing (ABHR) usage was also analyzed. Regression analyses, including multivariable regression analysis, were performed to evaluate trends. The association of antimicrobial use density (AUD) with CRE and CRPA detection rates was evaluated. Results: In 28 facilities nationwide, CBP, FQ, CAZ, AG, and PIP/TAZ use decreased over the 3-year period, whereas the use of CMZ, ABPC/SBT, CTRX/CTX, CFPM, and ABHR as well as the rates of CRE and CRPA detection increased. The average AUD did not significantly correlate with CRE and CRPA detection rates. The multivariable regression analysis did not reveal any significant correlation between each AUD or ABHR and CRE or CRPA detection. Conclusion: CBP and ABHR use showed a decreasing and an increasing trend, respectively, while CRPA and CRE detection rates exhibited a gradual increase. The considerably low CRE and CRPA detection rates suggest that slight differences in numbers may have been observed as excessive trend changes. Further investigation is warranted to evaluate selective pressure while considering the characteristics of ASP and the mechanisms underlying resistance.

DOI： 10.1016/j.jiph.2024.102474

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BACKGROUND: The association between care needs level (CNL) at hospitalisation and postdischarge outcomes in older patients with acute heart failure (aHF) has been insufficiently investigated. METHODS: This population-based cohort study was conducted using health insurance claims and CNL data of the Longevity Improvement & Fair Evidence study. Patients aged ≥65 years, discharged after hospitalisation for aHF between April 2014 and March 2022, were identified. CNLs at hospitalisation were classified as no care needs (NCN), support level (SL) and CNL1, CNL2-3 and CNL4-5 based on total estimated daily care time as defined by national standard criteria, and varied on an ordinal scale between SL&CNL1 (low level) to CNL4-5 (fully dependent). The primary outcomes were changes in CNL and death 1 year after discharge, assessed by CNL at hospitalisation using Cox proportional hazard models. RESULTS: Of the 17 724 patients included, 7540 (42.5%), 4818 (27.2%), 3267 (18.4%) and 2099 (11.8%) had NCN, SL&CNL1, CNL2-3 and CNL4-5, respectively, at hospitalisation. One year after discharge, 4808 (27.1%), 3243 (18.3%), 2968 (16.7%), 2505 (14.1%) and 4200 (23.7%) patients had NCN, SL&CNL1, CNL2-3, CNL4-5 and death, respectively. Almost all patients' CNLs worsened after discharge. Compared to patients with NCN at hospitalisation, patients with SL&CNL1, CNL2-3 and CNL4-5 had an increased risk of all-cause death 1 year after discharge (hazard ratio [95% confidence interval]: 1.19 [1.09-1.31], 1.88 [1.71-2.06] and 2.56 [2.31-2.84], respectively). CONCLUSIONS: Older patients with aHF and high CNL at hospitalisation had a high risk of all-cause mortality in the year following discharge.

DOI： 10.1093/ageing/afae152

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BACKGROUND: Previous studies have shown a possible association between statin use and a decreased risk of dementia, but the association has not been sufficiently established, especially in the super-aging society of Japan. OBJECTIVE: This study aimed to determine the association between statin use and the risk of dementia among Japanese participants aged> =65 years old. METHODS: Data from the Longevity Improvement and Fair Evidence (LIFE) Study were utilized, including medical and long-term care (LTC) claim data from 17 municipalities between April 2014 and December 2020. A nested case-control study was conducted with one case matched to five controls based on age, sex, municipality, and year of cohort entry. We used a conditional logistic regression model to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: This study included 57,302 cases and 283,525 controls, with 59.7% of the participants being woman. After adjusting for potential confounders, statin use was associated with a lower risk of dementia (OR, 0.70; 95% CI: 0.68-0.73) and Alzheimer's disease (OR: 0.66; 95% CI: 0.63-0.69). Compared with non-users, the ORs of dementia were as follows: 1.42 (1.34-1.50) for 1-30 total standardized daily dose (TSDD), 0.91 (0.85-0.98) for 31-90 TSDD, 0.63 (0.58-0.69) for 91-180 TSDD, and 0.33 (0.31-0.36) for >180 TSDD in dose-analysis. CONCLUSIONS: Statin use is associated with a reduced risk of dementia and Alzheimer's disease among older Japanese adults. A low cumulative statin dose is associated with an increased risk of dementia, whereas a high cumulative statin dose is a protective factor against dementia.

DOI： 10.3233/JAD-240113

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Language：English   Publisher：Hypertension Research  

There is insufficient evidence that angiotensin-converting enzyme inhibitors (ACEIs) can reduce pneumonia by inducing a dry cough that confers a protective effect on the airway. To increase the evidence base on the clinical use of ACEIs for pneumonia prevention, this retrospective cohort study aimed to comparatively examine the risk of pneumonia-related hospitalization between ACEI initiators and angiotensin II receptor blocker (ARB) initiators using claims data from two Japanese municipalities. We identified persons who were newly prescribed any ACEI or ARB as their first antihypertensive agent between April 2016 and March 2020. The Fine-Gray method was applied to a Cox proportional hazards model to estimate the subdistribution hazard ratio (HR) of ACEI use (reference: ARB use) for pneumonia-related hospitalization, with death treated as a competing risk. Sex, age, comorbidities, medications, and pneumococcal immunization were included as covariates. The analysis was conducted on 1421 ACEI initiators and 9040 ARB initiators, and the adjusted subdistribution HR of ACEI use was estimated to be 1.21 (95% confidence interval: 0.89–1.65; P = 0.22). ACEI initiation did not demonstrate any significant preventive effect against pneumonia-related hospitalization relative to ARB initiation. There remains a lack of strong evidence on the protective effects of ACEIs, and further research is needed to ascertain the benefits of their use in preventing pneumonia. (Figure presented.)

DOI： 10.1038/s41440-024-01768-7

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

The association between statin use and the risk of Parkinson’s disease remains inconclusive, particularly in Japan’s super-aging society. This study aimed to investigate the potential association between statin use and the risk of Parkinson’s disease among Japanese participants aged ≥65 years. We used data from the Longevity Improvement and Fair Evidence Study, which included medical and long-term care claims data from April 2014 to December 2020 across 17 municipalities. Using a nested case-control design, we matched one case to five controls based on age, sex, municipality, and cohort entry year. A conditional logistic regression model was used to estimate the odds ratios with 95% confidence intervals. Among the 56,186 participants (9,397 cases and 46, 789 controls), 53.6% were women. The inverse association between statin use and Parkinson’s disease risk was significant after adjusting for multiple variables (odds ratio: 0.61; 95% confidence interval: 0.56–0.66). Compared with non-users, the dose analysis revealed varying odds ratios: 1.30 (1.12–1.52) for 1–30 total standard daily doses, 0.77 (0.64–0.92) for 31-90 total standard daily doses, 0.62 (0.52–0.75) for 91–180 total standard daily doses, and 0.30 (0.25–0.35) for >180 total standard daily doses. Statin use among older Japanese adults was associated with a decreased risk of Parkinson’s disease. Notably, lower cumulative statin doses were associated with an elevated risk of Parkinson’s disease, whereas higher cumulative doses exhibited protective effects against Parkinson’s disease development.

DOI： 10.1093/braincomms/fcae195

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BACKGROUND: Rebamipide has been widely co-prescribed with non-steroidal anti-inflammatory drugs (NSAIDs) in Japan for decades. This study aimed to evaluate the effectiveness of rebamipide in preventing upper gastrointestinal bleeding in new users of NSAIDs without risk factors of NSAID-induced ulcers other than age. METHODS: A nested case-control study was conducted using medical claims data of 1.66 million inhabitants of 17 municipalities participating in Japan's Longevity Improvement & Fair Evidence study. The cohort entry (t0) corresponded to a new user of NSAIDs for osteoarthritis or low back pain. Patients with risk factors of NSAID-induced ulcers other than age were excluded. Cases were defined as patients who underwent gastroscopy for upper gastrointestinal bleeding (occurrence date was defined as index date). A maximum of 10 controls were selected from non-cases at the index date of each case by matching sex, age, follow-up time, and type and dosage of NSAIDs. Exposure to rebamipide was defined as prescription status from t0 to index date: Non-user (rebamipide was not co-prescribed during the follow-up period), Continuous-user (rebamipide was co-prescribed from t0 with the same number of tablets as NSAIDs), and Irregular-user (neither Non-user nor Continuous-user). Conditional logistic regression analysis was conducted to estimate each category's odds ratio compared to non-users. FINDINGS: Of 67,561 individuals who met the inclusion criteria, 215 cases and 1,516 controls were selected. Compared with that of Non-users, the odds ratios and 95% confidence interval were 0.65 (0.44-0.96) for Continuous-users and 2.57 (1.73-3.81) for Irregular-users. CONCLUSIONS: Continuous co-prescription of rebamipide significantly reduced the risk of upper gastrointestinal bleeding in an Asian cohort of new users of NSAIDs with osteoarthritis or low back pain without risk factors other than age.

DOI： 10.1371/journal.pone.0305320

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Language：English   Publisher：Japan Epidemiological Association  

<p><b>Background:</b> We evaluated the effectiveness of the BNT162b2 vaccine against infection, symptomatic infection, and hospitalization in older people during the Delta-predominant period (July 1 to September 30, 2021).</p><p><b>Methods:</b> We performed a population-based cohort study in an older adult population aged ≥65 years using data from the Vaccine Effectiveness, Networking, and Universal Safety Study conducted from January 1, 2019, to September 30, 2021, in Japan. We matched BNT162b2-vaccinated and -unvaccinated individuals in a 1:1 ratio on the date of vaccination of the vaccinated individual. We evaluated the effectiveness of the vaccine against infection, symptomatic infection, and coronavirus disease (COVID-19)-related hospitalization by comparing the vaccinated and unvaccinated groups. We estimated the risk ratio and risk difference using the Kaplan–Meier method with inverse probability weighting. The vaccine effectiveness was calculated as (1 − risk ratio) × 100%.</p><p><b>Results:</b> The study included 203,574 matched pairs aged ≥65 years. At 7 days after the second dose, the vaccine effectiveness of BNT162b2 against infection, symptomatic infection, and hospitalization was 78.1% (95% confidence interval [CI], 65.2–87.8%), 79.1% (95% CI, 64.6–88.9%), and 93.5% (95% CI, 83.7–100%), respectively.</p><p><b>Conclusion:</b> BNT162b2 was highly effective against infection, symptomatic infection, and hospitalization in Japan’s older adult population aged ≥65 years during the Delta-predominant period.</p>

DOI： 10.2188/jea.je20230106

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Language：English   Publisher：IJID Regions  

Objectives: This study aimed to characterize the epidemiology of scabies and its outbreaks in Japanese households, residential care facilities (RCFs), and hospitals using claims data. Methods: This descriptive epidemiological study was conducted using claims data from eight municipalities in Japan. Scabies cases were identified using a combination of recorded diagnoses and administered medications. The study period was from April 2015 to March 2019. Outbreaks were defined as ≥2 cases of scabies occurring within a calendar month at a single household, RCF, or hospital. Results: We identified 857 scabies cases for analysis. The annual prevalence of scabies ranged from 40 to 67 per 100,000 beneficiaries. The annual attack rate of scabies was found to be highest in RCFs (21 per 1000 RCFs), followed by hospitals (11 per 1000 hospitals) and households (0.25 per 1000 households). The annual outbreak attack rate was also highest in RCFs (4.0 per 1000 RCFs), followed by hospitals (1.6 per 1000 hospitals) and household (0.027 per household). The patterns of outbreaks varied widely among the RCFs. Conclusions: The study showcases the potential of claims data for detecting infectious disease outbreaks, which could provide valuable insight for the future management and prevention of scabies. Infection control of scabies in RCFs is crucial in aging societies.

DOI： 10.1016/j.ijregi.2024.03.008

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Language：English   Publisher：Journal of Psychiatric Research  

This retrospective cohort study examined the incidence of post-COVID psychiatric disorders in older adults according to hospitalization status and SARS-CoV-2 variant period in Japan. Claims data, COVID-19 case-related information, and vaccination records were obtained from three Japanese municipalities. We identified individuals aged ≥65 years who had COVID-19 or other respiratory tract infection (RTI) between March 2021 and December 2022. Participants were categorized into non-hospitalized and hospitalized patients, and the study period was divided into the Alpha (March to May 2021), Delta (June to December 2021), Omicron BA.1/BA.2 (January to June 2022), and Omicron BA.5 (July to December 2022) periods. Modified Poisson regression analyses were performed to estimate the incidence rate ratios (IRRs) for the occurrence of psychiatric disorders (organic mental disorders, psychotic disorders, mood disorders, anxiety disorders, and insomnia) three months after COVID-19 (reference: other RTI). For overall psychiatric disorders, we analyzed 19,489 non-hospitalized patients (COVID-19: 6,728, Other RTI: 12,761) and 2925 hospitalized patients (COVID-19: 1,036, Other RTI: 1889). When compared with other RTI cases, COVID-19 cases had significantly lower IRRs for overall psychiatric disorders in both non-hospitalized (IRR: 0.59, P < 0.001) and hospitalized cases (IRR: 0. 83, P = 0.045) during the Omicron BA.1/BA.2 period, but only in non-hospitalized cases (IRR: 0.45, P < 0.001) during the Omicron BA.5 period. The incidences of the individual post-COVID psychiatric disorders varied according to disorder type, hospitalization status, and SARS-CoV-2 variant period. These findings provide a foundation for further research to explore these variations and improve the provision of psychiatric care in future epidemics.

