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

DOI： 10.3233/JAD-220200

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

DOI： 10.1111/jgs.18068

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

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)   Publisher：Human Vaccines and Immunotherapeutics  

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

Web of Science

Scopus

PubMed

researchmap

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

Web of Science

Scopus

PubMed

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Age and Ageing  

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

Web of Science

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Alzheimer's Disease  

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

Scopus

PubMed

researchmap

Authorship：Last author  

researchmap

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

researchmap

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

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

Web of Science

Scopus

PubMed

researchmap

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

Web of Science

Scopus

PubMed

CiNii Research

Authorship：Last author  

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

researchmap

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

researchmap

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

researchmap

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

Authorship：Last author,　Corresponding author   Language：Others  

Language：Others  

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

Background: The associations between COVID-19 vaccination and post-COVID psychiatric disorders are unclear. Furthermore, it is uncertain if these associations differ depending on the dominant SARS-CoV-2 variant at the time of infection. This retrospective cohort study aimed to clarify the associations between COVID-19 vaccination and incident psychiatric disorders after breakthrough infection according to the different variant periods in Japan. Methods: Medical claims data, COVID-19 case-related information, and vaccination records were collected from three Japanese municipalities. The study population comprised public insurance enrollees aged ≥65 years who developed COVID-19 between June 2021 and December 2022. The study exposure was each participant's vaccination status 14 days before infection, and the outcomes were the occurrence of psychiatric disorders within three months of infection. Multivariable logistic regression analyses were performed to calculate the odds ratios (ORs) and 95 % confidence intervals (CIs) of vaccination for the occurrence of psychiatric disorders. Analyses were conducted for the Delta period (June to December 2021), Omicron BA.1/BA.2 period (January to June 2022), and Omicron BA.5 period (July to December 2022). Results: We analyzed 270 participants (vaccinated: 149) in the Delta period, 2,963 participants (vaccinated: 2,699) in the Omicron BA.1/BA.2 period, and 7,723 participants (vaccinated: 7,159) in the Omicron BA.5 period. During the Delta period, vaccinated participants had significantly lower odds for psychotic disorders (OR: 0.23, 95 % CI: 0.06–0.88, P = 0.032) than unvaccinated participants. During the Omicron BA.5 period, vaccinated participants had significantly lower odds for organic mental disorders (OR: 0.54, 95 % CI: 0.30–0.95, P = 0.033), psychotic disorders (OR: 0.31, 95 % CI: 0.19–0.53, P < 0.001), mood disorders (OR: 0.53, 95 % CI: 0.29–0.99, P = 0.046), and insomnia (OR: 0.48, 95 % CI: 0.32–0.72, P < 0.001) than unvaccinated participants. There were no significant differences in psychiatric disorders between the vaccinated and unvaccinated groups during the Omicron BA.1/BA.2 period. Conclusions: This is the first study to demonstrate that the associations between COVID-19 vaccination and post-COVID psychiatric disorders vary among the different variant periods. Future studies on these associations should be conducted with consideration to the prevalent circulating variants.

DOI： 10.1016/j.bbi.2024.02.018

Web of Science

Scopus

PubMed

researchmap

researchmap

Authorship：Last author,　Corresponding author  

researchmap

Language：English   Publisher：Vaccine  

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

Web of Science

Scopus

PubMed

Language：Others  

researchmap

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

Web of Science

Scopus

PubMed

CiNii Research

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

Web of Science

Scopus

PubMed

researchmap

Other Link： https://peerj.com/articles/16780.xml

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

Web of Science

Scopus

PubMed

Language：English   Publisher：Vaccine  

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

Web of Science

Scopus

PubMed

Authorship：Last author,　Corresponding author  

Authorship：Last author,　Corresponding author   Language：Others  

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

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

Authorship：Last author,　Corresponding author   Language：Others  

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

Web of Science

Scopus

PubMed

researchmap

Other Link： https://link.springer.com/article/10.1186/s12879-024-09035-3/fulltext.html

Language：Others  

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

Authorship：Last author   Language：Others  

Language：Others  

Authorship：Last author  

Authorship：Last author,　Corresponding author  

Authorship：Last author,　Corresponding author  

researchmap

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

researchmap

Authorship：Last author,　Corresponding author  

researchmap

researchmap

Authorship：Last author  

researchmap

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

researchmap

Authorship：Last author  

Authorship：Last author  

Authorship：Last author,　Corresponding author  

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

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

CiNii Research

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

Web of Science

PubMed

CiNii Research

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

Web of Science

Scopus

PubMed

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

Web of Science

Scopus

PubMed

Language：Others  

Language：Others  

Authorship：Last author  

researchmap

Authorship：Last author,　Corresponding author  

researchmap

Authorship：Last author   Language：Others  

Language：Others  

Authorship：Last author  

researchmap

Web of Science

Web of Science

Authorship：Last author  

researchmap

Authorship：Last author  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Open Forum Infectious Diseases  

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

Web of Science

Scopus

PubMed

researchmap

Publisher：医歯薬出版  

DOI： 10.32118/ayu28611921

CiNii Research

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

Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Journal of Infectious Diseases  

OBJECTIVES: To evaluate the effectiveness of vaccination on reducing household transmission of SARS-CoV-2 among common household types in Japan during the Omicron variant wave. METHODS: This retrospective study was conducted using vaccination records, COVID-19 infection data, and resident registry data from two Japanese municipalities. Households that experienced their first COVID-19 case between January and April 2022 were categorized into two groups according to the presence/absence of children aged ≤11 years. We constructed multivariable logistic regression models with generalized estimating equations to calculate the odds ratios (ORs) and 95&#37; confidence intervals for household transmission according to the vaccination statuses of primary cases and household contacts. RESULTS: We analyzed 7326 households with 17,586 contacts. In all households, the OR for household transmission was <0.6 (P <0.001) when the primary case and/or contact were vaccinated. In households with children aged ≤11 years, the OR was 0.71 (P <0.001) when only the contact was vaccinated. In households with all members aged ≥12 years, the OR was <0.5 (P <0.001) when the primary case and/or contact were vaccinated. CONCLUSION: COVID-19 vaccination effectively reduced household transmission in Japan during the Omicron variant wave.

DOI： 10.1016/j.ijid.2023.06.017

Web of Science

Scopus

PubMed

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

researchmap

Language：English   Publisher：Vaccine  

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

Web of Science

Scopus

PubMed

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)

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

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

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

Language：Others  

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

researchmap

Authorship：Lead author,　Corresponding author  

researchmap

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

Web of Science

Scopus

PubMed

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

researchmap

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

Publishing type：Research paper (scientific journal)  

researchmap

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

Scopus

PubMed

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

Web of Science

Scopus

PubMed

researchmap

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

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

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

researchmap

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

Web of Science

Scopus

PubMed

Authorship：Last author,　Corresponding author   Language：Others  

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

Web of Science

Scopus

PubMed

Authorship：Last author,　Corresponding author  

researchmap

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

Web of Science

Scopus

PubMed

Authorship：Lead author,　Corresponding author  

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

Web of Science

Scopus

PubMed

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

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

Web of Science

Scopus

PubMed

researchmap

Language：Others  

Language：Others  

Authorship：Lead author,　Corresponding author  

researchmap

Authorship：Last author,　Corresponding author  

researchmap

researchmap

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

Web of Science

Scopus

PubMed

researchmap

Authorship：Lead author,　Last author  

researchmap

Authorship：Last author   Language：Others  

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

Comparative risk of fracture in community‐dwelling older adults initiating suvorexant versus Z‐drugs: results from LIFE study

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

PubMed

CiNii Research

researchmap

Language：Others  

Authorship：Last author  

researchmap

Authorship：Last author,　Corresponding author  

researchmap

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)

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

Web of Science

Scopus

PubMed

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

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

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Open Forum Infectious Diseases  

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

Web of Science

Scopus

PubMed

researchmap

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

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

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

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

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

Web of Science

Scopus

PubMed

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

researchmap

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

researchmap

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

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

Language：English   Publisher：BMJ Open  

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

Web of Science

Scopus

PubMed

Web of Science

Language：Japanese  

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

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

Web of Science

Scopus

PubMed

researchmap

Language：Japanese  

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

researchmap

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

researchmap

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

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

Web of Science

Scopus

PubMed

researchmap

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

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

Web of Science

Scopus

PubMed

researchmap

Web of Science

Web of Science

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

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

Web of Science

Scopus

PubMed

researchmap

Language：Others  

researchmap

Language：Others  

Authorship：Lead author,　Corresponding author  

researchmap

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

researchmap

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

Web of Science

Scopus

PubMed

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

CiNii Research

Language：Others  

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

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

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

Web of Science

Scopus

PubMed

researchmap

Authorship：Lead author,　Corresponding author  

researchmap

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)

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

Web of Science

Scopus

PubMed

researchmap

Web of Science

Web of Science

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Antimicrobial Stewardship and Healthcare Epidemiology  

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

Scopus

PubMed

researchmap

Language：Japanese   Publisher：Pharmaceutical and Medical Device Regulatory Science Society of Japan  