DOI： 10.1016/j.jpsychires.2024.04.010

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Language：English   Publisher：(一社)日本疫学会  

Language：English   Publisher：Gerodontology  

Background: Several studies have investigated post-extraction bleeding in patients on antithrombotic therapy, but most included a small sample size. Objective: This study aimed to analyse post-extraction bleeding in patients on antithrombotic therapy using data from a large database. Materials and Methods: Claims data of National Health Insurance and Late-Stage Elderly Healthcare System enrollees who underwent tooth extraction between October 2014 and March 2019 (n = 107 767) in a large multiregional cohort study (Longevity Improvement and Fair Evidence study) were included. Antithrombotic therapy was determined based on the drug codes used at the time of tooth extraction (classified into six groups: no antithrombotic, single antiplatelet, dual antiplatelet, Direct Oral Anticoagulant, warfarin and combined antiplatelet and anticoagulant therapies). The outcome was defined as the presence of “post-extraction bleeding” as a receipt disease name in the same month as tooth extraction. To examine the association between antithrombotic therapy and post-extraction bleeding in detail, multiple logistic regression analysis was performed with post-extraction bleeding as the objective variable; each antithrombotic therapy as the explanatory variable; and age, sex and comorbidities as adjustment variables. Results: Antithrombotic therapy was administered in 14 343 patients (13.3%), and post-extraction bleeding was observed in 419 patients (0.4%). The rate of post-extraction bleeding was significantly lower in the no antithrombotic therapy and single antiplatelet groups than that in the other groups (odds ratio: 2.00–9.02). Conclusion: The frequency of post-extraction bleeding is high in patients on anticoagulation or dual antithrombotic therapy. Therefore, careful preparation before extraction is necessary in these patients.

DOI： 10.1111/ger.12703

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Language：English   Publisher：PLoS ONE  

Background Secondary healthcare data use has been increasing in the dental research field. The validity of the number of remaining teeth assessed from Japanese dental claims data has been reported in several studies, but has not been tested in the general population in Japan. Objectives To evaluate the validity of the number of remaining teeth assessed from Japanese dental claims data and assess its predictability against subsequent health deterioration. Methods We used the claims data of residents of a municipality that implemented oral health screening programs. Using the number of teeth in the screening records as the reference standard, we assessed the validity of the claims-based number of teeth by calculating the mean differences. In addition, we assessed the association between the claims-based number of teeth and pneumococcal disease (PD) or Alzheimer’s disease (AD) in adults aged ≥65 years using Cox proportional hazards analyses. Results Of the 10,154 participants, the mean number of teeth assessed from the claims data was 20.9, that in the screening records was 20.5, and their mean difference was 0.5. During the 3-year follow-up, PD or AD onset was observed in 10.4% (3,212/30,838) and 5.3% (1,589/ 30,207) of participants, respectively. Compared with participants with ≥20 teeth, those with 1–9 teeth had a 1.29 (95% confidence interval [CI]: 1.17–1.43) or 1.19 (95% CI: 1.04–1.36) times higher risk of developing PD or AD, respectively. Conclusion High validity of the claims-based number of teeth was observed. In addition, the claims-based number of teeth was associated with the risk of PD and AD.

DOI： 10.1371/journal.pone.0299849

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Authorship：Last author,　Corresponding author   Language：Others   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Journal of Hospital Infection  

Background: The effect of hospital participation in the Japan Nosocomial Infection Surveillance (JANIS) programme on surgical site infection (SSI) prevention is unknown. Aim: To determine if participation in the JANIS programme improved hospital performance in SSI prevention. Methods: This retrospective before–after study analysed Japanese acute care hospitals that joined the SSI component of the JANIS programme in 2013 or 2014. The study participants comprised patients who had undergone surgeries targeted for SSI surveillance at JANIS hospitals between 2012 and 2017. Exposure was defined as the receipt of an annual feedback report 1 year after participation in the JANIS programme. The changes in standardized infection ratio (SIR) from 1 year before to 3 years after exposure were calculated for 12 operative procedures: appendectomy, liver resection, cardiac surgery, cholecystectomy, colon surgery, caesarean section, spinal fusion, open reduction of long bone fracture, distal gastrectomy, total gastrectomy, rectal surgery, and small bowel surgery. Logistic regression models were used to analyse the association of each post-exposure year with the occurrence of SSI. Findings: In total, 157,343 surgeries at 319 hospitals were analysed. SIR values declined after participation in the JANIS programme for procedures such as liver resection and cardiac surgery. Participation in the JANIS programme was significantly associated with reduced SIR for several procedures, especially after 3 years. The odds ratios in the third post-exposure year (reference: pre-exposure year) were 0.86 [95% confidence interval (CI) 0.79–0.84] for colon surgery, 0.72 (95% CI 0.56–0.92) for distal gastrectomy, and 0.77 (95% CI 0.59–0.99) for total gastrectomy. Conclusion: Participation in the JANIS programme was associated with improved SSI prevention performance in several procedures in Japanese hospitals after 3 years.

DOI： 10.1016/j.jhin.2023.02.018

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：English   Publisher：(一社)日本疫学会  

<Highlight>●本研究の目的は、医療レセプトデータベースからフレイルを判定するClaimed-based frailty index(CFI)が、日本人高齢者にも適用できるかを、有害事象の予測を通して検討することである。●2014年4月から2019年3月に、ある12市町村の国民健康保険後期高齢者医療制度に加入している高齢者を対象にした。●CFIによるprefrail、frail群はrobust群と比較して、有意に要介護認定・死亡が起こりやすいことが明らかとなった。●本研究は、要介護認定・死亡の予測を通して、日本人高齢者におけるレセプトデータベースでも、CFIが適用できることを明らかにした。(著者抄録)

Language：English   Publisher：Journal of Hypertension  

Hypertension is the leading cardiovascular risk factor worldwide. However, in Japan, only 30% of patients have their blood pressure controlled under 140/90 mmHg, and nonadherence to antihypertensives is thought to be a reason for the poor control of hypertension. We therefore sought to assess the adherence to hypertension treatment and to evaluate factors influencing patients’ adherence in a large, representative sample of the Japanese population. To this end, we analyzed claims data from the LIFE Study database, which includes 112 506 Japanese adults with newly diagnosed hypertension. Medication adherence was measured for a year postdiagnosis using the proportion of days covered (PDC) method. Factors associated with adherence to antihypertensives were also assessed. Among the total 112 506 hypertensive patients, the nonadherence rate (PDC ≤ 80%) for antihypertensives during the first year after initiation of the treatment was 26.2%. Younger age [31 – 35 years: odds ratio (OR), 0.15; 95% confidence interval (95% CI), 0.12 – 0.19 compared with 71 – 74-year-old patients], male gender, monotherapy, and diuretics use [OR, 0.87; 95% CI, 0.82 – 0.91 compared with angiotensin II receptor blockers (ARBs)] were associated with poor adherence in the present study. Cancer comorbidity (OR, 0.84; 95% CI, 0.79 – 0.91 compared with no comorbidity), prescription at a hospital, and living in a medium-sized to regional city were also associated with poor adherence. Our present findings showing the current status of adherence to antihypertensive medications and its associated factors using claims data in Japan should help to improve adherence to antihypertensives and blood pressure control.

DOI： 10.1097/HJH.0000000000003661

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Language：English   Publisher：Vaccine  

Objectives: Although COVID-19 no longer constitutes a Public Health Emergency of International Concern, vaccination remains an important tool for reducing disease burden and mitigating future outbreaks. However, little is known about the impact of vaccination on medical expenditures and hospitalization duration after breakthrough infection. This study aimed to examine this impact during the Delta wave in Japan. Methods: This retrospective study was conducted using medical care claims data, vaccination records, and COVID-19-related information. COVID-19 cases in three municipalities were categorized into two age groups: 20–64 years and ≥65 years. For each group, we constructed linear regression models with a generalized estimating equation. We calculated the risk ratios (RRs) and 95% confidence intervals (CIs) of COVID-19 vaccination for total medical expenditures and hospitalization duration after adjusting for sex, comorbidities, and municipality. Results: We analyzed 618 cases aged 20-64 years (mean age: 38.4 years, women: 45.1%) and 208 cases aged ≥65 years (76.4 years, 53.8%). The RRs (95% CIs) of vaccination for total medical expenditures were 0.53 (0.44–0.64) in the 20-64 years age group and 0.51 (0.39–0.66) in the ≥65 years age group. Next, the RRs (95% CIs) of vaccination for hospitalization duration were 0.59 (0.42–0.83) in the 20–64 years age group and 0.69 (0.49–0.98) in the ≥65 years age group. Conclusions: COVID-19 vaccination was associated with lower total medical expenditures and hospitalization duration after breakthrough infection, with a more pronounced effect in older persons.

DOI： 10.1016/j.vaccine.2024.01.082

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Authorship：Last author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.bbi.2024.02.018

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Background: Little is known about the impact of physical activity (PA) and PPSV23 vaccination on pneumonia-related hospitalizations. This study examined the association between regular PA and pneumonia-related hospitalization according to PPSV23 vaccination status in older adults. Methods: This retrospective cohort study was conducted using health checkup data, medical care claims data, and vaccination records from two Japanese municipalities. Residents aged ≥65 years who had undergone a health checkup between April 2016 and March 2021 were categorized into a PPSV23 vaccinated or unvaccinated cohort. Each cohort was further divided into a PA group and no PA group. The hazard ratio (HR) of PA for pneumonia-related hospitalization was calculated for each cohort while adjusting for sex, age, comorbidities, and metabolic syndrome. Results: The vaccinated cohort comprised 16,295 participants (no PA: 5,139, PA: 11,156), and the unvaccinated cohort comprised 7,998 participants (no PA: 2,671, PA: 5,327). In the vaccinated cohort, the PA group had a significantly lower hazard for pneumonia-related hospitalization than the no PA group (adjusted HR: 0.58, P = 0.004). However, PA was not associated with pneumonia-related hospitalization in the unvaccinated cohort (adjusted HR: 0.70, P = 0.270). Conclusions: PA can reduce the risk of pneumonia-related hospitalization in vaccinated persons. Interventions that increase both vaccination rates and PA habits may help to reduce these hospitalizations in older adults.

DOI： 10.1016/j.vaccine.2024.01.060

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Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Hypertension is a frequent adverse event caused by vascular endothelial growth factor signaling pathway (VSP) inhibitors. However, the impact of hypertension on clinical outcomes during VSP inhibitor therapy remains controversial.</p><p><b><i>Methods and Results:</i></b> We reviewed 3,460 cancer patients treated with VSP inhibitors from the LIFE Study database, comprising Japanese claims data between 2016 and 2020. Patients were stratified into 3 groups based on the timing of hypertension onset: (1) new-onset hypertension (n=569; hypertension developing after VSP inhibitor administration); (2) pre-existing hypertension (n=1,790); and (3) no hypertension (n=1,101). Time to treatment failure (TTF) was used as the primary endpoint as a surrogate for clinical outcomes. The median (interquartile range) TTF in the new-onset and pre-existing hypertension groups was 301 (133–567) and 170 (72–358) days, respectively, compared with 146 (70–309) days in the non-hypertensive group (P<0.001 among all groups). In an adjusted Cox proportional hazard model, new-onset (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.50–0.68; P<0.001) and pre-existing (HR 0.85; 95% CI 0.73–0.98; P=0.026) hypertension were independent factors for prolonged TTF. The TTF of new-onset hypertension was longer than that of pre-existing hypertension (HR 0.68; 95% CI 0.62–0.76; P<0.001).</p><p><b><i>Conclusions:</i></b> This study highlighted that new-onset hypertension induced by VSP inhibitors was an independent factor for favorable clinical outcomes. Pre-existing hypertension before VSP inhibitor initiation was also a significant factor.</p>

DOI： 10.1253/circj.cj-22-0628

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PeerJ  

Background

Post-authorization safety studies (PASSs) of vaccines are important. PASSs enable the evaluation of association between vaccination and adverse events following immunization through common study designs. Clinical trials during vaccine development typically include a few thousand to 10,000 participants while a PASS might aim to detect a few adverse events per 100,000 vaccine recipients. While all available data may be utilized, prior consideration of power analyses are nonetheless crucial for interpretation in cases where statistically significant differences are not found.

Methods

This research primarily examined cohort study design and self-controlled case series (SCCS) design, estimating the power of a PASS under plausible conditions.

Results

Both the cohort study and SCCS designs necessitated large sample sizes or high event counts to guarantee adequate power. The SCCS design is particularly suited to evaluating rare adverse events. However, extremely rare events may not yield sufficient occurrences, thereby resulting in low power. Although the SCCS design can more efficiently control for time-invariant confounding in principle, it solely estimates relative measures. A cohort study design might be preferred if confounding can be adequately managed as it also estimates absolute measures. It may be an easy decision to use all the data at hand for either design. We found it necessary to estimate the sample size and number of events to be used in the study based on a priori information and anticipated results.

DOI： 10.7717/peerj.16780

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Language：English   Publisher：Vaccine  

Purpose: To investigate individual and environmental vaccination-related factors among the older adults in Japan, using administrative data. Methods: We conducted a cohort study and included people who reached the relevant age (≥65 years) for routine pneumococcal vaccination of older adults between April 2015 and March 2020. Monthly data of residents in the two municipalities from April 2014 to March 2020 and vaccination records from April 2015 to March 2020 were used. We defined five cohorts according to the year in which routine vaccinations were available. Each cohort was followed for a total of two years, with the first year being the “baseline period” and second year being the “vaccine follow-up period.” Pneumococcal vaccination data was extracted from vaccination records at “first dose.” Age, sex, socioeconomic status, comorbidities, hospital visit history, hospitalization history, Specific Health Check-ups participation, and information on contracted hospitals for pneumococcal vaccination were used as covariates. A multivariate logistic regression model was used to investigate the relationship between pneumococcal vaccination and vaccination-related factors. Odds ratios (OR) and 95 % confidence intervals (95 % CI) were calculated. Results: Analysis included 17,991 patients. Vaccination coverage was 33.6 % for all subjects. Multivariate analysis found the following as significant vaccination-related factors: female (OR: 1.18, 95 % CI: 1.11–1.26), not low income (1.76, 1.17–2.76), hospital visits: ≥once/month (1.27, 1.19–1.35), and Specific Health Check-ups participation (2.10, 1.95–2.27). No significant results were found for hospitals that contracted pneumococcal vaccination. Conclusions: Individual factors, such as sex and Specific Health Check-ups participation, were found to be important factors affecting pneumococcal vaccination among older adults in Japan. Environmental factors, such as the characteristics of residential areas, should be evaluated in further investigations.

DOI： 10.1016/j.vaccine.2023.12.009

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Background: To address the lack of an active vaccine safety surveillance system in Japan, the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study was initiated in 2021 as a pilot system using existing health insurance claims data and vaccination records. Methods: This study evaluated the value of the VENUS study by assessing the incidence of immune thrombocytopenic purpura (ITP) and Guillain-Barré syndrome (GBS) following vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) using a self-controlled case series (SCCS) design. Results: Incidence rate ratios for ITP during 28-day and 42-day risk periods were 0.89 (95% confidence interval [CI], 0.12–6.4), and 0.58 (95% CI, 0.081–4.2), respectively. Neither was statistically significant. Incidence rate ratios could not be estimated for GBS due to the limited sample size. Conclusion: The VENUS study can provide valuable insights to facilitate the establishment of an advanced vaccine monitoring system in Japan.

DOI： 10.1016/j.vaccine.2023.11.053

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Both new-onset and pre-existing hypertension are favorable indicators of clinical outcomes in patients treated with vascular endothelial growth factor inhibitors.

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Authorship：Last author   Language：Others   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Bivalent mRNA vaccine effectiveness against COVID-19 among older adults in Japan: a test-negative study from the VENUS study
Abstract

Background

Bivalent COVID-19 vaccines have been implemented worldwide since the booster vaccination campaigns of autumn of 2022, but little is known about their effectiveness. Thus, this study holistically evaluated the effectiveness of bivalent vaccines against infection in older adults in Japan.

Methods

We adopted the test-negative design using COVID-19 test data of individuals, aged ≥ 65 years, residing in three municipalities in Japan, who underwent tests in medical institutions between October 1 and December 30, 2022. Logistic regression analyses were conducted to estimate the odds of testing positive according to vaccination status. Vaccine effectiveness was defined as (1 − odds ratio) × 100&#37;.

Results

A total of 3,908 positive and 16,090 negative results were included in the analyses. Receiving a bivalent dose in addition to ≥ 2 monovalent doses was 33.6&#37; (95&#37; confidence interval [CI]: 20.8, 44.3&#37;) more effective than receiving no vaccination, and 18.2&#37; (95&#37; CI: 9.4, 26.0&#37;) more effective than receiving ≥ 2 monovalent doses but not receiving a bivalent vaccination. In addition, the effectiveness peaked at 14–20 days after administration and then gradually declined over time. Furthermore, a bivalent booster dose provided 18.6&#37; (95&#37; CI: 9.9, 26.5&#37;) additional protection among those vaccinated with ≥ 2 monovalent doses, in the absence of a previous infection history. However, we did not find sufficient evidence of effectiveness of bivalent vaccines among previously infected older adults.

Conclusions

Bivalent vaccines are effective against COVID-19 infections among older adults without a history of infection.

DOI： 10.1186/s12879-024-09035-3

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：Journal of Alzheimer's Disease  

Background: An association between poor oral health and cognitive decline has been reported. Most of these studies have considered the number of teeth as a criterion, only a few studies have analyzed the relationship between occlusal status and Alzheimer’s disease (AD). Objective: To elucidate whether posterior occlusal contact is associated with AD, focusing on the Eichner classification, among an older population aged 65 years or older in Japan. Methods: This study used monthly claims data of National Health Insurance in Japan from April 2017 to March 2020. The outcome was newly diagnosed AD defined according to ICD-10 code G30. The number of teeth was estimated by dental code data, and occlusal contact was divided into three categories, namely A, B, and C, according to the Eichner classification. Multivariate Cox proportional hazards models were used to analyze the association between a new diagnosis of AD and the Eichner classification. Results: A total of 22,687 participants were included, 560 of whom had newly diagnosed AD during a mean follow-up period of 12.2 months. The AD participants had a lower proportion of Eichner A and a higher proportion of Eichner C. After adjusting for covariates, hazard ratios (95% confidence intervals) with Eichner B and C were 1.34 (1.01–1.77) and 1.54 (1.03–2.30), respectively. Conclusions: In older people aged ≥ 65 years old, reduced posterior occlusal contact as well as tooth loss have an impact on AD. This study emphasizes the importance of paying attention to occlusal contacts to reduce the risk of AD.

DOI： 10.3233/JAD-230449

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Language：English   Publisher：National Center for Global Health and Medicine  

<p>Japan's government developed the Health Center Real-time Information-sharing System on COVID-19 (HER-SYS), the national COVID-19 surveillance system, which relies on manual data entry. Following the COVID-19 vaccination campaign, physicians were mandated to report COVID-19 cases with vaccination history <i>via</i> HER-SYS. However, concerns have arisen regarding the accuracy of this vaccination history. This study aimed to assess the validity of vaccination history recorded in HER-SYS. We used data from HER-SYS provided by three municipalities. The study cohort comprised COVID-19 cases registered in HER-SYS from February 2021 to March 2022. The validity of vaccination history in HER-SYS was assessed by cross-referencing with the Vaccination Record System (VRS) of these municipalities. We calculated sensitivity to gauge the extent of missing data in HER-SYS, and positive predictive value (PPV) to evaluate the accuracy of data entered into HER-SYS. Of the 19,260 COVID-19 cases included in the study cohort, HER-SYS and VRS identified 3,257 and 8,323 cases, respectively, as having the first-dose vaccination history. Cross-referencing identified 3,093 cases as true positives in HER-SYS. The sensitivity was 37.2% (95% confidence interval [CI]: 36.1−38.2) and the PPV was 95.0% (95% CI: 94.2−95.7). Collection of vaccination data by HER-SYS was found to be inadequate to obtain information on vaccination history of COVID-19 cases. This suggests that real-time data linkage across different systems such as HER-SYS and VRS would reduce the burden of manual data entry during the pandemic and lead to appropriate infection control measures based on more accurate information. </p>

DOI： 10.35772/ghmo.2024.01007

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Language：English   Publisher：Japan Epidemiological Association  

<p><b>Background:</b> The influence of the coronavirus disease 2019 (COVID-19) pandemic on dental care utilization may have differed according to individual characteristics or type of dental care provision. This study aimed to evaluate the changes in dental care utilization and per-attendance costs by age group and type of dental care during the COVID-19 pandemic in Japan.</p><p><b>Methods:</b> This time-series study used healthcare insurance claims data from 01/07/2019 to 09/27/2021 (143 weeks) from nine municipalities in Japan. Dental care utilization rate per week and average dental care cost per attendance by age groups (0–19 years/20–64 years/65–74 years/≥75 years) and types of dental care (outpatient/visiting) were used as outcome variables. COVID-19 pandemic waves in Japan were used as predictors: 1^st (03/23/2020–05/17/2020), 2^nd (06/22/2020–09/27/2020), 3^rd (10/26/2020–02/21/2021), 4^th (02/22/2021–06/07/2021), and 5^th (07/05/2021–09/13/2021) waves. Fixed-effects models were employed to estimate the proportional changes.</p><p><b>Results:</b> In the fixed-effects model, we observed large declines in dental care utilization during the 1^st (17.0–22.0%) and 2^nd waves (3.0–13.0%) compared to the non-pandemic wave period in all age groups. In contrast, the average dental care cost per attendance increased in all age groups by 5.2–8.6% during the 1^st wave.</p><p><b>Conclusion:</b> During the initial wave of the COVID-19 pandemic in Japan, dental care utilization decreased in all age groups, whereas the average dental care cost per attendance increased. The COVID-19 pandemic may have changed the dental care provision pattern towards less frequent and more concentrated dental care to avoid the risk of infection.</p>

DOI： 10.2188/jea.je20230323

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Language：English   Publisher：Journal of Alzheimer's Disease  

Background: The prevalence of Alzheimer's disease (AD) is increasing in Japan due to population aging. The association between sensory impairment and incident AD remains unclear. Objective: This study aimed to investigate the impact of sensory impairment on incident AD. Methods: We analyzed residents of five municipalities participating in the Longevity Improvement Fair Evidence (LIFE) Study. The participants comprised individuals who had newly applied for long-term care needs certification between 2017 and 2022 and had no cognitive impairment upon application or AD diagnosis within the preceding six months. Participants were classified according to sensory impairment status: visual impairment (VI), hearing impairment (HI), neither sensory impairment (NSI), and dual sensory impairment (DSI). The month succeeding the certification application was set as the index month, and the interval from that month until AD onset was assessed. Multivariable Cox proportional hazards analysis was performed to calculate the risk of AD onset according to sensory impairment status while adjusting for sex, age, dependence level, self-reliance level, and comorbidities. Results: Among 14,186 participants, we identified 1,194 (8.4%) who developed AD over a median follow-up period of 22.6 months. VI and HI only were not associated with incident AD. However, DSI conferred a significantly higher risk (HR: 1.6, CI: 1.1-2.2, p = 0.008) of AD onset than NSI. Conclusions: Individuals with concurrent DSI have a higher risk of developing AD than those with single or NSI. Preventing and treating sensory impairment may not only improve functional outcomes, but could also help to reduce the future risk of AD.

DOI： 10.3233/JAD-230806

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Language：English   Publisher：Journal of Antimicrobial Chemotherapy  

Background: Seasonal influenza vaccination might be considered an antimicrobial resistance (AMR) countermeasure because it can reduce unnecessary antimicrobial use for acute respiratory infection by mitigating the burden of such diseases. Objectives: To examine the association between seasonal influenza vaccination and antimicrobial use (AMU) in Japan at the community level and to examine the impact of influenza vaccination on the frequency of unnecessary antimicrobial prescription for upper respiratory infection. Methods: For patients who visited any healthcare facility in one of the 23 wards of Tokyo, Japan, due to upper respiratory infection and who were aged 65 years or older, we extracted data from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study database, which includes all claims data and vaccination records from the 2015–16 to 2020–21 seasons. We used the average treatment effect (ATE) with 1:1 propensity score matching to examine the association of vaccination status with frequency of antibiotic prescription, frequency of healthcare facility consultation, risk of admission and risk of death in the follow-up period of the same season (from 1 January to 31 March). Results: In total, 244 642 people were enrolled. Matched data included 101 734 people in each of the unvaccinated and vaccinated groups. The ATE of vaccination was −0.004 (95% CI −0.006 to −0.002) for the frequency of antibiotic prescription, −0.005 (−0.007 to −0.004) for the frequency of healthcare facility consultation, −0.001 (−0.002 to −0.001) for the risk of admission and 0.00 (0.00 to 0.00) for the risk of death. Conclusions: Our results suggest that seasonal influenza vaccination is associated with lower frequencies of unnecessary antibiotic prescription and of healthcare facility consultation.