DOI： 10.51018/pmdrs.53.6_507

CiNii Research

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

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

DOI： 10.1002/alz.053750

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

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  

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

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

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

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

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

Language：Others  

Language：Japanese  

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

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

OBJECTIVES: New versions of balloon-expandable and self-expandable valves for transcatheter aortic valve replacement (TAVR) have been developed, but few studies have examined the outcomes associated with these devices using national-level data. This study aimed to elucidate the clinical and economic outcomes of TAVR for aortic stenosis in Japan through an analysis of real-world data. METHODS: This retrospective cohort study was performed using data from patients with aortic stenosis who had undergone transfemoral TAVR with Edwards SAPIEN 3, Medtronic CoreValve, or Medtronic Evolut R valves throughout Japan from April 2016 to March 2018. Pacemaker implantation, mortality, and health expenditure were examined for each valve type during hospitalization and at 1 month, 3 months, 6 months, and 1 year. Generalized linear regression models and Cox proportional hazards models were used to examine the associations between the valve types and outcomes. RESULTS: We analyzed 7244 TAVR cases (SAPIEN 3: 5276, CoreValve: 418, and Evolut R: 1550) across 145 hospitals. The adjusted 1-year expenditures for SAPIEN 3, CoreValve, and Evolut R were $79 402, $76 125, and $75 527, respectively; SAPIEN 3 was significantly more expensive than the other valves (P < .05). The pacemaker implantation hazard ratios (95% confidence intervals) for CoreValve and Evolut R were significantly higher (P < .001) than SAPIEN 3 at 2.61 (2.07-3.27) and 1.80 (1.53-2.12), respectively. The mortality hazard ratios (95% confidence intervals) for CoreValve and Evolut R were not significant at 1.11 (0.84-1.46) and 1.22 (0.97-1.54), respectively. CONCLUSIONS: SAPIEN 3 users had generally lower pacemaker implantation and mortality but higher expenditures than CoreValve and Evolut R users.

DOI： 10.1016/j.jval.2020.10.022

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

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

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

Language：Others  

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.

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

In an 80-bed fee-based retirement home with nursing care, the dispatched-pharmacist has provided prescription recommendations to visiting physicians based on pathogen identification using Gram staining as part of an antimicrobial stewardship program. Thus, we evaluated the effects of pharmacist-supported antimicrobial stewardship. We calculated the total number of all antimicrobials and macrolides, fluoroquinolones, and cephalosporins prescriptions per 100 residents per month at the retirement home from January 2013 to December 2017. Using log-transformed monthly resident numbers with an offset before and after the intervention, we performed Poisson regression analyses that adjusted for monthly mean age. Interrupted time series analyses (ITSA) were conducted to examine the changes in the incidence rate ratios for the baseline and slope before and after the intervention. The total number of all antimicrobial prescriptions per 100 residents per month from 2013 to 2017 was 14.10, 18.51, 10.59, 5.41, and 3.90, respectively. Although there was a significant pre-intervention increase in the total number of all antimicrobial prescriptions, the intervention was followed by a significant decrease. There was also a significant reduction in the slope. ITSA of the changes in the prescription of macrolides and fluoroquinolones showed that there were significant pre-intervention increase and followed by a significant post-intervention decrease in the slope. There was no significant change in cephalosporin prescriptions by the intervention. Our study shows that pharmacist-supported AS can reduce antimicrobial prescriptions in a retirement home. Nevertheless, further studies are needed to collect and analyse more data on similar interventions.

DOI： 10.1016/j.jiac.2020.04.008

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

DOI： 10.1371/journal.pone.0237316

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

The effects of raising the long‐term care insurance co‐payment rate on the utilization of long‐term care services

DOI： 10.1111/ggi.13935

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

Aim: The effect of raising insurance co-payment rates on healthcare service utilization in Japan remains unclear. In this study, we utilized patient-level long-term care (LTC) insurance claims data to analyze these effects. Methods: Claims data were obtained on individuals certified as requiring LTC in City A and City B, Fukuoka Prefecture, Japan during August 2014–July 2016. Individuals whose LTC insurance co-payment rate increased from 10% to 20% in August 2015 were regarded as high-income individuals; individuals whose co-payment rate remained at 10% were regarded as non–high-income individuals. We examined the changes in LTC service utilization between high-income individuals and non–high-income individuals during the study period. Monthly LTC insurance charges were analyzed to evaluate service utilization. We created monthly panel data for the study participants, and quantified the differences in LTC service utilization before and after August 2015 between the high-income and non–high-income groups. Care needs levels and age were included as covariates in a fixed-effects model. Results: The sample comprised 7711 individuals (1000 high-income individuals and 6711 non–high-income individuals) in City A and 647 individuals (84 high-income individuals and 563 non–high-income individuals) in City B. After adjusting for care needs levels and age, the co-payment rate increase was associated with reductions in monthly LTC insurance charges of $34.3 (P < 0.001) in City A and $91.0 (P = 0.022) in City B. Conclusion: The increase in co-payment rate for high-income individuals in August 2015 negatively affected their utilization of LTC services. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2020; ••: ••–••.

DOI： 10.1111/ggi.13935

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

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

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

In an 80-bed fee-based retirement home with nursing care, the dispatched-pharmacist has provided prescription recommendations to visiting physicians based on pathogen identification using Gram staining as part of an antimicrobial stewardship program. Thus, we evaluated the effects of pharmacist-supported antimicrobial stewardship. We calculated the total number of all antimicrobials and macrolides, fluoroquinolones, and cephalosporins prescriptions per 100 residents per month at the retirement home from January 2013 to December 2017. Using log-transformed monthly resident numbers with an offset before and after the intervention, we performed Poisson regression analyses that adjusted for monthly mean age. Interrupted time series analyses (ITSA) were conducted to examine the changes in the incidence rate ratios for the baseline and slope before and after the intervention. The total number of all antimicrobial prescriptions per 100 residents per month from 2013 to 2017 was 14.10, 18.51, 10.59, 5.41, and 3.90, respectively. Although there was a significant pre-intervention increase in the total number of all antimicrobial prescriptions, the intervention was followed by a significant decrease. There was also a significant reduction in the slope. ITSA of the changes in the prescription of macrolides and fluoroquinolones showed that there were significant pre-intervention increase and followed by a significant post-intervention decrease in the slope. There was no significant change in cephalosporin prescriptions by the intervention. Our study shows that pharmacist-supported AS can reduce antimicrobial prescriptions in a retirement home. Nevertheless, further studies are needed to collect and analyse more data on similar interventions.

DOI： 10.1016/j.jiac.2020.04.008

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

OBJECTIVE: We aimed to ascertain the degree of influence of income disparity among older people with newly developed dementia on the probability and duration of stay in a hospital or long-term care facility and the degree of influence on medical expenses for hospitalization and care costs. METHODS: This was a retrospective cohort study. Study participants included 12 829 individuals aged 75 years or older not diagnosed with dementia between April 2012 and March 2013 but newly diagnosed with dementia between April 2013 and March 2014. Participants were categorized according to income. We evaluated the associations of income with the probability and duration of stay in a hospital or long-term care facility and the costs for hospitalization and care. RESULTS: In the adjusted analyses, high-income individuals had a lower probability of admission to a hospital or long-term care facility than middle- and high-income individuals. In all hospitals, low-income individuals had the longest duration of stay, but in long-term care facilities, income categories varied by facility type. Medical expenses for hospitalization and care costs were highest in the low-income group. CONCLUSION: Income category affects the probability and duration of stay in the hospital or a long-term care facility, as well as expenses for hospitalization and care. It is necessary to consider a policy to enable low-income older patients with dementia to continue living at home.

DOI： 10.1002/gps.5248

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

© 2020 Japan Society of Chemotherapy. All rights reserved. Antimicrobial use (AMU) is positively correlated with the occurrence of antimicrobial resistance (AMR). Inappropriate use of antimicrobials in elderly care facilities may promote and spread AMR to surrounding communities through intercommunication between these facilities and hospitals. Therefore, AMU surveillance in elderly care facilities is important The Ministry of Health, Labour, and Welfare of Japan developed the National Insurance Claims Database (NDB), and this database is open to any researchers who pass its qualification exam. Although the NDB was previously used to estimate the state of national and prefectural AMU surveillance, it is unknown to what extent it can be used for AMU surveillance in elderly care facilities. Therefore, we evaluated the usefulness of the NDB for AMU surveillance in elderly care facilities. For us to be able to extract their AMU data from the NDB. elderly care facilities needed to meet both the following conditions: (1) they needed to have specified that their data could be extracted from the NDB; and (2) the medical fees of their patients were paid by medical insurance, not nursing insurance. Only two of the four kinds of elderly care facilities, namely, beds for long-term care in hospitals and intensive care home for elderly patients, met these conditions. However, AMU in beds for long-term care in hospitals could not be estimated using the NDB, because the detailed treatment information is unavailable in this database due to their comprehensive medicine system, in which all medical costs are paid as admission fees. The only situation in which AMU could be estimated using the NDB was in the case where the drugs were prescribed in intensive care home for elderly patients by visiting doctors; prescriptions could not be extracted from the NDB when they were prescribed in clinics or hospitals. In conclusion. AMU surveillance in elderly care facilities using the NDB is possible only for a very limited set of elderly care facilities at present However, introduction of a system of mandatory reporting of detailed treatment information in long-term care hospitals, and/or of combining medical insurance and nursing insurance data, is currently planned. Therefore, the situation could change in the near future. An AMU surveillance system may also be widely applicable to the surveillance of other dnigs. As society faces challenges from the rapidly aging population, we should continue to develop drug Use surveillance systems for elderly care facilities using the NDB to solve issues related to polypharmacy or inappropriate drug use, including the use of antibiotics.