DOI： 10.1093/jac/dkad340

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Language：English   Publisher：International Journal of Geriatric Psychiatry  

Objectives: Several studies have investigated that anticholinergic drugs cause cognitive impairment. However, the risk of dementia associated with anticholinergics has not been extensively investigated in the super-aging society of Japan. We conducted this study to assess the association between anticholinergic drugs and the risk of dementia in older adults in Japan. Methods: This nested case-control study used data from the Longevity Improvement & Fair Evidence Study, which includes claim data in Japan from 2014 to 2020. We included 66,478 cases of diagnosed dementia and 328,919 matched controls aged ≥65 years, matched by age, sex, municipality, and cohort entry year. Primary exposure was the total cumulative anticholinergic drugs prescribed from cohort entry date to event date or matched index date, which was the total standardized daily doses for each patient, calculated by adding the total dose of different types of anticholinergic drugs in each prescription, divided by the World Health Organization-defined daily dose values. Odds ratios for dementia associated with cumulative exposure to anticholinergic drugs were calculated using conditional logistic regression adjusted for confounding variables. Results: The mean (standard deviation) age at index date was 84.3 (6.9), and the percentage of women was 62.1%. From cohort entry date to event date or matched index date, 18.8% of the case patients and 13.7% of the controls were prescribed at least one anticholinergic drug. In the multivariable-adjusted model, individuals with anticholinergic drugs prescribed had significantly higher odds of being diagnosed with dementia (adjusted odds ratio, 1.50 [95% confidence interval, 1.47–1.54]). Among specific types of anticholinergic drugs, a significant increase in risk was observed with the use of antidepressants, antiparkinsonian drugs, antipsychotics, and bladder antimuscarinics in a fully multivariable-adjusted model. Conclusions: Several types of anticholinergic drugs used by older adults in Japan are associated with an increased risk of dementia. These findings suggest that the underlying risks should be considered alongside the benefits of prescribing anticholinergic drugs to this population.

DOI： 10.1002/gps.6029

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BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron BA.5 became prevalent in July 2022 in Japan. Bivalent messenger RNA (mRNA) vaccines were approved as booster doses for individuals who received the primary series or booster dose by monovalent vaccines. We aimed to assess the effectiveness of bivalent vaccines in Japanese adults aged ≥65 years. METHODS: We conducted a population-based cohort study using data collected from January 2019 to February 2023 in Japan. We included individuals aged ≥65 years in a municipality who received the first or second booster dose of monovalent mRNA vaccines. We estimated the effectiveness of the second or third booster dose of bivalent mRNA vaccines during the Omicron BA.5-predominant period (July-December 2022), compared with ≥90 days after the booster dose of monovalent vaccines. We used a Cox proportional hazard regression model with vaccination status as a time-dependent covariate. RESULTS: A total of 81 977 individuals aged ≥65 years (mean [standard deviation] age, 78.3 [7.4] years; 33 487 male [40.8%]) were included in the study cohort. Among them, 57 396 were vaccinated with the second or third dose of bivalent vaccines (BA.1 or BA.4/5). The effectiveness against coronavirus disease 2019 (COVID-19) was estimated to be 57.9% (95% confidence interval, 52.7%-62.5%) for ≥14 days after the second or third bivalent booster dose, compared with 90 days after the first or second monovalent booster dose. CONCLUSIONS: The study showed that the bivalent mRNA vaccines as the second and third doses would provide protection against COVID-19 among adults ≥65 years in Japan.

DOI： 10.1093/ofid/ofad475

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DOI： 10.32118/ayu28611921

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DOI： 10.1016/j.ijid.2023.06.017

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Background: Although the effectiveness of coronavirus disease 2019 (COVID-19) vaccines is a crucial public health concern, evidence from Western Pacific countries is limited, including Japan. This study aimed to estimate the COVID-19 vaccines effectiveness (VE) against infection during the Delta variant predominance (July–September 2021) in Japan. Methods: We performed a test-negative study using COVID-19 test data of ≥20-year-old residents in four municipalities who were tested in medical institutions between July 1 and September 30, 2021. We extracted COVID-19 test data from healthcare claims data, and the vaccination status at the testing date was ascertained using the Vaccination Record System data. Confirmed positive cases were identified using data from the national system for COVID-19, Health Center Real-time Information-sharing System on COVID-19. Logistic regression analyses were conducted to estimate the odds of testing positive according to vaccination status. VE was calculated as (1 − odds ratio) × 100%. Results: This study included 530 positive and 15,650 negative results. Adjusted manufacturer-unspecified VE was 4.1% (95% confidence interval [CI], −36.5–32.6) at 0–13 days after the first dose, 45.2% (95% CI, 13.4–65.3) at ≥14 days after the first dose, 85.2% (95% CI, 69.9–92.7) at 0–13 days after the second dose, and 79.6% (95% CI, 72.6–84.8) at ≥14 days after the second dose. In addition, the VE after the second dose was highest at 14–34 days after the dose (VE, 89.1%; 95% CI, 80.5–93.9). Conclusions: High real-world effectiveness of COVID-19 vaccines, especially two doses, against infection during the Delta variant predominance in Japan was confirmed.

DOI： 10.1016/j.vaccine.2023.07.035

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Language：English   Publisher：(一社)日本疫学会  

2019年にスタートした「Longevity Improvement & Fair Evidence(LIFE)Study」は、多地域を対象にした住民コホート型のデータベースプロジェクトである。LIFE Studyは、日本における健康寿命の延伸と健康格差の是正に向けたエビデンスの創出を目指している。現時点で、4都道府県18市町村の住民142万人の健康関連データなどを蓄積している。全年齢層および全疾患をカバーしており、日本発のリアル・ワールド・エビデンスを創出可能なプラットフォームになることが期待される。(著者抄録)

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Language：English   Publisher：Social Science and Medicine  

Economic stability is thought to be associated with health outcomes. Income changes may affect the occurrence of herpes zoster (HZ), which is a neurocutaneous disease caused by the varicella-zoster virus. This retrospective cohort study aimed to examine the associations between annual income changes and incident HZ in a Japanese population. The analysis was conducted using a database of public health insurance claims data linked with administrative data containing income levels. The study population comprised 48,317 middle-aged persons aged 45–64 years from five municipalities, and participants were followed-up from April 2016 until March 2020. Income changes were categorized as income unchanged (income in the year of interest remained within 50% of income in the previous year), income rise (income increased by more than 50% from the previous year to the year of interest), and income drop (income decreased by more than 50% from the previous year to the year of interest). Cox proportional hazards regression analyses were performed to calculate the hazard ratios of HZ for income drop and income rise (reference: income unchanged) as time-varying variables. Covariates included age, sex, and immune-related conditions. The results showed that income drop was significantly associated with a higher hazard ratio (1.15, 95% confidence interval: 1.00–1.31) for HZ. In contrast, income rise was not associated with HZ. A subgroup analysis revealed that the lowest baseline income group had a significantly higher risk of HZ when experiencing an income drop (HR: 1.56, 95% CI: 1.13–2.15). As zoster vaccination is voluntary and vaccination coverage in middle-aged persons is low in Japan, our findings indicate that it may be advantageous to promote and subsidize voluntary vaccinations for middle-aged people with low baseline income who have experienced substantial income reductions in order to reduce the risk of HZ.

DOI： 10.1016/j.socscimed.2023.115981

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Language：English   Publisher：Vaccine  

Background: There are currently no COVID-19 vaccine assessment systems in Japan that allow for the active surveillance of both vaccinated and unvaccinated persons. Herein, we describe the development of Japan's first COVID-19 vaccine effectiveness and safety assessment system with active surveillance capabilities. Methods: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study was developed as a multi-source database that links four data types at the individual resident level: Basic Resident Register (base population information), Vaccination Record System (vaccination-related information), Health Center Real-time Information-sharing System on COVID-19 (HER-SYS; information on COVID-19 occurrence), and health care claims data (information on diagnoses, hospitalizations, diagnostic tests, and treatments). These data were obtained from four municipalities. Individual residents were linked across the data types using five matching algorithms based on names, birth dates, and sex; the data were anonymized after linkage. To ascertain the viability of the VENUS Study's database for COVID-19 vaccine assessments, we examined the trends in COVID-19 vaccinations, COVID-19 cases, and polymerase chain reaction (PCR) test numbers. We also evaluated the linkage rates across the data types. Results: Our multi-source database was able to monitor COVID-19 vaccinations, COVID-19 cases, and PCR test numbers throughout the pandemic. Using the five algorithms, the data linkage rates between the COVID-19 occurrence information in the HER-SYS and the Basic Resident Register ranged from 85·4% to 91·7%. Conclusion: If used judiciously with an understanding of each data source's characteristics, the VENUS Study can provide a viable data platform that facilitates active surveillance and comparative analyses for population-based research on COVID-19 vaccine effectiveness and safety in Japan.

DOI： 10.1016/j.vaccine.2023.03.059

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Language：Others   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Background

This study was performed to assess the increased risk of herpes zoster (HZ) associated with mRNA vaccines for coronavirus disease 2019.

Methods

This population-based cohort study was conducted in 4 municipalities in Japan. Individuals covered under public health insurance systems without a history of HZ were followed from October 1, 2020 to November 30, 2021. Incidence rates of HZ within 28 days of BNT162b2 or mRNA-1273 vaccination were compared. Adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using a Poisson regression model, including vaccination status as a time-dependent covariate. Subgroup analyses by sex, age, and municipality were also conducted.

Results

A total of 339 548 individuals (median age, 74 years) were identified. During follow up, 296 242 individuals (87.2%) completed the primary series, among whom 289 213 and 7019 individuals received homologous BNT162b2 and mRNA-1273 vaccines, respectively. The adjusted IRRs of the first and second BNT162b2 vaccinations were 1.05 (95% CI, 0.84–1.32) and 1.09 (95% CI, 0.90–1.32), respectively. No cases of HZ were observed after mRNA-1273 vaccination. In subgroup analysis, the adjusted IRR of the second BNT162b2 vaccination was 2.94 (95% CI, 1.41–6.13) in individuals aged &amp;lt;50 years old.

Conclusions

No increased risk of HZ was found after BNT162b2 vaccination in the overall study population. However, an increased risk was observed in the younger subgroup.

DOI： 10.1093/ofid/ofad274

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Other Link： https://academic.oup.com/ofid/article-pdf/10/7/ofad274/51009557/ofad274.pdf

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Language：English   Publisher：Brain, Behavior, and Immunity - Health  

Physical symptoms such as fatigue and muscle weakness, and psychiatric symptoms like depression and anxiety are considered as complications and sequelae of COVID-19. This epidemiological study investigated the actual status of psychiatric symptoms and disorders caused by COVID-19, from four major university hospitals and five general hospitals in Fukuoka Prefecture, Japan, having a population of 5 million. We conducted a survey of psychiatric disorders associated with COVID-19 using Diagnosis Procedure Combination (DPC) data and the psychiatric records of the hospitals. In the study period from January 2019 to September 2021, 2743 COVID-19 admissions were determined from DPC data across the nine sites. These subjects had significantly more anxiety, depression, and insomnia, and were receiving higher rates of various psychotropic medications than controls influenza and respiratory infections. A review of psychiatric records revealed that the frequency of organic mental illness with insomnia and confusion was proportional to the severity of COVID-19 infection and that anxiety symptoms appeared independent of infection severity. These results indicate that COVID-19 is more likely to produce psychiatric symptoms such as anxiety and insomnia than conventional infections.

DOI： 10.1016/j.bbih.2023.100615

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Language：English   Publisher：Cancer Epidemiology  

Background: People with metabolic syndrome have an elevated risk of developing colorectal cancer (CRC), and are recommended to undergo cancer screening. This study examined the association between metabolic syndrome and CRC screening participation in Japan. Methods: This retrospective cohort study was conducted using insurance claims data, health checkup data, and cancer screening data from a Japanese city. The study population comprised persons aged 40–74 years who had undergone health checkups between fiscal years (FY) 2016 and 2019. The exposure was metabolic syndrome risk (high risk, moderate risk, and no risk) as determined during health checkups. The outcome was CRC screening participation. Logistic regression analyses were performed to examine the associations between metabolic syndrome risk and CRC screening participation. Results: We analyzed 20,558 people in the FY2016 cohort, 19,065 people in the FY2017 cohort, 17,496 people in the FY2018 cohort, and 15,647 people in the FY2019 cohort. The odds of CRC screening participation were significantly lower in the moderate-risk group (P < 0.05) in all FYs except FY2019 and the high-risk group (P < 0.001) in all FYs when compared with the no-risk group. When analyzed according to age group, older persons aged 65–74 years generally had significantly lower odds of CRC screening participation than persons aged 40–49 years across all metabolic syndrome risk groups. Conclusion: This is the first study from Japan to show that people with metabolic syndrome, especially older persons aged 65–74 years, are less likely to undergo CRC screening than people without metabolic syndrome. These findings indicate a need to develop and implement age-specific measures to increase cancer screening uptake among persons with metabolic syndrome.

DOI： 10.1016/j.canep.2023.102335

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Language：English   Publisher：BMJ Open  

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan. Design Retrospective study. Setting Six hundred and thirty-one primary care institutions in Japan. Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database. Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3-6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1-25 points). Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality. Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.