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

AIM: The recently developed direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infections are costly. Cost-effectiveness analyses of DAAs require accurate healthcare expenditure estimates for the various HCV disease states, but few studies have produced such estimates using national-level data. This study utilized nationally representative data to estimate the healthcare expenditure for each HCV disease state. METHODS: We identified all patients infected with HCV between April 2010 and March 2018 from a nationwide administrative claims database in Japan. Monthly patient-level healthcare expenditures were calculated for the following disease states: chronic hepatitis C (CHC), compensated cirrhosis (CC), decompensated cirrhosis (DC), and hepatocellular carcinoma (HCC). The expenditures for the CHC and CC states were also compared before DAA treatment and after sustained virologic response (SVR) was achieved. A longitudinal two-part model was employed to estimate the healthcare expenditures for each state. RESULTS: During the study period, 1,564,043 patients with 146,488,137 patient-months of data met the inclusion criteria. The year of valuation was 2017. The mean monthly healthcare expenditures per patient (95&#37; confidence intervals) for the pre-DAA CHC, CC, DC, and HCC states were US&#36;267 (US&#36;267-268), US&#36;428 (US&#36;427-429), US&#36;666 (US&#36;663-669), and US&#36;969 (US&#36;966-972), respectively. The mean monthly healthcare expenditures per patient for the post-SVR (≥ 2 years) CHC and CC states were US&#36;176 (US&#36;176-177) and US&#36;238 (US&#36;236-240), respectively. Healthcare expenditure increased with increasing age in all disease states (P < 0.05). CONCLUSIONS: These healthcare expenditure estimates from a nationally representative sample have potential applications in cost-effectiveness analyses of DAAs.

DOI： 10.1007/s40273-019-00861-x

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

BACKGROUND: Infection is a major complication for patients with haematological malignancies. It is important to better understand the use of antimicrobial agents and antibiotic resistance for appropriate treatment and prevention of drug resistance. However, very few multi-centre analyses have focused on the use of antimicrobial agents and antibiotic resistance have been carried out in Japan. This study aimed to describe the characteristics of the use of antimicrobial agents and antibiotic resistance in patients with haematological malignancies. METHODS: We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in Japan. We included patients diagnosed with haematological malignancies, who were hospitalized in a haematology ward between 1 April 2015 and 30 September 2017 in 37 hospitals. Descriptive statistics were used to summarize patient characteristics, antimicrobial utilization, bacterial infections, and antibiotic resistance. RESULTS: In total, 8064 patients were included. Non-Hodgkin lymphoma (50.0&#37;) was the most common malignancy. The broad-spectrum antibiotics displayed a following antimicrobial use density (AUD): cefepime (156.7), carbapenems (104.8), and piperacillin/tazobactam (28.4). In particular, patients with lymphoid leukaemia, myeloid leukaemia, or myelodysplastic syndromes presented a higher AUD than those with Hodgkin lymphoma, non-Hodgkin lymphoma, or multiple myeloma. The most frequent bacterial species in our study cohort was Escherichia coli (9.4&#37;), and this trend was also observed in blood specimens. Fluoroquinolone-resistant E. coli (3.6&#37;) was the most frequently observed antibiotic-resistant strain, while other antibiotic-resistant strains were rare. CONCLUSIONS: Broad-spectrum antibiotics were common in patients with haematological malignancies in Japan; however, antibiotic-resistant bacteria including carbapenem-resistant or multidrug-resistant bacteria were infrequent. Our results provide nationwide, cross-sectional insight into the use of antimicrobial agents, prevalence of bacteria, and antibiotic resistance, demonstrating differences in antimicrobial utilization among different haematological diseases.

DOI： 10.1186/s12941-020-00348-0

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

Longitudinal trends of and factors associated with inappropriate antibiotic prescribing for non-bacterial acute respiratory tract infection in Japan: A retrospective claims database study, 2012–2017

DOI： 10.1371/journal.pone.0223835

Language：Others  

Language：Others  

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

As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January-February, February-March, March-April, and April-May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March-April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.

DOI： 10.1111/hsc.12707

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

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

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

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

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

DOI： 10.1007/s00198-018-4798-9

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

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

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

Language：English  

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.

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

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

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

AimTo quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients.
MethodsWe carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care.
ResultsThe case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95&#37; CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95&#37; CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95&#37; CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95&#37; CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95&#37; CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95&#37; CI 0.59-1.53). However, home care was significantly associated with a reduction of &#36;7523 (95&#37; CI &#36;7093-7991, P = 0.015) in treatment costs.
ConclusionsDespite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254.

DOI： 10.1111/ggi.12977

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

Aim: To determine whether age, proximity to death and long-term care insurance certification are related to receiving hospital inpatient care; the number of hospital bed days (HBD) among older Japanese adults in the last year of life; and to estimate the total number of HBD.
Methods: Using health insurance claims and death certificate data, the present retrospective cohort study examined the HBD of city residents aged >= 65 years who died between September 2006 and October 2009 in Soma City, Japan. Using a two-part model, factors associated with receiving hospital inpatient care and the total number of HBD in each quarter in the last year of life were examined.
Results: The total number of HBD in the last year of life varied widely; 13&#37; had no admission, and 27&#37; stayed >= 90 days. Younger age, approaching death and having long-term care insurance certification were significantly associated with being more likely to receive hospital inpatient care during each quarterly period in the last year of life. In contrast, having long-term care insurance certification and the last 3-month period before death, compared with the first 3-month period, were significantly associated with a fewer number of HBD.
Conclusions: The present study showed that older age was associated with being less likely to receive hospital inpatient care. The findings regarding the risk of inpatient care and total number of HBD in the last year of life help to understand resource use among older dying adults, and to develop evidence-based healthcare policies within aging societies.

DOI： 10.1111/ggi.12777

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

Aims: To investigate the association between nonadherence to diabetes treatment and the occurrence of diabetes complications.
Methods: Our study retrospectively identified adherence and nonadherence to diabetes treatment in patients during the first year of observation after new diagnoses of type 2 diabetes enrolled in commercial database from 52 health insurers in Japan. Participants were insurance enrollees with type 2 diabetes who received healthcare between 2005 and 2013, and who could be tracked for more than 12 months from the initiation of diabetes treatment. We compared the occurrence of diabetes-related complications (retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion) and all-cause healthcare expenditure during the second to eighth years.
Results: We identified 1784 nonadherent patients and 9547 adherent patients. Cox proportional hazard models showed that the occurrence of microvascular complications was significantly higher in the nonadherent group: the hazard ratios (95&#37; confidence intervals) for retinopathy, nephropathy, and neuropathy were 2.04 (1.57-2.66), 1.91 (1.35-2.72), and 1.83 (1.02-3.27), respectively. However, no significant differences were observed between the adherent and nonadherent groups for the macrovascular complications (ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion). In addition, the nonadherent group had a significantly higher cumulative healthcare expenditure than the adherent group during the second-to-fifth-year period (p = 0.029) and the second-to-sixth-year period (p = 0.009) after treatment initiation.
Conclusions: Nonadherence in the first year of diabetes may increase the incidence of complications and result in higher expenditures for patients and payers. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.diabres.2016.11.007

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

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

Background Inaccurate estimates of diabetes-related healthcare costs can undermine the efficiency of resource allocation for diabetes care. The quantification of these costs using claims data may be affected by the method for defining diagnoses.
Objectives The aims were to use panel data analysis to estimate diabetes-related healthcare costs and to comparatively evaluate the effects of diagnostic definitions on cost estimates.
Research design Monthly panel data analysis of Japanese claims data.
Subjects The study included a maximum of 141,673 patients with type 2 diabetes who received treatment between 2005 and 2013.
Measures Additional healthcare costs associated with diabetes and diabetes-related complications were estimated for various diagnostic definition methods using fixed-effects panel data regression models.
Results The average follow-up period per patient ranged from 49.4 to 52.3 months. The number of patients identified as having type 2 diabetes varied widely among the diagnostic definition methods, ranging from 14,743 patients to 141,673 patients. The fixed-effects models showed that the additional costs per patient per month associated with diabetes ranged from US&#36;180 [95 &#37; confidence interval (CI) 178-181] to US&#36;223 (95 &#37; CI 221-224). When the diagnostic definition excluded rule-out diagnoses, the diabetes-related complications associated with higher additional healthcare costs were ischemic heart disease with surgery (US&#36;13,595; 95 &#37; CI 13,568-13,622), neuropathy/extremity disease with surgery (US&#36;4594; 95 &#37; CI 3979-5208), and diabetic nephropathy with dialysis (US&#36;3689; 95 &#37; CI 3667-3711).
Conclusions Diabetes-related healthcare costs are sensitive to diagnostic definition methods. Determining appropriate diagnostic definitions can further advance healthcare cost research for diabetes and its applications in healthcare policies.

DOI： 10.1007/s40273-016-0402-3

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

OBJECTIVE. To estimate the cost-effectiveness of safety-engineered devices (SEDs) relative to non-SEDs for winged steel needles, intravenous catheter stylets, suture needles, and insulin pen needles.
DESIGN. Decision analysis modeling.
PARTICIPANTS. Hypothetical cohort of healthcare workers who utilized needle devices.
METHODS. We developed a decision-analytic model to estimate and compare the life-cycle costs and benefits for SED and non-SED needle devices. For this cost-effectiveness analysis, we quantified the total direct medical cost per needlestick injury, number of needlestick injuries avoided, and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the robustness of the base-case analysis.
RESULTS. In the base-case analysis, we calculated the incremental cost-effectiveness ratios of SED winged steel needles, intravenous catheter stylets, suture needles, and insulin pen needles to be &#36;2,633, &#36;13,943, &#36;1,792, and &#36;1,269 per needlestick injury avoided, respectively. Sensitivity analyses showed that the calculated incremental cost-effectiveness ratio values for using SEDs did not fall below zero even after adjusting the values of each parameter.
CONCLUSION. The use of SED needle devices would not produce cost savings for hospitals. Government intervention may be needed to systematically protect healthcare workers in Japan from the risk of bloodborne pathogen infections.

DOI： 10.1017/ice.2016.110

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

Background and aim: A new insertable cardiac monitor, Reveal LINQ (Medtronic, Dublin, Ireland), was approved for clinical use in Japan in March 2016 for detecting atrial fibrillation in patients who develop ischemic stroke with no clearly definable etiology even after extensive workup, so-called cryptogenic ischemic stroke. Cooperation between a specialist of the Japan Stroke Society and a trained cardiologist or cardiac surgeon is needed both for appropriate patient selection and appropriate management of the device. In this paper, the clinical significance of and diagnostic methods for cryptogenic stroke and covert atrial fibrillation are explained, along with our proposal for the clinical indications for this new device. Methods, results, and conclusion: The majority of cryptogenic ischemic strokes are considered to be embolic. In particular, covert atrial fibrillation is drawing attention as the causal emboligenic disease, and it was identified in 30&#37; of patients with long-term observation using an insertable cardiac monitor. Should atrial fibrillation be present, there is a high risk of recurrent stroke, and the cardioembolic stroke that appears is generally severe. The ability to identify atrial fibrillation would be beneficial for preventing stroke recurrence, as anticoagulants can then be used as an established method of secondary prevention. Because the use of insertable cardiac monitors is somewhat invasive, and long-term care systems are also needed, patients suitable for examination using the new device would need to be identified on the basis of detailed diagnostics in accordance with current medical practice in Japan.

DOI： 10.1016/j.jstrokecerebrovasdis.2016.05.012

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

Objective: To identify patient-related risk factors for surgical site infection (SSI) following eight types of gastrointestinal surgery that could be collected as part of infection surveillance efforts.
Design: Record linkage from existing datasets comprising the Japan Nosocomial Infections Surveillance (JANIS) and Diagnosis Procedure Combination (DPC) programmes.
Methods: Patient data from 35 hospitals were retrieved using JANIS and DPC from 2007 to 2011. Patient-related factors and the incidence of SSI were recorded and analysed. Risk factors associated with SSI were examined using multi-level mixed-effects logistic regression models.
Results: In total, 2074 appendectomies; 2084 bile duct, liver or pancreatic procedures; 3460 cholecystectomies; 7273 colonic procedures; 482 oesophageal procedures; 4748 gastric procedures; 2762 rectal procedures and 1202 small bowel procedures were analysed. Using multi-variate analyses, intra-operative blood transfusion was found to be a risk factor for SSI following all types of gastrointestinal surgery, except appendectomy and small bowel surgery. In addition, diabetes was found to be a risk factor for SSI following colon surgery [odds ratio (OR) 1.23, P = 0.028] and gastric surgery (OR 1.70, P < 0.001). Use of steroids was significantly associated with a higher incidence of SSI following cholecystectomy (OR 2.83, P = 0.003) and colon surgery (OR 1.27, P = 0.040).
Conclusions: Intra-operative blood transfusion, diabetes and use of steroids are risk factors for SSI following gastrointestinal surgery, and should be included as part of SSI surveillance for these procedures. (C) 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jhin.2016.04.005

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

Quantifying Additional Healthcare Resource Consumption Associated with MRSA Infection
&emsp;This study tried to quantify the additional healthcare resources (indicated by length of hospital stay and healthcare expenditure) consumed by MRSA infections. The study included patients who had been discharged from our hospital (a 380&ndash;bed tertiary hospital) between December 2012 and December 2014. The database for analysis involved the combination of 2 administrative datasets: JANIS infection surveillance data for all admissions, and data from a government survey on the post-implementation effects of the diagnosis procedure combination system. The data were analyzed through propensity score matching. Propensity scores were estimated using a logistic regression model in which the independent variable was a dichotomous MRSA infection variable (1: infected; 0: uninfected). Using the propensity score, 1:1 matching was performed between cases (MRSA infection) and controls (no MRSA infection). The data was also analyzed using another matching method that addressed time-dependent bias. The additional healthcare resources associated with MRSA infections were calculated from the differences in the mean quantities of resources consumed between cases and controls. The total of 24,538 patients in the study included 47 identified as MRSA-infected patients. Including time-dependent bias, infected patients were associated with an additional length of stay of 13.1 days (95&#37; confidence intervals [CI] 3.7&ndash;22.4, p=0.008) and an additional incremental healthcare cost of 1.07 million yen (95&#37; CI 0.317&ndash;1.822, p=0.007). Excluding time-dependent bias, the additional length of stay was 21.2 days (95&#37; CI 11.7&ndash;30.8, p<0.001) and the additional healthcare cost was 1.61 million yen (95&#37; CI 0.643&ndash;2.570, p=0.001). The additional healthcare resource consumption associated with MRSA infections was estimated using propensity score matching using 2 matching methods that differed according to whether or not time-dependent bias was included. The 2 methods produced different estimates, indicating that failure to address time-dependent bias may lead to overestimates of the additional healthcare resources consumed. These estimates have possible applications in evaluating the cost-effectiveness of infection control and prevention measures.

DOI： 10.4058/jsei.31.173

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

Cryptogenic ischemic stroke and embolic stroke of undetermined source: clinical implications and importance for detection of covert atrial fibrillation in Japan
Cryptogenic ischemic stroke, stroke with no clear definable cause even after extensive workup, does not have fixed diagnostic criteria. Proportion of this type of stroke among overall ischemic stroke varies much, ranging from 16&#37; to 39&#37;. Majority of cryptogenic ischemic stroke is considered as embolism, and the concept of embolic stroke of undetermined source has been recently proposed. In particular, covert atrial fibrillation is drawing attention, and it was identified in 30&#37; of patients in long-term observation using an insertable cardiac monitor. A next-generation insertable cardiac monitor is small and has the capability of remote monitoring. Thus, it has been in clinical use to detect atrial fibrillation in patients with cryptogenic ischemic stroke in the United States, Europe, and Australia. If atrial fibrillation would be identified, anticoagulants can be legally used for prevention of stroke recurrence, and could reduce its recurrence in patients with cryptogenic ischemic stroke. A request has been submitted by the Japan Stroke Society to the Ministry of Health, Labor and Welfare, Japan, indicating the high medical needs of the next-generation insertable cardiac monitor to detect covert atrial fibrillation after cryptogenic ischemic stroke. If the use of the device is approved, patients appropriate for the use should be selected based on detailed examination including head MRI in accordance with the current situation of medical practice in Japan.

DOI： 10.3995/jstroke.10416

Language：English  

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

OBJECTIVE. To develop and internally validate a surgical site infection (SSI) prediction model for Japan.
DESIGN. Retrospective observational cohort study.
METHODS. We analyzed surveillance data submitted to the Japan Nosocomial Infections Surveillance system for patients who had undergone target surgical procedures from January 1, 2010, through December 31, 2012. Logistic regression analyses were used to develop statistical models for predicting SSIs. An SSI prediction model was constructed for each of the procedure categories by statistically selecting the appropriate risk factors from among the collected surveillance data and determining their optimal categorization. Standard bootstrapping techniques were applied to assess potential overfitting. The C-index was used to compare the predictive performances of the new statistical models with those of models based on conventional risk index variables.
RESULTS. The study sample comprised 349,987 cases from 428 participant hospitals throughout Japan, and the overall SSI incidence was 7.0&#37;. The C-indices of the new statistical models were significantly higher than those of the conventional risk index models in 21 (67.7&#37;) of the 31 procedure categories (P<.05). No significant overfitting was detected.
CONCLUSIONS. Japan-specific SSI prediction models were shown to generally have higher accuracy than conventional risk index models. These new models may have applications in assessing hospital performance and identifying high-risk patients in specific procedure categories.

DOI： 10.1017/ice.2015.302

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

Background: Quantitative information on the effectiveness of safety-engineered devices (SEDs) is needed to support decisions regarding their implementation.
Aim: To elucidate the effects of SED use in winged steel needles, intravenous (IV) catheter stylets and suture needles on needlestick injury (NSI) incidence rates in Japan.
Methods: Japan EPINet survey data and device utilization data for conventional devices and SEDs were collected from 26 participating hospitals between 1 April 2009 and 31 March 2014. The NSI incidence rate for every 100,000 devices was calculated according to hospital, year and SED use for winged steel needles, IV catheter stylets and suture needles. Weighted means and 95&#37; confidence intervals (CI) were used to calculate overall NSI incidence rates.
Findings: In total, there were 236 NSIs for winged steel needles, 152 NSIs for IV catheter stylets and 180 NSIs for suture needles. The weighted NSI incidence rates per 100,000 devices for SEDs and non-SEDs were as follows: winged steel needles, 2.10 (95&#37; CI 1.66-2.54) and 14.95 (95&#37; CI 2.46-27.43), respectively; IV catheter stylets, 0.95 (95&#37; CI 0.60-1.29) and 6.39 (95&#37; CI 3.56-9.23), respectively; and suture needles, 1.47 (95&#37; CI -1.14-4.09) and 16.50 (95&#37; CI 4.15-28.86), respectively. All devices showed a significant reduction in the NSI incidence rate with SED use (P < 0.001 for winged steel needles, P = 0.035 for IV catheter stylets and P = 0.044 for suture needles).
Conclusion: SED use substantially reduces the incidence of NSIs, and is therefore recommended as a means to prevent occupational infections in healthcare workers and improve healthcare safety. (C) 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jhin.2015.09.019

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

Objectives
To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community".
Design
Retrospective cohort study.
Setting
Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities.
Participants
Patients aged 65 years and above who had undergone hip fracture surgery.
Measurements
Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization.
Results
The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US&#36;28,360 (95&#37; confidence interval: 27,787-28,972) and US&#36;21,951 (21,511-22,420), respectively, indicating an average increase of US&#36;6,409 in organized care.
Conclusion
Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.