DOI： 10.1136/bmjopen-2022-068642

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Language：English   Publisher：PLoS ONE  

Objective Japan introduced a financial incentive scheme in April 2016 to improve hospital-based dementia care, but its effectiveness remains unclear. This study aimed to investigate the scheme's impact on medical and long-term care (LTC) expenditures, as well as on changes in care needs levels and daily living independence levels among older persons one year after hospital discharge. Methods We linked medical and LTC claims databases, and retrospectively identified patients who received LTC needs certification and daily living independence assessments in Fukuoka, Japan. Case patients (received care under the new scheme) were those admitted from April 2016 to March 2018, and control patients were those admitted from April 2014 to March 2016 (before the scheme was implemented). Through propensity score matching, we identified 260 case patients and 260 control patients, and compared using t-tests, and chi-square tests. Results The analyses found no significant differences between the case and control groups in medical expenditure (US$26,685 vs US$24,823, P = 0.37), LTC expenditure (US$16,870 vs US $14,374, P = 0.08), daily living independence level changes (26.5% vs 20.4%, P = 0.12), or care needs level changes (36.9% vs 30%, P = 0.11). Conclusions The financial incentive scheme for dementia care did not demonstrate any beneficial effects on patients' healthcare expenditures or health conditions. Further studies are needed to examine the scheme's long-term effects.

DOI： 10.1371/journal.pone.0282965

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The protective effect of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against cardiovascular disease has been investigated in the United States and Europe; however, its effect has not been fully established. This study aimed to investigate the protective effect of PPSV23 on cardiovascular events in adults aged ≥ 65 years. This population-based nested case-control study was conducted using the claims data and vaccine records between April 2015 and March 2020 from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study. PPSV23 vaccination was identified using vaccination records in each municipality. The primary outcome was acute myocardial infarction (AMI) or stroke. The adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for PPSV23 vaccination were calculated using conditional logistic regression. Among 383,781 individuals aged ≥ 65 years, 5,356 and 25,730 individuals with AMI or stroke were matched with 26,753 and 128,397 event-free controls, respectively. Individuals who were PPSV23 vaccinated, compared with the unvaccinated individuals, had significantly lower odds of AMI or stroke events (aOR, 0.70 [95% CI, 0.62-0.80] and aOR, 0.81 [95% CI, 0.77-0.86], respectively). More recent PPSV23 vaccination was associated with lower odds ratios (AMI, aOR 0.55 [95% CI, 0.42-0.72] for 1-180 days and aOR 1.11 [95% CI, 0.84-1.47] for 720 days or longer; stroke, aOR 0.83 [95% CI, 0.74-0.93] for 1-180 days and aOR 0.90 [95% CI, 0.78-1.03] for 720 days or longer). Among Japanese older adults, individuals who were PPSV23 vaccinated, compared with unvaccinated individuals, had significantly lower odds of AMI or stroke events.

DOI： 10.1016/j.vaccine.2023.02.077

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science (PLoS)  

Background

The Sustaining Health by Integrating Next-generation Ecosystems (SHINE) Study was developed as a data platform that incorporates personal health records (PHRs) into health-related data at the municipal level in Japan. This platform allows analyses of the associations between PHRs and future health statuses, and supports the production of evidence for developing preventive care interventions. Herein, we introduce the SHINE Study’s profile and describe its use in preliminary analyses.

Methods

The SHINE Study involves the collection of participants’ health measurements and their addition to various health-related data from the Longevity Improvement &amp; Fair Evidence (LIFE) Study. With cooperation from municipal governments, measurements can be acquired from persons enrolled in government-led long-term care prevention classes and health checkups who consent to participate in the SHINE Study. For preliminary analyses, we collected salivary test measurements, lifelog measurements, and gait measurements; these were linked with the LIFE Study’s database. We analyzed the correlations between these measurements and the previous year’s health care expenditures.

Results

We successfully linked PHR data of 33 participants for salivary test measurements, 44 participants for lifelog measurements, and 32 participants for gait measurements. Only mean torso speed in the gait measurements was significantly correlated with health care expenditures (r = -0.387, P = 0.029).

Conclusion

The SHINE Study was developed as a data platform to collect and link PHRs with the LIFE Study’s database. The analyses undertaken with this platform are expected to contribute to the development of preventive care tools and promote health in Japan.

DOI： 10.1371/journal.pone.0281512

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DOI： 10.1111/jgs.18068

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Public Health  

Association between periodontal pocket depth determined during dental check-ups and new onset of diabetes in community residents: the LIFE study

DOI： 10.11236/jph.22-038

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Language：Japanese   Publisher：日本公衆衛生学会  

目的 近年,糖尿病と歯周病には双方向の関連性があることが多数報告されている。しかしながら,歯周ポケットの深さと糖尿病の新規発症に関する縦断的な関連性についてはさらなる議論の余地がある。従って,本研究は地域住民における成人歯科健診データを用いて,歯周ポケットの深さと糖尿病の新規発症の関連性を検証することを目的とした。方法 本研究は,東京都某区で2016年4月から2019年3月までに成人歯科健診を受診した20歳以上の成人5,163人(57.4±13.9歳,女性66.3%)を対象として,歯科健診の歯周ポケットコードを用いて歯周ポケット健全群,4～5mm群,6mm以上群の3群に分類し2020年3月末日まで追跡を行った。さらに同区の国民健康保険および後期高齢者医療保険の医科レセプトデータ傷病名から,疑い病名を除く糖尿病のICD10コードを抽出し,歯科健診の受診日以降に発症した者を糖尿病ありと定義してアウトカムに用いた。糖尿病発症率の比較にはログランク検定及びCox比例ハザード回帰分析を用いた生存時間分析と感度分析を行った。結果 ログランク検定の結果,3群間の糖尿病累積発症率は有意に異なっていた(P<0.01)。また,性別,年齢,喫煙習慣,現在歯数,口腔清掃状態を調整したCox比例ハザード回帰分析の結果,歯周ポケット健全群に対する6mm以上群の調整ハザード比(95%信頼区間)は1.44(1.04-2.00)倍の有意な関連性が認められた。さらに40歳以上を対象とした感度分析の調整ハザード比(95%信頼区間)は歯周ポケット健全群に対して6mm以上群が1.55(1.11-2.16)倍,40歳以上の男性では1.72(1.04-2.85)倍の有意な関連性を認めた。しかし,40歳以上の女性には有意な関連性は認められなかった(1.39[0.89-2.18])。結論 本研究の結果,地域住民において歯周ポケットの深さと糖尿病の発症に関する縦断的な関連性が示唆された。特に,40歳以上の男性においてその関連性が顕著であったことから,40歳未満の若年層とりわけ若い男性に対して適切な歯科保健指導を実践し口腔状態を良好に保つことは口腔衛生の観点のみならず,将来的な糖尿病予防の観点からも重要であると考えられる。(著者抄録)

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Language：English   Publisher：Journal of Alzheimer's Disease  

Background: Accurate epidemiological data on mild cognitive impairment (MCI) and Alzheimer's disease (AD) can inform the development of prevention and control measures, but there is a lack of such data in Japan. Objective: To investigate the disease burden and progression in patients with new-onset MCI or AD in Japan. Methods: Using claims data, this multi-region cohort study was conducted on new-onset MCI and AD patients in 17 municipalities from 2014 to 2021. To characterize the patients, we investigated their age, comorbidities, and long-term care (LTC) needs levels at disease onset according to region type (urban, suburban, or rural). Disease burden was examined using health care expenditures and LTC expenditures, which were estimated for 1, 2, and 3 years after disease onset. Kaplan-Meier curves were plotted for AD progression in new-onset MCI patients and death in new-onset AD patients. Results: We analyzed 3,391 MCI patients and 58,922 AD patients. In MCI and AD patients, health care expenditures were high in the first year ($13,035 and $15,858, respectively), but had declined by the third year ($8,278 and $10,414, respectively). In contrast, LTC expenditures (daily living support) steadily increased over the 3-year period (MCI patients: $1,767 to $3,712, AD patients: $6,932 to $9,484). In the third year after disease onset, 30.9% of MCI patients developed AD and 23.3% of AD patients had died. Conclusions: This provides an important first look at the disease burden and progression of MCI and AD in Japan, which are high-priority diseases for a rapidly aging population.

DOI： 10.3233/JAD-230471

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Risk of cardiovascular events leading to hospitalization after Streptococcus pneumoniae infection: A retrospective cohort LIFE study.

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BACKGROUND: Vaccine effectiveness against the severe acute respiratory syndrome coronavirus 2 Omicron BA.2 sublineage in Japan is unknown. We assessed the effectiveness of a third dose of COVID-19 mRNA vaccine compared with that of 2 doses. METHODS: We performed a population-based cohort study using a municipality database located in the Chubu region of Japan during the Omicron BA.1- and BA.2-predominant periods (January 1-March 31, 2022 and April 1-27, 2022, respectively). We included residents aged ≥16 years who received a second vaccine dose at ≥14 days before the start of each period, regardless of the third dose. We compared the data at 14 days after the second and third dose and at 2-week intervals from 14 days to 10 weeks after the third dose using a Cox regression model. Vaccine effectiveness was defined as (1 - hazard ratio) × 100 (%). RESULTS: In total, 295 705 and 288 184 individuals were included in the BA.1- and BA.2-predominant periods, respectively. The effectiveness of a third dose against infection was 62.4% and 48.1% in the BA.1- and BA.2-predominant periods, respectively. Vaccine effectiveness at 2-3 weeks and ≥10 weeks after the third dose decreased from 63.6% (95% confidence interval [CI], 56.4-69.5%) to 52.9% (95% CI, 41.1-62.3%) and from 54.5% (95% CI, 3.0-78.7%) to 40.1% (95% CI, 15.1-57.7%) in the BA.1- and BA.2-predominant periods, respectively. CONCLUSIONS: A third dose was moderately effective against BA.1 and BA.2 sublineages, but its effectiveness decreased by approximately 10% age points from 2-3 weeks to ≥10 weeks after the third vaccination.

DOI： 10.1093/ofid/ofac636

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Effectiveness of messenger RNA vaccines against infection with SARS-CoV-2 during the periods of Delta and Omicron variant predominance in Japan: the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study
OBJECTIVES: We aimed to evaluate COVID-19 messenger RNA vaccine effectiveness during the Delta- and Omicron-predominant periods in Japan. METHODS: We conducted a population-based cohort study among individuals aged 16-64 years during two periods: the Delta-predominant period (July 1-December 31, 2021) and the Omicron-predominant period (January 1-March 29, 2022). RESULTS: When comparing individuals who were vaccinated with those who were unvaccinated, the effectiveness of a second dose against symptomatic infection was 89.8&#37; (95&#37; confidence interval [CI]: 80.5-94.7&#37;) during the Delta-predominant period and 21.2&#37; (95&#37; CI: 11.0-30.3&#37;) during the Omicron-predominant period. The effectiveness of a third dose against symptomatic infection was 71.8&#37; (95&#37; CI: 60.1-80.1&#37;) during the Omicron-predominant period. CONCLUSION: Vaccine effectiveness against symptomatic infection decreased during the Omicron-predominant period but was maintained by a third dose.

DOI： 10.1016/j.ijid.2022.10.001

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The Effect of renin-angiotensin system inhibitors in cancer patients treated with anti-VEGF therapy.

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Language：English   Publisher：Open Heart  

Background Cancer treatment with vascular endothelial growth factor signalling pathway (VSP) inhibitors frequently causes hypertension. Although previous reports suggested that the antihypertensive drug renin-angiotensin system inhibitor (RASI) may have a positive synergistic effect with VSP inhibitors, the actual impact on clinical outcomes is unknown. Objectives The study aims to clarify whether RASIs exhibit clinical benefits for patients with cancer with hypertension. Method From the Longevity Improvement and Fair Evidence Study database, comprising Japanese claims data between 2016 and 2020, we reviewed 2380 patients treated with VSP inhibitors who received antihypertensive treatment during cancer therapy. The patients were classified into two groups: with-RASI (n=883) and without-RASI (n=1497). In addition, 1803 of these patients treated for hypertension with RASI-only (n=707) or calcium channel blocker-only (n=1096) were also reviewed. The time-to-treatment failure (TTF), the interval from initiation of chemotherapy to its discontinuation, was applied as the primary endpoint. Results The median TTFs were 167 (60-382) days in the with-RASI group and 161 (63-377) days in the without-RASI group (p=0.587). All models, including Cox proportional hazard models and multiple propensity score models, did not reveal the superiority of with-RASI treatment. In the propensity score matching model, the HR for treatment with-RASI compared with that for without-RASI was 0.96 (95% CI 0.86 to 1.06, p=0.386). In addition, the TTFs of RASI-only were not superior to calcium channel blocker-only (p=0.584). Conclusions RASIs for hypertension do not benefit clinical outcomes during cancer therapy with VSP inhibitors. In addition, RASIs and calcium channel blockers have comparable clinical efficacy as first-line antihypertensive.