DOI： 10.1371/journal.pone.0133694

Language：Japanese  

Increased Burden on Medical Resources of Penicillin-Resistant Streptococcus Pneumoniae Infections: Estimates Using JANIS Data
Drug-resistant bacterial infections in patients can aggravate disease conditions and prolong treatment durations, resulting in increased use of medical resources, and hinder measures aimed at moderating already strained health care costs. This study quantitatively estimated the additional medical resources used for drug-resistant bacterial infections, focusing on cases with penicillin-resistant Streptococcus pneumoniae (PRSP) infections judged by the Japan Nosocomial Infection Surveillance (JANIS). JANIS data and Diagnosis Procedure Combination/Per-Diem Payment System data were analyzed. The JANIS program collects data directly from voluntarily participating hospitals. The patients with PRSP infection were defined by the JANIS data. All subjects were categorized based on their diseases and surgical procedures as recorded in the data. Pairs of subjects with and without PRSP infections in each category were then matched according to a propensity score. To investigate the additional medical resources used due to PRSP infections, the differences in mean length of stay (LOS) and hospitalization costs were calculated between the matched pairs. The results showed that among all subjects, patients with PRSP infections had a mean LOS duration that was 2.79 days longer than uninfected patients. For patients under 5 years of age, PRSP infections resulted in an increase of 2.08 days in LOS and an additional 110,634 yen in hospitalization costs. This study presents a quantitative estimate of additional medical resources used due to PRSP infections. These drug-resistant bacterial infections resulted in clear increases in LOS among all patients, as well as increases in LOS and hospitalization costs in patients under 5 years of age. These findings have wide potential applications and can support technical assessments for infection control based on cost effectiveness. Comprehensive infection control measures that target drug-resistant bacterial infections are expected to be further developed.

DOI： 10.4058/jsei.30.165

Language：Others  

DOI： 10.14982/rsmp.5.1

Language：Japanese  

The effect of counter-referral of outpatients on the subsequent admission rate
Laying stress on the referral system is expected to promote functional differentiation. However, reduction in outpatient hospital services, which also enables functional differentiation, has not progressed. The purpose of this study was to identify the problems in, and factors influencing counter-referral for functional differentiation and to clarify the relationship between counter-referral, which is considered to affect policy making on reduction of outpatient services, and the subsequent admission rate. Data of patients with chronic obstructive pulmonary disease （COPD） or asthma who returned to the outpatient clinic of the Department of Respiratory Medicine, Nanpuh Hospital, were analyzed using a logistic regression model. Admission rates were compared by survival time analysis using propensity score matching. The analyses revealed that factors such as long-term prescription and outpatient visits to multiple departments were associated with increased counter-referral. In addition, comparison of the admission rates by survival time analysis showed no relationship between the counter-referral of outpatients and reduction in the subsequent admission rate. Thus, promotion of counter-referral of outpatients for reduction in general outpatient services may be expected to lead to functional differentiation of regional medical care in outpatient medical services.

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)  

Objectives: The benefit of intravenous recombinant tissue plasminogen activator (rt-PA) therapy for very old patients with acute ischemic stroke remains unclear. The aim of this study was to elucidate the efficacy and safety of intravenous rt-PA therapy for patients over 80 years old.
Methods: Of 13,521 stroke patients registered in the Fukuoka Stroke Registry in Japan from June 1999 to February 2013, 953 ischemic stroke patients who were over 80 years old, hospitalized within 3 h of onset, and not treated with endovascular therapy were included in this study. Among them, 153 patients were treated with intravenous rt-PA (0.6 mg/kg). For propensity score (PS)-matched case-control analysis, 148 patients treated with rt-PA and 148 PS-matched patients without rt-PA therapy were selected by 1:1 matching with propensity for using rt-PA. Clinical outcomes were neurological improvement, good functional outcome at discharge, in-hospital mortality, and hemorrhagic complications (any intracranial hemorrhage [ICH], symptomatic ICH, and gastrointestinal bleeding).
Results: In the full cohort of 953 patients, rt-PA use was associated positively with neurological improvement and good functional outcome, and negatively with in-hospital mortality after adjustment for multiple confounding factors. In PS-matched case-control analysis, patients treated with rt-PA were still at lower risk for unfavorable clinical outcomes than non-treated patients (neurological improvement, odds ratio 2.67, 95&#37; confidence interval 1.61-4.40; good functional outcome, odds ratio 2.23, 95&#37; confidence interval 1.16-4.29; in-hospital mortality, odds ratio 0.30, 95&#37; confidence interval 0.13-0.65). There was no significant association between rt-PA use and risk of hemorrhagic complications in the full and PS-matched cohorts.
Conclusions: Intravenous rt-PA therapy was associated with improved clinical outcomes without significant increase in risk of hemorrhagic complications in very old patients (aged. 80 years) with acute ischemic stroke.

DOI： 10.1371/journal.pone.0110444

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：English   Publishing type：Research paper (scientific journal)  

Background: Experience curve effects were first observed in the industrial arena as demonstrations of the relationship between experience and efficiency. These relationships were largely determined by improvements in management efficiency and quality of care. In the health care industry, volume-outcome relationships have been established with respect to quality of care improvement, but little is known about the effects of experience on management efficiency. Here, we examine the relationship between experience and hospital management in Japanese hospitals.
Methods: The study sample comprised individuals who had undergone surgery for unruptured abdominal aortic aneurysms and had been discharged from participant hospitals between April 1, 2006 and December 31, 2008. We analyzed the association between case volume (both at the hospital and surgeon level) and postoperative complications using multilevel logistic regression analysis. Multilevel log-linear regression analyses were performed to investigate the associations between case volume and length of stay (LOS) before and after surgery.
Results: We analyzed 909 patients and 849 patients using the hospital-level and surgeon-level analytical models, respectively. The odds ratio of postoperative complication occurrence for an increase of one surgery annually was 0.981 (P<0.001) at the hospital level and 0.982 (P<0.001) at the surgeon level. The log-linear regression analyses showed that shorter postoperative LOS was significantly associated with high hospital-level case volume (coefficient for an increase of one surgery: -0.006, P = 0.009) and surgeon-level case volume (coefficient for an increase of one surgery: -0.011, P = 0.022). Although an increase of one surgery annually at the hospital level was statistically associated with a reduction of preoperative LOS by 1.1&#37; (P = 0.006), there was no significant association detected between surgeon-level case volume and preoperative LOS (P = 0.504).
Conclusion: Experience at the hospital level may contribute to the improvement of hospital management efficiency.

DOI： 10.1371/journal.pone.0106884

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

DOI： 10.4058/jsei.29.231

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

Language：Japanese  

Guideline for economic evaluation of healthcare technologies in Japan

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

Background: The National Healthcare Safety Network transitioned from surgical site infection (SSI) rates to the standardized infection ratio (SIR) calculated by statistical models that included perioperative factors (surgical approach and surgery duration). Rationally, however, only patient-related variables should be included in the SIR model.
Methods: Logistic regression was performed to predict expected SSI rate in 2 models that included or excluded perioperative factors. Observed and expected SSI rates were used to calculate the SIR for each participating hospital. The difference of SIR in each model was then evaluated.
Results: Surveillance data were collected from a total of 1,530 colon surgery patients and 185 SSIs. C-index in the model with perioperative factors was statistically greater than that in the model including patient-related factors only (0.701 vs 0.621, respectively, P < .001). At one particular hospital, for which the percentage of open surgery was lowest (33.2&#37;), SIR estimates changed considerably from 0.92 (95&#37; confidence interval: 0.84-1.00) for the model with perioperative variables to 0.79 (0.75-0.85) for the model without perioperative variables. In another hospital with a high percentage of open surgery (88.6&#37;), the estimate of SIR was decreased by 12.1&#37; in the model without perioperative variables.
Conclusion: Because surgical approach and duration of surgery each serve as a partial proxy of the operative process or the competence of surgical teams, these factors should not be considered predictive variables. Copyright (c) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.ajic.2012.10.004

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

Comparison of surgical site infection (SSI) rates across institutions has been an effective infection control measure, but success relies on the quality of risk adjustments. This study assessed desirable risk-adjustment methodologies for use in the Japan Nosocomial Infections Surveillance (JANIS) network. Patients who underwent 1 of 6 digestive system procedures (APPY, BILI, CHOL, COLN, GAST, or REC) were included. Logistic regression analysis was performed to predict the risk of developing SSI in the following two models: (1) selected variables that consist of an NNIS Risk Index, or (2) all variables that were collected at SSI surveillance. Model performances were assessed using the c-index. Two regression models were also developed that included or excluded factors regarding surgery duration as well as laparoscopic surgery. The difference in the standardized infection ratio (SIR) in each model was then evaluated. Surveillance data were collected from a total of 37,251 procedures from 37 institutions. Odds ratios regarding the development of SSI were generally different between procedures and risk factors. Except for APPY, the c-index was statistically greater in the model with all variables than in the model including risk index factors only (p < 0.001). The estimates of SIR were considerably different between models with adjustment of surgery duration and laparoscopic surgery versus models without these adjustments. The two models offered contradictory evidence regarding hospital performance. Multivariate logistic regression analyses that use all available variables from SSI surveillance were found to be superior to NNIS risk index methodology. When calculating SIR, we should consider the exclusion of surgery duration and laparoscopic surgery as risk-adjustment factors.

DOI： 10.4058/jsei.28.63

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

Purpose To estimate the impact of surgical site infection (SSI) on postoperative resource consumption for colon and rectal open and laparoscopic surgeries after accounting for infection depth and patient characteristics, and to compare these estimates among institutions.
Methods We collected administrative and SSI-related data from eight Japanese hospitals, and used generalized linear models to estimate excess postoperative length of stay (LOS) and charges attributable to SSI. Covariates included wound class, American Society of Anesthesiologists (ASA) score, operation time, emergency, colostomy, trauma, implant, and comorbidities.
Results We examined 1,108 colon surgery (CS) and 477 rectal surgery (RS) patients. For open surgery, the postoperative LOS in non-SSI patients was 13.5 (CS) and 15.9 days (RS). Compared with non-SSI patients, the postoperative LOS increased by 4.5 (CS) and 2.8 days (RS) for superficial SSI, 6.8 (CS) and 8.5 days (RS) for deep SSI, and 7.8 and 9.5 days for space/organ SSI. For laparoscopic surgery, the postoperative LOS was 9.8 (CS) and 14.6 days (RS). SSI was significantly associated with increased postoperative LOS for superficial SSI [by 4.8 (CS) and 3.6 days (RS)], deep SSI [by 10.3 (CS) and 23.9 days (RS)], and space/organ SSI [by 8.9 days (RS)]. The postoperative LOS among hospitals was 3.8-10.4 days (CS) and 1.3-12.2 days (RS). Postoperative SSI-attributable charges ranged from &#36;386 to &#36;2,873, depending on organ, procedure, and infection depth.
Conclusions This study quantified the impact of SSIs on resource consumption and confirmed significant cost variations among hospitals. These variations could not be explained by patient characteristics or infection type.

DOI： 10.1007/s15010-012-0317-7

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

CLINICAL EPIDEMIOLOGY OF FALLS/SLIPS BASED ON INCIDENT REPORTING DATA AT A TEACHING HOSPITAL IN JAPAN : A RETROSPECTIVE CASE STUDY
To understand how Falls/Slips (Falls) occurred at hospitals, the epidemiological aspects were explored by using incident reporting and administrative profiling data. There were 7,717 incident reports collected between 2007 and 2009 FY at a teaching hospital in Japan. They included 1,764 reports for Falls and Falls rate (FR) was 1.84/1,000 patient-days (1,000 pt・dys). Of 1,764 cases for Falls, Mean age±SD (standard deviation) were 66.9±19.2 y.o. for male (950 cases) and 69.9±19.2 y.o. for female (814 cases). FRs were 2.06 for male and 1.87/1,000 pt・dys for female. FR in 70's (555 cases) was 2.82/1,000 pt・dys and the highest by age. With clinical services, FR of orthopedics was 1.14 and FR of cardiovascular and respiratory medicine were 1.97. FRs at internal medical services was higher than those at surgical services. Furthermore, with respect to duration between admission and Falls, FR for the second day after admission was 0.16/1,000 pt・dys （118 cases） and the highest, 0.12 （84 cases） for the third day after admission, and 0.11 （78 cases） for the date of admission, and FR was getting lower day by day. The mean of duration was 12.4 days, and the cumulative percentage exceeded 50% on the eleventh day after admission. Since the epidemiological characteristics of Falls are explored from the viewpoint of FR, appropriate and effective actions for patient safety are needed.

DOI： 10.11303/jsha.49.205

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

ANALYSIS OF CHANGES IN ACCESSIBILITY BY TRANSFERRING PATIENTS FROM ACUTE CARE HOSPITALS TO CONVALESCENT HOSPITALS USING GEOGRAPHIC INFORMATION SYSTEM (GIS) : A regional cooperative critical-path for femoral neck fracture as an example
Promotion of regional referral systems, such as regional cooperative critical-paths, enables patients to effectively and safely receive medical care, while benefiting from the advancement and specialization of technology. On the other hand, the influence of the promotion of referral systems on accessibility, such as trends in the movement of patients has scarcely been elucidated. Therefore, the purpose of this study was (1) to visualize the areas from which patients are drawn to hospitals, and (2) to elucidate changes in accessibility by transferring patients to convalescent hospitals using geographic information system (GIS), in acute care hospitals in regions with advanced regional cooperation. In this study, substantial areas covered by acute care hospitals were wider than secondary medical areas, and 32.5% patients were transferred to convalescent hospitals outside the secondary medical areas. Geographic dissociation between secondary medical areas established by the Medical Service Act and the actual areas covered by hospitals were clarified. It was suggested that the evaluation of accessibility using GIS can be utilized in developing health resources reflecting the actual state of health care and in making health plans.

DOI： 10.11303/jsha.49.173

Language：Japanese  

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

The challenge of conducting the effectiveness analysis for patient safety measures: lessons from measures to boost incident reporting.

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

THE FEATURES OF THE IMPLEMENTATION OF REGIONAL LIAISON CRITICAL PATHWAYS FOR HIP FRACTURE AND STROKE
Objective:The objective of this study is (1) to reveal hospital factors associated with the strength of a local healthcare network, and (2) to assess whether the implementation of a liaison critical pathway promotes differentiated functionality of the hospitals. Methods:This study utilized a questionnaire to collect patient volume, average length of stay, details of the pathways used, and characteristics of the regions from all 625 hospitals that implemented a liaison critical pathway. The data was analyzed using linear regression modeling. Results:Of the 625 hospitals surveyed, 232 (37.1&#37;) hospitals participated in the study. In terms of hip fracture, hospitals with high patient volume (p=0.002) and short average length of stay (p=0.005) were related to high applicability of a liaison critical pathway. The average length of stay was significantly shorter by 12.8&#37; in hospitals implementing the liaison critical pathway with specific criteria for discharge from acute hospital (p=0.036) when compared to hospitals without specific discharge criteria. Conclusions:This study suggested an importance of discharge criteria in the liaison critical pathway.

DOI： 10.11303/jsha.49.31

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

Issues of introducing cost-effectiveness analysis in the field of infection control are inevitably controversial. However, cost of illness studies, which are essential for cost-effectiveness analysis, have not been adequately carried out in Japan. This study estimated postoperative resource consumption attributable to surgical site infection (SSI) in gastrectomy patients who underwent gastrectomy between July 2007 and December 2010 at six participating hospitals. The JANIS/DPC Integrated Database was developed after collecting JANIS-related data and administrative DPC data. The generalized linear model was used to estimate excess postoperative length of stay (LOS) and charges (based on fee-for-service) attributable to SSI. A total of 42 SSI cases were identified among 857 surgeries. The generalized linear model was used to estimate the impact of SSI and revealed that compared with non-SSI patients, postoperative LOS and charges increased by 6.6 days and 206,000 yen for superficial SSI patients, 12.8 days and 398,000 yen for deep SSI patients, and 18.3 days and 1,021,000 yen for organ/space SSI patients, respectively. The JANIS/DPC Integrated Database was developed by combining JANIS-related data and DPC data and used to estimate postoperative extra resource consumption in gastrectomy patients at six hospitals. These data may prove useful in cost-effectiveness analysis for future infection control programs in Japan.

DOI： 10.4058/jsei.27.389

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：English  

Hospital-acquired infections (HAIs) present a substantial problem for healthcare providers, with a relatively high frequency of occurrence and considerable damage caused. There has been an increase in the number of cost-effectiveness and cost-savings analyses of HAI control measures, and the quantification of the cost of HAT (COHAI) is necessary for such calculations. While recent guidelines allow researchers to utilize COHAI estimates from existing published literature when evaluating the economic impact of HAI control measures, it has been observed that the results of economic evaluations may not be directly applied to other jurisdictions due to differences in the context and circumstances in which the original results were produced. The aims of this study were to conduct a systematic review of published studies that have produced COHAI estimates from 1980 to 2006 and to evaluate the quality of these estimates from the perspective of transferability. From a total of 89 publications, only eight papers (9.0&#37;) had a high level of transferability in which all components of costs were described, data for costs in each component were reported, and unit costs were estimated with actual costing. We also did not observe a higher citation level for studies with high levels of transferability. We feel that, in order to ensure an appropriate contribution to the infection control program decision-making process, it is essential for researchers who estimate COHAI, analysts who use COHAI estimates for decision-making, as well as relevant journal reviewers and editors to recognize the importance of a transferability paradigm.