DOI： 10.1136/openhrt-2022-002135

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Background: Donepezil is frequently used to treat Alzheimer’s disease (AD) symptoms but is associated with early discontinuation. Determining the persistence rates of anti-dementia drug use after donepezil initiation may inform the development and improvement of treatment strategies, but there is little evidence from Japan. Objective: To determine anti-dementia drug persistence following donepezil initiation among AD patients in Japan using insurance claims data. Methods: Insurance claims data for AD patients with newly prescribed donepezil were obtained from 17 municipalities between April 2014 and October 2021. Anti-dementia drug persistence was defined as a gap of ≤60 days between the last donepezil prescription and a subsequent prescription of donepezil, another cholinesterase inhibitor, or memantine. Cox proportional hazards models were used to analyze the association between care needs levels and discontinuation. Results: We analyzed 20,474 AD patients (mean age±standard deviation: 82.2±6.3 years, women: 65.7%). The persistence rates were 89.1% at 30 days, 79.4% at 90 days, 72.6% at 180 days, 64.5% at 360 days, and 58.3% at 540 days after initiation. Among the care needs levels, the hazard ratio (95% confidence interval) for discontinuation was 1.01 (0.94–1.07) for patients with support needs, 1.12 (1.06–1.18) for patients with low long-term care needs, and 1.31 (1.21–1.40) for patients with moderate-to-high long-term care needs relative to independent patients. Conclusion: Japanese AD patients demonstrated low anti-dementia drug persistence rates that were similar to those of other countries. Higher long-term care needs were associated with discontinuation. Further measures are needed to improve drug persistence in AD patients.

DOI： 10.3233/jad-220200

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Objectives To elucidate the risk of cardiovascular event occurrence following Streptococcus pneumoniae infection. Design Retrospective cohort study using a LIFE Study database. Setting Three municipalities in Japan. Participants Municipality residents who were enrolled in either National Health Insurance or the Latter-Stage Elderly Healthcare System from April 2014 to March 2020. Exposure Occurrence of S. pneumoniae infection. Primary outcome measures Occurrence of one of the following cardiovascular events that led to hospitalisation after S. pneumoniae infection: (1) coronary heart disease (CHD), (2) heart failure (HF), (3) stroke or (4) atrial fibrillation (AF). Results S. pneumoniae-infected patients were matched with non-infected patients for each cardiovascular event. We matched 209 infected patients and 43 499 non-infected patients for CHD, 179 infected patients and 44 148 non-infected patients for HF, 221 infected patients and 44 768 non-infected patients for stroke, and 241 infected patients and 39 568 non-infected patients for AF. During follow-up, the incidence rates for the matched infected and non-infected patients were, respectively, 38.6 (95% CI 19.9 to 67.3) and 30.4 (29.1 to 31.8) per 1000 person-years for CHD; 69.6 (41.9 to 108.8) and 50.5 (48.9 to 52.2) per 1000 person-years for HF; 75.4 (48.3 to 112.2) and 35.5 (34.1 to 36.9) per 1000 person-years for stroke; and 34.7 (17.9 to 60.6) and 11.2 (10.4 to 12.0) per 1000 person-years for AF. Infected patients were significantly more likely to develop stroke (adjusted HR: 2.05, 95% CI 1.22 to 3.47; adjusted subdistribution HR: 1.94, 95% CI 1.15 to 3.26) and AF (3.29, 1.49 to 7.26; 2.74, 1.24 to 6.05) than their non-infected counterparts. Conclusions S. pneumoniae infections elevate the risk of subsequent stroke and AF occurrence. These findings indicate that pneumococcal infections have short-term effects on patients' health and increase their midterm to long-term susceptibility to serious cardiovascular events.

DOI： 10.1136/bmjopen-2021-059713

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Development and application of a Japanese vaccine database for comparative assessments in the post-authorization phase: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study.
BACKGROUND: Japan currently lacks a data platform that can support quantitative assessments of the causal relationships between vaccines and adverse events. This study describes the development and application of the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study to facilitate such assessments. METHODS: A database was created by linking public insurance enrollees' claims data with vaccination records acquired from participating municipalities. To provide an overview of the study data, we produced descriptive statistics of sex, age, and vaccinations. We also conducted a pilot study using the database to assess influenza vaccine safety during the 2018/2019 season among older persons (≥65 years) residing in a single municipality. RESULTS: Our database was created using data from approximately 1.12 million individuals in 7 municipalities between 2013 and 2020. The data during fiscal year 2018 included 853,016 individuals (male: 363,079, female: 489,937) with a median age of 70 years (interquartile range: 52-79). We obtained information on 17 vaccine types, including the pneumococcal vaccine and influenza vaccine. In the pilot study, we analyzed 48,723 vaccinated persons matched with 48,723 unvaccinated persons. The only adverse event that occurred in both groups was Bell's palsy, which had an adjusted incidence rate ratio of 1.21 (95 &#37; confidence interval: 0.48-3.07). CONCLUSIONS: The VENUS Study is Japan's first healthcare data platform that enables comparative assessments of vaccinated and unvaccinated persons in large samples covering all age groups. Efforts are underway to increase the number of participating municipalities and to generate evidence on vaccine effectiveness and safety.

DOI： 10.1016/j.vaccine.2022.08.069

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Influenza vaccine effectiveness against hospitalization during the 2018/2019 season among older persons aged ≥ 75 years in Japan: The LIFE-VENUS Study.
BACKGROUND: Older persons are recommended to receive annual influenza vaccinations due to their increased susceptibility to influenza infections and related complications. Routine assessments of influenza vaccine effectiveness (IVE) in older persons may help to improve vaccine development and vaccination strategies, but there is a lack of consistent epidemiological data from Japan. This study aimed to evaluate IVE against hospitalization during the 2018/2019 season among older persons aged ≥ 75 years in Japan. METHODS: This cohort study was conducted using insurance claims data and vaccination records provided by the Longevity Improvement & Fair Evidence - Vaccine Effectiveness, Networking, and Universal Safety (LIFE-VENUS) Study. The study cohort comprised older persons aged ≥ 75 years residing in an urban municipality in Japan. Vaccinated participants were identified through vaccination records from October 2018 to January 2019, and were matched with unvaccinated participants using a 1:1 ratio. The IVE against hospitalization was calculated as (1-hazard ratio) × 100&#37; while adjusting for covariates such as age, sex, comorbidities, previous vaccinations, and care needs levels. RESULTS: We analyzed 30,881 vaccinated participants matched with 30,881 unvaccinated participants. Among these, 587 (1.9&#37;) vaccinated participants and 644 (2.1&#37;) unvaccinated participants were hospitalized during the 2018/2019 season. The adjusted IVE against hospitalization was estimated to be 28.9&#37; (16.6-39.4&#37;). CONCLUSIONS: The influenza vaccine for the 2018/2019 season showed moderate effectiveness among older persons in Japan. The LIFE-VENUS Study represents a potential platform for the continued monitoring of IVE among the older Japanese population.

DOI： 10.1016/j.vaccine.2022.07.002

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Medical visits and health-care expenditures of patients attending orthopedic clinics during the COVID-19 pandemic in Japan: LIFE Study
Abstract

Background

The first state of emergency for coronavirus disease 2019 (COVID-19) in Japan was imposed from April to May 2020. During that period, people were urged to avoid non-essential outings, which may have reduced their access to health care.

Methods

Using health-care claims data from a city in Fukuoka prefecture, Japan, we conducted a retrospective cohort study of the state of emergency’s impact on patients’ medical visits to orthopedic clinics and their associated health-care expenditures. These measures were compared between 2019 and 2020 using a year-over-year analysis and unpaired t-tests.

Results

The analysis showed that medical visits in 2020 significantly decreased by 23.7&#37; in April (P &amp;lt; 0.01) and 17.6&#37; in May (P &amp;lt; 0.01) when compared with the previous year. Similarly, monthly outpatient health-care expenditure significantly decreased by 2.4&#37; (P &amp;lt; 0.01) in April 2020 when compared with April 2019. In contrast, the health-care expenditure per capita per visit significantly increased by 1.5&#37; (P &amp;lt; 0.01) in June 2020 (after the state of emergency was lifted) when compared with June 2019.

Conclusion

As orthopedic clinics in Japan are reimbursed using a fee-for-service system, the increases in per capita expenditures after the state of emergency may be indicative of physician-induced demand. However, we posit that it is more likely that a post-emergency increase in anti-inflammatory and analgesic treatments for spondylopathies, low back pain and sciatica induced a temporary rise in these expenditures.

DOI： 10.1093/intqhc/mzac056

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Background: Characterising the psychiatric sequelae of coronavirus disease 2019 (COVID-19) can inform the development of long-term treatment strategies. However, few studies have examined these sequelae at different time points after COVID-19 infection. Aims: The study aimed to investigate the incidences and risks of acute and delayed psychiatric sequelae in patients hospitalised with COVID-19 in Japan. Methods: This retrospective cohort study was conducted using a database comprising healthcare claims data from public health insurance enrollees residing in a Japanese city. We analysed a primary cohort comprising patients hospitalised with COVID-19 between March 2020 and July 2021 and two control cohorts comprising patients hospitalised with influenza or other respiratory tract infections (RTI) during the same period. We calculated the incidences of acute (1-3 months after infection) and delayed (4-6 months after infection) psychiatric sequelae. These sequelae were identified using diagnosis codes and categorised as mood/anxiety/psychotic disorder, mood disorder, anxiety disorder, psychotic disorder or insomnia. Multivariable logistic regression models were used to estimate the odds ratios (ORs) of psychiatric sequelae occurrence after COVID-19 infection compared with influenza and other RTI. Results: The study population with acute psychiatric sequela consisted of 662 patients with COVID-19, 644 patients with influenza, and 7369 patients with RTI who could be followed for 3 months; the study population with delayed psychiatric sequelae consisted of 371 patients with COVID-19, 546 patients with influenza, and 5397 patients with RTI who could be followed for 6 months. In the analysis of acute psychiatric sequelae, COVID-19 had significantly higher odds of mood/anxiety/psychotic disorder (OR: 1.39, p=0.026), psychotic disorder (OR: 2.13, p<0.001), and insomnia (OR: 2.59, p<0.001) than influenza, and significantly higher odds of insomnia (OR: 1.44, p=0.002) and significantly lower odds of anxiety disorder (OR: 0.56, p<0.001) than other RTI. In the analysis of delayed psychiatric sequelae, COVID-19 had significantly higher odds of psychotic disorder (OR: 2.25, p=0.007) than influenza, but significantly lower odds of anxiety disorder (OR: 0.55, p=0.011) than other RTI. Conclusions: COVID-19 was generally associated with an increased risk of psychiatric sequelae occurring within 3 months after infection, but had a lower risk of new psychiatric sequelae developing 4-6 months after infection.

DOI： 10.1136/gpsych-2022-100802

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Authorship：Lead author,　Corresponding author  

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Language：English   Publisher：International Journal of Infectious Diseases  

Objectives: This study aimed to identify the risk factors for pneumococcal disease. Methods: The study was performed using insurance claims data from the residents of 12 Japanese municipalities. Based on recorded diagnoses, we identified chronic medical conditions in each patient between April 2015 and March 2016 and examined the subsequent occurrence of a pneumococcal disease from April 2016 onward. Cox proportional hazards models were used to estimate the hazard ratio of each chronic medical condition for a pneumococcal disease occurrence. Results: The study was conducted on 732,235 patients, of whom, 61,306 (8.4%) were aged 0-18 years, 184,367 (25.2%) were aged 19-49 years, 126,078 (17.2%) were aged 50-64 years, and 360,484 (49.2%) were aged ≥65 years. A higher number of conditions was associated with a higher incidence of pneumococcal disease. Significant risk factors for pneumococcal disease in all patients included chronic heart disease, chronic lung disease, diabetes mellitus, cancer, and chronic renal disease. Furthermore, chronic lung disease, diabetes mellitus, aspiration pneumonia, and immunosuppressant use were risk factors among patients aged 50-64 years. Conclusions: Persons aged 50-64 years with multiple chronic medical conditions or with specific conditions are at a higher risk of developing pneumococcal disease, indicating a need to consider their inclusion in routine vaccination programs.

DOI： 10.1016/j.ijid.2021.12.365

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Language：English   Publisher：National Institute of Public Health  

<p><b>Objectives</b>: The decision-making process for vaccination programs must be informed by cost-effectiveness analyses. This study was performed to quantify the medical expenditures for pneumococcal disease (PD) in Japan.</p><p><b>Methods</b>: Surveillance data from the Japan Nosocomial Infections Surveillance program and insurance claims data were collected from community-acquired PD patients admitted to 29 hospitals in Japan. Patients with positive blood specimens were designated as having invasive PD (IPD). We estimated the medical expenditures incurred during the PD hospitalization episodes.</p><p><b>Results</b>: The study sample comprised 1,358 PD patients from 28 hospitals between April 2015 and September 2017. Of these, 69 were IPD patients and 1,289 were non-IPD patients. The mean medical expenditures (standard deviation) for all PD patients, IPD patients, and non-IPD patients were estimated to be $6,610 ($13,133), $13,975 ($16,415), and $6,216 ($12,823), respectively.</p><p><b>Conclusion</b>: This study is the first to quantify the medical expenditures for community-acquired PD in Japan.</p>

DOI： 10.20683/jniph.71.1_87

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Risk factors for pneumococcal disease in persons with chronic medical conditions: Results from the LIFE Study.