DOI： 10.1007/s15010-011-0095-7

Language：Japanese  

Language：Japanese  

Language：English  

Language：English  

Quantifying the additional costs of hospital-acquired infections (COHAI) is essential for developing cost-effective infection control measures. The methodological approaches to estimate these costs include case reviews, matched comparisons and regression analyses. The choice of cost estimation methodologies can affect the accuracy of the resulting estimates, however, with regression analyses generally able to avoid the bias pitfalls of the other methods. The objective of this study was to elucidate the distributions and trends in cost estimation methodologies in published studies that have produced COHAI estimates. We conducted systematic searches of peer-reviewed publications that produced cost estimates attributable to hospital-acquired infection in MEDLINE from 1980 to 2006. Shifts in methodologies at 10-year intervals were analysed using Fisher's exact test. The most frequent method of COHAI estimation methodology was multiple matched comparisons (59.6&#37;), followed by regression models (25.8&#37;), and case reviews (7.9&#37;). There were significant increases in studies that used regression models and decreases in matched comparisons through the 1980s, 1990s and post-2000 (P = 0.033). Whereas regression analyses have become more frequently used for COHAI estimations in recent years, matched comparisons are still used in more than half of COHAI estimation studies. Researchers need to be more discerning in the selection of methodologies for their analyses, and comparative analyses are needed to identify more accurate estimation methods. This review provides a resource for analysts to overview the distribution, trends, advantages and pitfalls of the various existing COHAI estimation methodologies. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jhin.2010.10.006

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

Background Delays in reporting of medical errors may signal deficiencies in the performance of hospital-based incident reporting. We sought to understand the characteristics of hospitals, providers and patient injuries that affect such delays.
Setting and Methods All incident reports filed between May 2004 and August 2005 at the Kyoto University Hospital (KUH) in Japan and the Brigham and Women's Hospital (BWH) in the USA were evaluated. Lag time between each event and the submission of an incident report were computed. Multivariable Poisson regression with overdispersion, to control for previously described confounding factors and identify independent predictors of delays, was used.
Results Unadjusted lag times were significantly longer for physicians than other reporters (3.6 vs 1.8 days, p<0.0001), longer for major than minor events (4.1 vs 1.9 days, p=0.0006) and longer at KUH than at BWH (3.1 vs 1.0 days, p<0.0001). In multivariable analysis, lag times at KUH remained nearly three times longer than at BWH (incidence-rate ratio 2.95, 95&#37; CI 2.84 to 3.06, p<0.0001).
Conclusions Lag time provides a novel and useful metric for evaluating the performance of hospital-based incident reporting systems. Across two very different health systems, physicians reported far fewer events, with significant delays compared with other providers. Even after controlling for important confounding factors, lag times at KUH were nearly triple those at BWH, suggesting significant differences in the performance of their reporting systems, potentially attributable to either the ease of online reporting at BWH or to the greater attention to patient safety reporting in that hospital.

DOI： 10.1136/qshc.2008.029215

Language：Japanese  

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

Background Incident reporting is a promising tool to enhance patient safety, but few empirical studies have been conducted to identify factors that increase the number of incident reports.
Objective To evaluate how the number of incident reports are related to system-level activities and reporting design.
Methods A questionnaire survey was administered to all 1039 teaching hospitals in Japan. Items on the survey included number of reported incidents; reporting design of incidents; and status for system-level activities, including assignment of safety managers, conferences, ward rounds by peers, and staff education. Staff education encompasses many aspects of patient safety and is not limited to incident reporting. Poisson regression models were used to determine whether these activities and design of reporting method increase incident reports filed by physicians and nurses.
Results Educational activities were significantly associated with reporting by physicians (53&#37; increase, p < 0.001) but had no significant effect on nurse-generated reports. More reports were submitted by physicians and nurses in hospitals where time involved with filing a report was short (p < 0.05). The impact of online reporting was limited to a 26&#37; increase in physicians' reports (p < 0.05).
Conclusion In accordance with the suggestions by previous studies that examined staff perceptions and attitudes, this study empirically demonstrated that to decrease burden to reporting and to implement staff educations may improve incident reporting.

DOI： 10.1136/qshc.2008.027532

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

Objective. Several studies raise questions about whether clinical practice guidelines actually guide practice. We evaluated patterns of use of breast-conserving surgery (BCS) over time to examine the effect of guideline publication.
Design. Retrospective analysis of time-series data on breast cancer treatment. Multiple logistic regression analysis was performed, adjusting for covariates including the patient's age, comorbidity status and admission year, to assess whether the use of BCS was higher after publication of treatment guidelines.
Setting. Five teaching hospitals participating in the Quality Improvement/Indicator Project (QIP) in Japan.
Participants. Female breast cancer patients who received surgical treatment at five teaching hospitals from January 1996 through December 2007 (n = 2199).
Main Outcome Measure. Rates of use of BCS.
Results. The proportion of BCS use increased from 26.4&#37; before guideline publication to 59.9&#37; after guideline publication in Japan. After controlling for other characteristics, the use of BCS has increased significantly over time, especially since 2001. Women aged 70 years and older (P=0.004) and those with any comorbidity (P < 0.001) were significantly less likely to receive BCS.
Conclusions. This study demonstrated that the adjusted proportion of BCS has increased dramatically since 2001, 2 years after guideline publication in Japan and this is consistent with a relationship between guideline publication and a change in this clinical practice.

DOI： 10.1093/intqhc/mzp037

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

Transparency of costing is essential for decision-makers who require information on the efficiency of a health care programme, because effective decisions depend largely on applicability to their settings. The main objectives of this study were to assess published studies for transparency of cost estimates.
We first developed criteria with two axes by reviewing publications dealing with economic evaluations and cost accounting studies: clarification of the scope of costing and accuracy of method evaluating costs. We then performed systematic searches of the literature for studies which estimated prevention costs and assessed the transparency and accuracy of costing based on our criteria.
Forty studies met the inclusion criteria. Half of the studies reported data for both the quantity and unit price of programmes in regard to prevention costs. Although 30 studies estimated costs of adverse events, 19 of these described the scope of costing only, and just five studies used a micro-costing method. Among 30 studies that estimated 'gross cost savings' and 'net cost savings', there was a huge discrepancy in labels.
Even if a cost study was conducted in accordance with existing techniques of economic evaluation which mostly paid attention to internal validity of cost estimates, without adequate explanation of the process of costing, reproducibility cannot be assured and the study may lose its value as scientific information. This study found that there is tremendous room for improvement.

DOI： 10.1111/j.1365-2753.2008.01033.x

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

Objective To reveal the amount of time and financial cost required to obtain informed consent and to preserve documentation.
Methods The questionnaire was delivered to all staff in six acute care public hospitals in Japan. We examined health care staff perceptions of the time they spent obtaining informed consent and documenting information. All data were collected in 2006 and estimates in the past week in 2006 were compared to estimates of time spent in a week in 1999. We also calculated the economic costs of incremental amounts of time spent in these procedures.
Results In 2006, health care staff took about 3.89 hours [95&#37; Confidence Interval (CI) 3.71-4.07] per week to obtain informed consent and 6.64 hours (95&#37; CI 6.40-6.88) per week to write documentation on average. Between 1999 and 2006, the average amount of time for conducting informed consent was increased to 0.67 (P < 0.001) hours per person-week, and the average amount of time for documentation was increased to 0.70 (P < 0.001) hours per person-week. The annual economic cost of activities for informed consent and documentation in a 100-bed hospital increased from 117 755 to 449 402 US dollars.
Conclusions We found a considerable increase in time spent on informed consent and documentation, and associated cost over a 7-year time period. Although greater attention to the informed consent process should be paid to ensure the notions of patient autonomy and self-determination, the increased resources devoted to these practices must be considered in light of current cost containment policies.

DOI： 10.1111/j.1365-2753.2008.00987.x

Language：Japanese  

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

Objective: We examined the relationship between hospital structural characteristics and system-level activities for patient safety and infection control, for use in designing, an incentive structure to promote patient safety.
Methods: This study utilized a questionnaire to collect institutional data about hospital infrastructure and volume of patient safety activities from all 1039 teaching hospitals in Japan. The patient safety activities were focused on meetings and conferences, internal audits, staff education and training, incident reporting and infection surveillance. Generalized linear modeling was used.
Results: Of the 1039 hospitals surveyed, 418 (40.2&#37;) hospitals participated. The amount of activities significantly increased by over 30&#37; in hospitals with dedicated patient safety and infection control full-time staff (P < 0.001 and P < 0.01, respectively). High profit margins also predicted the increase of patient safety programs (P < 0.01). Perceived lack of administrative leadership was associated with reduced volume of activities (P<0.05), and the economic burden of safety programs was found to be disproportionately large for small hospitals (P<0.05).
Conclusions: Hospitals with increased resources had greater spread of patient safety and infection control activities. To promote patient safety programs in hospitals, it is imperative that policy makers require the assignment of dedicated full-time staff to patient safety. Economic Support for hospitals will also be required to assure that safety programs are Sustainable. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.healthpol.2008.04.009