Language：English   Publishing type：Research paper (scientific journal)  

There are few multicenter investigations regarding the relationship between antimicrobial resistance (AMR) and infection-control activities in Japanese hospitals. Hence, we aimed to identify Japanese hospital subgroups based on facility characteristics and infection-control activities. Moreover, we evaluated the relationship between AMR and hospital subgroups. We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in 124 hospitals from April 2016 to March 2017. Hospitals were classified using cluster analysis based the principal component analysis-transformed data. We assessed the relationship between each cluster and AMR using analysis of variance. Ten variables were selected and transformed into four principal components, and five clusters were identified. Cluster 5 had high infection control activity. Cluster 2 had partially lower activity of infection control than the other clusters. Clusters 3 and 4 had a higher rate of surgeries than Cluster 1. The methicillin-resistant Staphylococcus aureus (MRSA)/S. aureus detection rate was lowest in Cluster 1, followed, respectively, by Clusters 5, 2, 4, and 3. The MRSA/S. aureus detection rate differed significantly between Clusters 4 and 5 (p = 0.0046). Our findings suggest that aggressive examination practices are associated with low AMR whereas surgeries, an infection risk factor, are associated with high AMR.

DOI： 10.3390/antibiotics11020229

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Language：English   Publisher：国立保健医療科学院  

目的:ワクチン接種プログラムの意思決定プロセスには,費用対効果評価が必要である.本研究の目的は,市中肺炎球菌感染症(PD)による医療費を推定することである.方法:日本の29のDPC対象病院に入院した市中肺炎球菌感染症患者について,厚生労働省院内感染対策サーベイランス事業(JANIS)の検査部門データとDPCデータを突合した.JANISデータにおいて血液検体が陽性の患者を侵襲性肺炎球菌感染症(IPD)と定めた.市中肺炎球菌感染症症例の医療費を推定した.結果:解析対象症例は28病院における1,358症例である.IPD症例は69症例,非IPD症例は1,289症例であった.全PD症例,IPD症例,非IPD症例における平均医療費(標準偏差)は,それぞれ6,610ドル(13,133ドル),13,975ドル(16,415ドル),6,216ドル(12,823ドル)と推定された.結論:本研究は日本において市中肺炎球菌感染症による医療費を初めて定量化することができた.(著者抄録)

Authorship：Lead author,　Corresponding author  

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Language：Others   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

Economic Status and Mortality in Patients with Alzheimer's Disease in Japan: The Longevity Improvement and Fair Evidence Study

DOI： 10.1016/j.jamda.2021.08.025

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Language：Japanese   Publisher：一般財団法人 医薬品医療機器レギュラトリーサイエンス財団  

DOI： 10.51018/pmdrs.53.6_507

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To compare the incremental costs and healthcare utilization of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with those of methicillin-susceptible S. aureus (MSSA) bacteremia. DESIGN: Retrospective cohort study using data from April 2014 to March 2015. SETTING: Antimicrobial resistance surveillance and hospital claims data from 16 Japanese hospitals. PATIENTS: The study included 73 patients with S. aureus bacteremia: 23 with MRSA and 50 with MSSA. METHODS: MRSA bacteremia was identified using blood cultures and drug-susceptibility tests. MRSA- and MSSA-related medical practices were evaluated. The costs were calculated and compared. All the medical costs were classified into empirical and definitive therapy periods and expressed in Japanese yen (JPY, 1 USD = 106 JPY). Additionally, costs at aggressive and passive bacterial test-performing facilities were compared. RESULTS: No significant differences existed in MRSA-related resource use per patient episode between MRSA and MSSA bacteremia during empirical therapy. However, during definitive therapy, in MRSA bacteremia compared with MSSA bacteremia, this difference was higher. The average MRSA-related costs of empirical therapy for MRSA and MSSA were 13,380 and 9,140 JPY (126 and 86 USD) per patient, and for definitive therapy, they were 69,810 and 29,510 JPY (659 and 278 USD) per patient, respectively. No significant differences were noted. Conversely, the average examination costs during definitive therapy differed significantly: 9,740 vs 3,850 JPY (92 vs 36 USD), respectively (P = .0294). Furthermore, the incremental costs in aggressive facilities were lower for the definitive therapy period than those in passive facilities. CONCLUSIONS: In the definitive therapy period, MRSA bacteremia had higher incremental costs and greater use of healthcare resources. In addition, the incremental costs in aggressive facilities were lower than those in passive facilities.

DOI： 10.1017/ash.2022.280

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DOI： 10.1002/alz.053750

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Medical Care and Long-Term Care Expenditures Attributable to Alzheimer's Disease Onset: Results from the LIFE Study.
BACKGROUND: Alzheimer's disease (AD) can increase both medical care and long-term care (LTC) costs, but the latter are frequently neglected in estimates of AD's economic burden. OBJECTIVE: To elucidate the economic burden of new AD cases in Japan by estimating patient-level medical care and LTC expenditures over 3 years using a longitudinal database. METHODS: The study was performed using monthly claims data from residents of 6 municipalities in Japan. We identified patients with new AD diagnoses between April 2015 and March 2016 with 3 years of follow-up data. Medical care and LTC expenditures were estimated from 1 year before onset until 3 years after onset. To quantify the additional AD-attributable expenditures, AD patients were matched with non-AD controls using propensity scores, and their differences in expenditures were calculated. RESULTS: After propensity score matching, the AD group and non-AD group each comprised 1748 individuals for analysis (AD group: mean age±standard deviation, 81.9±7.6 years; women, 66.0&#37;). The total additional expenditures peaked at &#36;1398 in the first month, followed by &#36;1192 and &#36;1031 in the second and third months, respectively. The additional LTC expenditures increased substantially 3 months after AD onset (&#36;227), and gradually increased thereafter. These additional LTC expenditures eventually exceeded the additional medical care expenditures in the second year after AD onset. CONCLUSION: Although total AD-attributable expenditures peaked just after disease onset, the impact of LTC on these expenditures rose over time. Failure to include LTC expenditures would severely underestimate the economic burden of AD.

DOI： 10.3233/JAD-201508

Language：Japanese  

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Changes to hospital inpatient volume after newspaper reporting of medical errors.

Language：Others   Publishing type：Research paper (scientific journal)  

The background occurrence of selected clinical conditions prior to the start of an extensive national vaccination program in Japan
Introduction

The COVID-19 pandemic caused by SARS-CoV-2 has now affected tens of millions of people globally. It is the hope that vaccines against SARS-CoV-2 will deliver a comprehensive solution to this global pandemic; however, this will require extensive national vaccination programs. Ultimately, clinical conditions and even sudden unexplained death will occur around the time of vaccination, thus a distinction needs to be made between events that are causally related to the vaccine or temporally related to vaccination. This study aimed to estimate the background occurrence of 43 clinical conditions in the Japanese population.

Methods

A retrospective cohort study was conducted from 2013 to 2019 using data from two large healthcare claims databases (MDV and JMDC) in Japan. The estimated number of new cases and incidence were calculated based on the actual number of new cases identified in the databases. The PubMed and Ichushi-web databases, as well as grey literature such as guidelines and government statistics, were also searched to identify any publications related to incidence of these conditions in Japan.

Results and conclusion

The estimates of the number of total cases and incidence were similar for the MDV and JMDC databases for some diseases. In addition, some estimates were similar to those in the scientific literature. For example, from the MDV and JMDC databases, estimates of incidence of confirmed Bell’s palsy in 2019 were 41.7 and 47.9 cases per 100,000 population per year, respectively. These estimates were of the same order from the scientific publication. Determining whether clinical conditions occurring around the time of vaccination are causally or only temporally related to vaccination will be critical for public health decision makers as well as for the general public. Comparison of background occurrence at the population level may provide some additional objective evidence for the evaluation of temporality or causality.

DOI： 10.1371/journal.pone.0256379

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National database study of trends in bacteraemia aetiology among children and adults in Japan: a longitudinal observational study.

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DOI： 10.1016/j.jval.2020.10.022

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Healthcare resources attributable to methicillin-resistant Staphylococcus aureus orthopedic surgical site infections.

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Low-intensity pulsed ultrasound is frequently used to treat fractures after osteosynthesis in elderly patients: A study using open data from the National Database of Health Insurance Claims of Japan.

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DOI： 10.1016/j.jiac.2020.04.008

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DOI： 10.1371/journal.pone.0237316

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DOI： 10.1111/ggi.13935

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DOI： 10.1111/ggi.13935

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Comparing Retreatments and Expenditures in Flow Diversion Versus Coiling for Unruptured Intracranial Aneurysm Treatment: A Retrospective Cohort Study Using a Real-World National Database

DOI： 10.1093/neuros/nyz377

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DOI： 10.1016/j.jiac.2020.04.008

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DOI： 10.1002/gps.5248

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DOI： 10.1007/s40273-019-00861-x

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DOI： 10.1186/s12941-020-00348-0

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DOI： 10.1371/journal.pone.0223835

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DOI： 10.1111/hsc.12707

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A comparative analysis of treatment costs for home-based care and hospital-based care in enteral nutrition patients: A retrospective analysis of claims data

DOI： 10.1016/j.healthpol.2018.12.006

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Cost-effectiveness of implementing guidelines for the treatment of glucocorticoid-induced osteoporosis in Japan

DOI： 10.1007/s00198-018-4798-9

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Inpatient expenditures attributable to hospital-onset Clostridium difficile infection: a nationwide case-control study in Japan.

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Do pharmacists have the most potential for patient safety in Japan? Learning from a 2010 nationwide survey
Background: Unlike in many other countries, patient safety (PS) in Japan has been promoted under the social insurance medical fee schedule, with the implementation of preferential medical fee paid to medical institutions as incentives. Meanwhile, many hospitals do not assign a full-time physician as PS manager at PS division due to the shortage of physicians.Objective: The Health Ministry in Japan has been promoting PS by utilizing the preferential patient safety countermeasure fee (PPSCF) since 2006. This study aims to address the potential of pharmacists for PS at hospitals implementing the PPSCF.Methods: A nationwide questionnaire survey targeting 2,674 hospitals with the PPSCF was performed from 2010 to 2011. Of the 669 hospitals that responded, 627 hospitals were eligible for analysis, including 178 hospitals implementing PPSCF 1 with 400 beds or more (group A), 286 hospitals implementing PPSCF 1 with 399 beds or fewer (group B), and 163 hospitals implementing PPSCF 2 (group C).Results: Although the mean values of PS activities for nurses were the highest among physicians, nurses, and pharmacists, the values per person recalculated for pharmacists were the highest, and the ranges of the values per person for pharmacists were narrowest across the three professional groups. For example, the number per person of incident reports filed in group A was 2.37 ± 0.30 for pharmacists, 1.14 ± 0.11 for physicians, and 2.09 ± 0.31 for nurses (p = .002). For pharmacists, those values were 2.37 ± 0.30 in group A, 2.43 ± 0.14 in group B and 2.35 ± 0.19 in group C (p = .802).Conclusions: Across health professionals, pharmacists may have the most potential for PS under the social insurance medical fee schedule in Japan.

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Effects of changes in eating speed on obesity in patients with diabetes: a secondary analysis of longitudinal health check-up data
Objective

Few studies have examined the causal relationships between lifestyle habits and obesity. With a focus on eating speed in patients with type 2 diabetes, this study aimed to analyse the effects of changes in lifestyle habits on changes in obesity using panel data.

Methods

Patient-level panel data from 2008 to 2013 were generated using commercially available insurance claims data and health check-up data. The study subjects comprised Japanese men and women (n=59 717) enrolled in health insurance societies who had been diagnosed with type 2 diabetes during the study period. Body mass index (BMI) was measured, and obesity was defined as a BMI of 25 or more. Information on lifestyle habits were obtained from the subjects’ responses to questions asked during health check-ups. The main exposure of interest was eating speed (‘fast’, ‘normal’ and ‘slow’). Other lifestyle habits included eating dinner within 2 hours of sleeping, after-dinner snacking, skipping breakfast, alcohol consumption frequency, sleep adequacy and tobacco consumption. A generalised estimating equation model was used to examine the effects of these habits on obesity. In addition, fixed-effects models were used to assess these effects on BMI and waist circumference.

Results

The generalised estimating equation model showed that eating slower inhibited the development of obesity. The ORs for slow (0.58) and normal-speed eaters (0.71) indicated that these groups were less likely to be obese than fast eaters (P<0.001). Similarly, the fixed-effects models showed that eating slower reduced BMI and waist circumference. Relative to fast eaters, the coefficients of the BMI model for slow and normal-speed eaters were −0.11 and −0.07, respectively (P<0.001).