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

Objective: The aim of this study was to assess the status and the cost of hospital patient safety systems. Methods: We conducted a national questionnaire survey of all the 1039 teaching hospitals in Japan. The study was constructed to evaluate the costs of the systems for patient safety focused on staff assignment, meetings and conferences, internal audit, staff education and training, incident reporting, infection surveillance, infectious disposal, management of medication use, clinical engineering, and patient counseling.
Results: The status to maintain patient safety systems might be at least as decent. The mean estimated total cost of systems for patient safety was US&#36; 20,449 (95&#37; confidence interval [CI], 19,632-21,266) per 100 bed-months or US&#36; 8.52 (95&#37; CI, 8.18-8.86) per inpatient-day. The ratio of costs to revenue was 1.68&#37; (95&#37; CI, 1.61-1.75). The annual necessary costs occurring in hospitals where the costs of patient safety were under the average level across all the 1032 teaching hospitals in Japan was US&#36; 259.7 million.
Conclusions: Our results show that hospital-wide activities for patient safety pose significant costs to hospitals and national healthcare systems. Our data may provide financial information for designing and improving patient safety systems. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.healthpol.2008.04.004

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

Objective: The aim of this study was to assess the financial costs to hospitals for the implementation of hospital-wide patient safety and infection control programs.
Methods: We conducted questionnaire surveys and structured interviews in seven acute-care teaching hospitals with an established reputation for their efforts towards improving patient safety. We defined the scope of patient safety activities by use of an incremental activity measure between 1999 and 2004. Hospital-wide incremental manpower, material, and financial resources to implement patient safety programs were measured.
Results: The total incremental activities were 19,414-78,540 person-hours per year. The estimated incremental costs of activities for patient safety and infection control were calculated as US&#36; 1.100-2.335 million per year, equivalent to the employment of 17-40 full-time healthcare staff. The ratio of estimated costs to total medical revenue ranged from 0.55&#37; to 2.57&#37;. Smaller hospitals tend to shoulder a higher burden compared to larger hospitals.
Conclusions: Our study provides a framework for measuring hospital-wide activities for patient safety. Study findings suggest that the total amount of resources is so great that cost-effective and evidence-based health policy is needed to assure the sustainability of hospital safety programs. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.healthpol.2008.02.006

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

Objectives To assess predictive value of patient characteristics and severity of aneurysmal subarachnoid haemorrhage (SAH) patients for clinical outcomes, and thereby estimate risk-adjusted clinical outcomes and compare the outcomes across hospitals.
Methods We selected 256 aneurysmal SAH patients from eight teaching hospitals in Japan. The clinical outcomes of patients at the time of discharge were assessed by the Glasgow Outcome Scale (GOS). A multiple logistic regression analysis was performed to identify predictors for the GOS status at the time of discharge. The risk-adjusted proportion of patients with a favourable GOS outcome was then estimated for each facility and compared across hospitals.
Results The logistic regression analysis revealed that younger age (P < 0.001), patients with good World Federations of Neurological Surgeons grade at admission (P < 0.001) and absence of chronic renal failure or ischaemic heart disease as a comorbid condition (P < 0.001) were identified as significant predictors for favourable GOS outcome at the time of discharge among aneurysmal SAH patients (C statistic = 0.88). We found that one hospital had significantly better outcomes than the others.
Conclusion After comparison of risk-adjusted values across hospitals, the clinical management methods of the hospital that showed the best performance were examined and shared among providers.

DOI： 10.1111/j.1365-2753.2007.00882.x

Language：Japanese  

PROFILING OF DEVELOPMENT AND IMPLEMENTATION OF PATIENT SAFETY SYSTEMS IN TEACHING HOSPITALS

Language：Japanese  

Language：Japanese  

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

Background: In Japan, as in many other countries, several quality and safety assurance measures have been implemented since the 1990' s. This has occurred in spite of cost containment efforts. Although government and hospital decision-makers demand comprehensive analysis of these activities at the hospital-wide level, there have been few studies that actually quantify them. Therefore, the aims of this study were to measure hospital-wide activities for patient safety and infection control through a systematic framework, and to identify the incremental volume of these activities implemented over the last five years.
Methods: Using the conceptual framework of incremental activity corresponding to incremental cost, we defined the scope of patient safety and infection control activities. We then drafted a questionnaire to analyze these realms. After implementing the questionnaire, we conducted several in-person interviews with managers and other staff in charge of patient safety and infection control in seven acute care teaching hospitals in Japan.
Results: At most hospitals, nurses and clerical employees acted as the main figures in patient safety practices. The annual amount of activity ranged from 14,557 to 72,996 person-hours ( per 100 beds: 6,240; per 100 staff: 3,323) across participant hospitals. Pharmacists performed more incremental activities than their proportional share. With respect to infection control activities, the annual volume ranged from 3,015 to 12,196 person-hours ( per 100 beds: 1,141; per 100 staff: 613). For infection control, medical doctors and nurses tended to perform somewhat more of the duties relative to their share.
Conclusion: We developed a systematic framework to quantify hospital-wide activities for patient safety and infection control. We also assessed the incremental volume of these activities in Japanese hospitals under the reimbursement containment policy. Government and hospital decision makers can benefit from this type of analytic framework and its empirical findings.

DOI： 10.1186/1472-6963-7-140

Language：Others  

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

Though risk adjustment is necessary in order to make equitable comparisons of resource utilization in the treatment of acute myocardial infarction patients, there is little in the literature that can be practically applied without access to clinical records or specialized registries. The aim of this study is to show that effective models of resource utilization can be developed based on administrative data, and to demonstrate a practical application of the same models by comparing the risk-adjusted performance of the hospitals in our dataset. The study sample included 1748 AMI cases discharged front 10 large, private teaching hospitals in Japan, between 10 April 2001 and 30 June 2004. Explanatory variables included procedures (CABG and PCI), length of stay, outcome, patient demographics, diagnosis and comorbidity status. Multiple linear regression models constructed for the study were able to account for 66.5, 27.7, and 58.4&#37; of observed variation in total charges, length of stay and charges per day, respectively. The performance of models constructed for this study was comparable to or better than performance reported by other studies that made use of explanatory variables extracted from clinical data. The use of administrative data in risk adjustment makes broad scale application of risk adjustment feasible. Copyright (c) 2006 John Wiley & Soils, Ltd.

DOI： 10.1002/hec.1177

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

This study aimed to develop a new risk-adjustment method to assess acute myocardial infarction (AMI) in-hospital mortality. Risk-adjustment was based on variables obtained from administrative data from Japanese hospitals, and included factors such as age, gender, primary diagnosis and co-morbidity. The infarct location was determined using the criteria of the International Classification of Diseases (10th version). Potential comorbidity risk factors for mortality were selected based on previous studies and their critical influence analysed to identify major co-morbidities. The remaining minor co-morbidities were then divided into two groups based on their medical implications. The major co-morbidities included shock, pneumonia, cancer and chronic renal failure. The two minor co-morbidity groups also demonstrated a substantial impact on mortality. The model was then used to assess clinical performance in the participating hospitals. Our model reliably employed the available data for the risk-adjustment of AMI mortality and provides a new approach to evaluating clinical performance.

DOI： 10.1177/147323000703500502

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

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

Language：Others   Book type：Scholarly book

Language：Others   Book type：Scholarly book

Language：Others   Book type：Scholarly book

Language：Others  

Event date： 2011.12

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：三重   Country：Japan  

Event date： 2010.11

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京   Country：Japan  

Language：English  

Venue：Dublin   Country：Ireland  

Event date： 2024.10

Presentation type：Symposium, workshop panel (public)  

researchmap

Event date： 2024.8

Presentation type：Poster presentation  

researchmap

Event date： 2024.8

Presentation type：Oral presentation (general)  

researchmap

Event date： 2024.8

Presentation type：Poster presentation  

researchmap

Event date： 2024.6

Presentation type：Oral presentation (general)  

researchmap

Event date： 2024.6

Presentation type：Symposium, workshop panel (nominated)  

researchmap

Event date： 2024.5

Presentation type：Oral presentation (general)  

researchmap

Event date： 2024.4

Presentation type：Poster presentation  

researchmap

Event date： 2024.3

Presentation type：Oral presentation (general)  

researchmap

Event date： 2024.3

Presentation type：Oral presentation (general)  

researchmap

Event date： 2024.3

Presentation type：Oral presentation (general)  

researchmap

Event date： 2024.1 - 2024.2

Presentation type：Poster presentation  

researchmap

Event date： 2024.1 - 2024.2

Presentation type：Oral presentation (general)  

researchmap

Event date： 2024.1 - 2024.2

Presentation type：Poster presentation  

researchmap

Event date： 2024.1 - 2024.2

Presentation type：Poster presentation  

researchmap

Event date： 2024.1 - 2024.2

Presentation type：Poster presentation  

researchmap

Event date： 2024.1 - 2024.2

researchmap

Event date： 2024.1 - 2024.2

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Language：Others  

Country：Other  

Event date： 2023.11

Presentation type：Poster presentation  

researchmap

Event date： 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.11

Presentation type：Poster presentation  

researchmap

Event date： 2023.11

Presentation type：Poster presentation  

researchmap

Event date： 2023.11

Presentation type：Poster presentation  

researchmap

Event date： 2023.11

researchmap

Event date： 2023.11

Presentation type：Poster presentation  

researchmap

Event date： 2023.11

Presentation type：Poster presentation  

researchmap

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Language：Others  

Country：Other  

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Poster presentation  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10 - 2023.11

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10

Language：Others  

Country：Other  

Event date： 2023.10

Presentation type：Oral presentation (general)  

researchmap

Event date： 2023.10

Language：Others  

Country：Other  

Event date： 2023.10

Presentation type：Oral presentation (general)  

researchmap