Discussion

Changes in eating speed can affect changes in obesity, BMI and waist circumference. Interventions aimed at reducing eating speed may be effective in preventing obesity and lowering the associated health risks.

DOI： 10.1136/bmjopen-2017-019589

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DOI： 10.1111/ggi.12977

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DOI： 10.1111/ggi.12777

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DOI： 10.1016/j.diabres.2016.11.007

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DOI： 10.1007/s40273-016-0402-3

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DOI： 10.1017/ice.2016.110

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DOI： 10.1016/j.jstrokecerebrovasdis.2016.05.012

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DOI： 10.1016/j.jhin.2016.04.005

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&emsp;本研究の目的は，MRSA感染症における追加的医療資源(入院日数・出来高換算医療費)の推計である． &emsp;対象は調査病院を2012年12月～2014年12月に退院した患者で，解析手法はMRSA感染有無を目的変数にしたロジスティック回帰によって推定される傾向スコアによるマッチング法を用いた．傾向スコア推定後，DPC10桁が同一でスコアが近似するMRSA感染者と非感染者を1対1でマッチングした．また，時間依存バイアスに対処したマッチング法も併せて行った．両者の医療資源の差異の平均から追加医療資源を算出し有意差の検定は対応のあるt検定を用いた． &emsp;解析対象症例数は24,538例で，感染者数は47名であった．MRSA感染症による入院日数の延長は時間依存バイアスに対処した場合：13.1日(95&#37;信頼区間3.7日&ndash;22.4日，p=0.008)および医療費の増加は107.0万円(31.7万円&ndash;182.2万円，p=0.007)であり，時間依存バイアスに対処しない場合：21.2日(95&#37;信頼区間11.7日&ndash;30.8日，p<0.001)および医療費の増加は160.7万円(64.3万円&ndash;257.0万円，p=0.001)と算出された． &emsp;本研究は，傾向スコアを用い時間依存バイアスに対処したマッチング法でMRSA感染症による追加的医療費を推計した．結果，時間依存バイアスに対処しなければ結果を過大評価することが明らかとなった．本推計値は感染制御における費用対効果を計る資料として活用できる．

DOI： 10.4058/jsei.31.173

Language：Japanese   Publishing type：Research paper (scientific journal)  

発症原因を特定できない潜因性脳梗塞は，病型分類法によって診断基準が異なり，脳梗塞全体に占める頻度も16～39％と研究間で差が大きい．この中に塞栓症が多く含まれると考えられ，塞栓源不明脳塞栓症という概念も提唱された．とくに潜在性心房細動が注目され，植込み型心電図記録計を用いた長期間の観察では3 割の患者に心房細動が同定された．次世代型植込み型心電図記録計は小型で遠隔監視が可能であり，海外では潜在性心房細動の検出目的に用いられている．心房細動を同定できれば，確立した再発予防法として抗凝固薬を使用でき，脳梗塞再発予防に利するであろう．次世代型植込み型記録計を国内で潜在性心房細動検出目的に用いることを日本脳卒中学会から厚生労働省に要望している．使用が承認された場合は，わが国の診療事情に合わせて頭部MRIを含めたより詳細な診断に基づいて，検査に相応しい患者を抽出すべきと考え，その基準を提案する．

DOI： 10.3995/jstroke.10416

Language：English  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1017/ice.2015.302

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jhin.2015.09.019

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1371/journal.pone.0133694

Language：Japanese  

耐性菌感染による重症化と治療期間の延伸は，追加的な医療資源量の増加をもたらす．これは逼迫する医療費の適正化に向けた施策の障害にもなっている．本研究では，Japan Nosocomial Infection Surveillance全入院患者部門データ(以下，JANISデータ)において判定されているペニシリン耐性肺炎球菌(penicillin-resistant Streptococcus pneumoniae: PRSP)感染症例をもとに耐性菌感染による追加的医療資源量の推計を行った．解析対象となるデータは，調査協力を得られた1病院から直接収集したJANISデータと診断群分類別包括評価(Diagnosis Procedure Combination/Per-Diem Payment System)データを用いた．PRSP感染者と非感染者の判定はJANISデータに基づいた．すべての対象症例を病名と術式行為が一致する層別に分類し，各層からプロペンシティスコアをもとにPRSP感染有無に関するマッチングを行った．このマッチングされたペア差の平均値から追加的医療資源となる在院日数と入院医療費を推定した．   すべてのペアを対象にしたPRSP感染による在院日数の増加は2.79日であった．また年齢区分5歳未満では在院日数2.08日，入院医療費110,634円の増加が認められた．本研究では，PRSP感染によって生じる追加的医療資源量を推計した．この耐性菌感染によって在院日数の増大と5歳未満においては在院日数と入院医療費の増大が明らかとなった．本研究成果は，感染制御に関する費用対効果を踏まえた技術評価の側面を支える基礎資料として，広く貢献できるものと考える．耐性菌感染の抑制に向けた包括的な感染制御の発展が期待される．

DOI： 10.4058/jsei.30.165

Language：Others  

DOI： 10.14982/rsmp.5.1

Language：Japanese  

医療連携を主体とした機能分化の推進が期待されている。しかしながら，機能分化を可能とする病院の外来縮小は進んでいない。本研究は，機能分化に向けた逆紹介の課題要因を明らかにするとともに，外来縮小の方針決定に影響を与えると考えられた逆紹介とその後の入院率との関連を明らかにすることを目的とした。南風病院呼吸器内科に外来受診をした慢性閉塞性肺疾患（COPD）と喘息疾患の再診患者を対象にロジスティック回帰分析を行った。入院率の比較については傾向スコアマッチングを用いた生存時間分析を実施した。解析の結果，長期処方実績や複数科外来受診などの要因が逆紹介と関連していた。また生存時間分析による入院率の比較では，外来患者の逆紹介とその後の入院率の減少に関連は認められなかった。一般外来の縮小に向けた外来患者の逆紹介が推進されることで，外来診療における地域医療の機能分化が期待された。

DOI： 10.11303/jsha.52.19

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Others  

DOI： 10.14982/rsmp.4.257

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1371/journal.pone.0110444

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1371/journal.pone.0106884

Language：Japanese   Publishing type：Research paper (scientific journal)  

近年，我が国の医療財政は著しく逼迫しており，診療報酬の総体的な抑制は，医療機関経営の財務をも圧迫している．そのため，限られた医療資源の効率的配分の実現が強く求められており，診療報酬制度は効率性を勘案した評価へとパラダイムシフトが起こりつつある．同時に，医療機関内部においても，どの領域のどの活動にどの程度の資源を投じるか？を科学的に意思決定する動きが加速度的に増しているものと思われる．医療経済評価とは，こうした政策レベル・病院経営レベルにおける意思決定を科学的に判断するためのツールである．   本稿では，医療経済評価の基本的な考え方と，医療経済評価の実施手法について解説する．実施手法は広範囲に及ぶため，医療経済評価の核となる，(1)分析の立場，(2)比較対照，(3)分析手法，(4)分析期間，(5)アウトカム指標，(6)費用の測定，(7)割引，(8)不確実性の取り扱い，の中心事項について紹介する．

DOI： 10.4058/jsei.29.324

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.4058/jsei.29.231

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese  

日本においては、現在のところ実践的に広く使用されている医療経済評価ガイドラインは存在しない。このことは、各研究者によって行われる分析間の比較可能性を困難にし、さらには使用する分析手法がブラックボックスにおちいりやすく、経済評価の透明性が損なわれる結果にもつながっている。そこで、各国で作成されている医療経済評価ガイドラインや公表されている文献を参照しながら、研究班に参加した専門家のコンセンサスによってガイドラインを作成していった。研究班は経済評価の専門家から構成され、まずはガイドラインに必要な13セクションを同定した。各セクション内において、経済評価を行う上で方法論上の論点になる部分を抽出し、それに対する回答を作成するための検討を重ねていった。このプロセスは、2011年度と2012年度の2年度にわたって継続して行われ、参加したメンバーのコンセンサスにより、最終版は2012年度末に完成した。各項目は、簡潔な文章によって記述され、その意味するところを明確にするため3つの星によるレーティングシステムを用いた。ガイドラインでは、原則としては公的医療費支払者の立場を標準とする。ただし、分析の目的によってはそれ以外の立場を用いてもよい。アウトカム指標は、分析者が最も適すると考えるアウトカム指標を用いてよいが、質調整生存年(QALY)を用いた分析を含めることを推奨している。割引率は、費用・効果ともに年率2&#37;で割り引くことを推奨している。本ガイドラインが、日本における経済評価研究の質と比較可能性を高めることが期待される。(著者抄録)

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ajic.2012.10.004

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.4058/jsei.28.63

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s15010-012-0317-7

Language：Japanese   Publishing type：Research paper (scientific journal)  

2007∼09年度に収集された転倒・転落のインシデントレポート1,764件を対象に，転倒率（件/1,000患者・日）を用いて転倒・転落に関する疫学的側面を検討した。患者の平均年齢は男66.6±18.8歳（950件），女69.9±19.2歳（814件）であった。全体の転倒率は1.84件/1,000患者・日，性別では男2.06および女1.87であった。年齢別では，70歳代が2.82件/1,000患者・日（555件）でもっとも高く，高齢者ほど高い傾向にあった。診療科別において，外科系では整形外科が最低で1.14件/1,000患者・日，内科系では循環器内科および呼吸器内科が最低で1.97を示し，外科系より内科系診療科が高い傾向にあった。また，入院から転倒発生までの日数における転倒率（転倒件数）について，入院翌日が0.16件/1,000患者・日（118件）でもっとも高く，ついで入院3日目が0.12（84件），入院当日が0.11（78件）で以降漸減していた。転倒発生の平均値は12.4日であった。 転倒率からみた転倒の疫学的側面から，入院診療科や入院からの日数に応じた防止策を講じることが必要である。

DOI： 10.11303/jsha.49.205

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

地域連携クリティカルパスをはじめとする地域医療連携の促進によって，患者は技術の高度化・専門化の恩恵を受けながら効率的かつ安全に医療を受けることが可能になる。一方で，医療連携の促進による患者の移動傾向等のアクセシビリティはほとんど明らかになっていない。 そこで本研究は，地域連携の先進的地域の急性期病院において，（1）患者の来院圏の可視化 （2）回復期病院への転院によるアクセシビリティの変化をGISを用いて明らかにすることを目的とした。 本研究における急性期医療機関の実質的な医療圏は，二次医療圏を超えた広範な地域にわたり，32.5%は二次医療圏外の回復期医療機関に転院していた。医療法で定められる二次医療圏と実質的な診療圏の乖離が地理的に明らかとなった。GISを用いてアクセシビリティを把握することによって，医療の実態を反映した医療資源の整備や，医療計画の立案等に活用可能であることが示唆された。

DOI： 10.11303/jsha.49.173

Language：Japanese  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

厚生労働省は21世紀の医療提供体制の方向性として地域連携を掲げており，これを達成するツールとして地域連携パスがある。本研究は，（1）地域連携を積極的に実施している病院の特徴，および，（2）連携パス運用による機能分化の促進効果，を明らかにすることを目的に実施した。 地域連携診療計画管理料（計画管理料）を算定している全計画管理病院（625病院）を対象に，質問票調査を行った。データ解析には線形回帰モデルを用いた。 232病院（37.1&#37;）から回答を得た。大腿骨頸部骨折症例に対する計画管理料算定割合の高い病院の特徴として，患者数の多さ（p=0.002），短い平均在院日数（p=0.005）などが検出された。診療計画に転院基準を定めた病院は，定めのない病院に比べて，大腿骨頸部骨折の急性期平均在院日数が12.8&#37;短かった（p=0.036）。 本研究は，地域連携を実施する上で，診療計画に転院基準を定めることの重要性を示唆するものである。

DOI： 10.11303/jsha.49.31

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.4058/jsei.27.389

Language：Japanese  

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DOI： 10.1007/s15010-011-0095-7

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DOI： 10.1016/j.jhin.2010.10.006

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/qshc.2008.029215

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DOI： 10.1136/qshc.2008.027532

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DOI： 10.1093/intqhc/mzp037

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DOI： 10.1111/j.1365-2753.2008.01033.x

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DOI： 10.1111/j.1365-2753.2008.00987.x

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DOI： 10.1016/j.healthpol.2008.04.009

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DOI： 10.1016/j.healthpol.2008.04.004

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DOI： 10.1016/j.healthpol.2008.02.006

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DOI： 10.1111/j.1365-2753.2007.00882.x

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DOI： 10.1186/1472-6963-7-140

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DOI： 10.1002/hec.1177

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1177/147323000703500502

Language：Japanese   Book type：General book, introductory book for general audience

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Event date： 2011.12

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Venue：三重   Country：Japan  

Event date： 2010.11

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