記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Human Vaccines and Immunotherapeutics  

Safety data on human papillomavirus (HPV) vaccination in the Japanese population remain limited owing to the lack of healthcare databases available for vaccine safety assessment. In this study, we assessed the risk of adverse events of special interest (AESIs) following HPV vaccination among females aged 12–26 y using medical claims data linked to routine or catch-up vaccination records provided by municipalities. We conducted a population-based cohort study and self-controlled case series (SCCS) from April 2015 to March 2023 for bivalent/quadrivalent vaccines and from April 2023 to March 2024 for the 9-valent vaccine. All females eligible for the vaccination program were included in the cohort study, whereas only those who experienced AESIs were included in the SCCS. The observation period was classified according to vaccination status as unvaccinated and post-vaccination risk periods following the first, second, and third doses. Adjusted rate ratios with 95% confidence intervals were estimated for the cohort and SCCS. In the bivalent/quadrivalent vaccines analysis cohort (25131 females), 1763, 1492, and 975 received the first, second, and third doses, respectively. In the 9-valent vaccine analysis cohort (38970 females), 3931, 2389, and 934 received the first, second, and third doses, respectively. Rates of 54 AESIs were calculated during unvaccinated periods. AESIs with feasible quantitative analyses for either the bivalent/quadrivalent or 9-valent vaccines included migraine, hypotension, asthma, polycystic ovary syndrome, postural orthostatic tachycardia syndrome, hypothyroidism, hyperthyroidism, and epilepsy. No statistically significant increased risk following HPV vaccination was observed for these AESIs. Larger datasets are needed to assess rarer AESIs.

DOI： 10.1080/21645515.2026.2688606

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：IJID Regions  

Objectives To describe routine Japanese encephalitis (JE) vaccination coverage patterns among priority and nonpriority groups during the 2021 JE vaccine shortage and prioritization policy in Japan, and after supply restoration. Methods Using vaccination and resident registry data from three municipalities in the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study, we assessed cumulative vaccination coverage at each fiscal year (FY)-end in nine Phase 1 birth cohorts and nine Phase 2 annual cohorts (April 2014–March 2023) using descriptive analyses. Results Among 60,122 children in Phase 1 and 74,914 in Phase 2, first- and second-dose coverage in the prioritized FY 2018 birth cohort was 62.0% and 50.5%, respectively, at age 3 years. Third-dose coverage at age 4 years declined to 6.9% in the FY 2017 birth cohort, compared with 37.5% to 41.4% in prior cohorts, and increased to 49.9% by age 5 years. Fourth-dose coverage at age 9 years was 1.3% in the FY 2012 birth cohort and increased to 32.7% by age 10 years. Conclusion The JE vaccine shortage temporarily reduced coverage among nonpriority groups, whereas coverage was maintained among prioritized children in 3 Japanese municipalities. Age- and dose-specific monitoring could identify deferred cohorts and support targeted follow-up measures in case of vaccine supply disruptions.

DOI： 10.1016/j.ijregi.2026.100958

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ageing/afag246

PubMed

記述言語：英語  

DOI： 10.1002/alz.71692

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Diabetes Obesity and Metabolism  

Aims: To examine adjusted cardiovascular outcome associations among older adults with type 2 diabetes who had sustained sodium–glucose cotransporter 2 inhibitor (SGLT2i) or dipeptidyl peptidase-4 inhibitor (DPP-4i) therapy for ≥ 6 months, focusing on the maintenance phase and heterogeneity across body mass index (BMI) strata. Materials and Methods: We conducted a nationwide-scale landmark cohort study using linked claims and health examination data in Japan. Adults aged ≥ 65 years with type 2 diabetes who maintained SGLT2i or DPP-4i for ≥ 6 months were included. Weighted discrete-time hazard models with inverse probability of treatment and censoring weighting were applied. Results: Among 24 380 participants (4223 SGLT2i; 20 157 DPP-4i), sustained SGLT2i use was associated with lower hazards of heart failure hospitalisation (HR, 0.775; 95% CI, 0.628–0.958) and MACE (myocardial infarction, stroke or all-cause mortality) (HR, 0.848; 95% CI, 0.753–0.955). Stroke hazard was lower (HR, 0.834; 95% CI, 0.721–0.965), whereas myocardial infarction and all-cause mortality were not clearly different. The association for heart failure hospitalisation was directionally consistent across BMI strata (p for interaction = 0.953), whereas MACE estimates differed across BMI strata (p for interaction = 0.007), with no clear association in the lowest BMI group (< 22 kg/m²; HR, 1.226; 95% CI, 0.931–1.615). Conclusions: Among older adults who had maintained treatment for ≥ 6 months, sustained SGLT2i use was associated with lower subsequent risks of heart failure hospitalisation and MACE. Heart failure associations were directionally consistent across BMI strata, whereas BMI-related MACE heterogeneity was exploratory and should not be interpreted as evidence to guide treatment by BMI alone.

DOI： 10.1111/dom.71151

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Geroscience  

Evidence on meal timing and dementia is limited. We examined late-night dinner and skipping breakfast in relation to incident dementia. We conducted a population-based cohort study using linked medical insurance claims, long-term care insurance claims, and government-subsidized health checkup data from 19 participating in the Longevity Improvement & Fair Evidence (LIFE) Study. Cohort entry was from April 2016 to March 2021. Late-night dinner (dinner within 2 h of bedtime ≥ 3 times/week) and skipping breakfast (≥ 3 times/week) were assessed at health checkup and analyzed as dichotomous exposures (yes/no). Incident all-cause dementia was identified in claims data using ICD-10 codes. Associations were estimated using cause-specific Cox proportional hazards models, treating death as censoring and reporting hazard ratios with 95% confidence intervals, with prespecified adjustment for baseline demographic, lifestyle, and comorbidity factors. Among 283,166 participants (mean [standard deviation] age, 72.8 [5.5] years; 58.5% women), late-night dinner was reported by 36,609 (12.9%) and skipping breakfast by 17,727 (6.3%). During follow-up, 18,056 incident dementia cases and 16,390 deaths occurred. Both late-night dinner (hazard ratio, 1.17; 95% confidence interval, 1.12–1.20) and skipping breakfast (1.13; 1.06–1.20) were associated with higher hazards of incident all-cause dementia. Late-night dinner and skipping breakfast were associated with a higher risk of incident all-cause dementia in a large cohort of older Japanese adults. Meal timing behaviors assessed during routine health checkups may be relevant for dementia prevention strategies, although causal inference requires further study.

DOI： 10.1007/s11357-026-02438-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Periodontology  

Background: Although positive associations between fewer remaining teeth and an increased risk of various systemic diseases have been reported, the precise dose-response relationship has not been fully clarified. This study aimed to evaluate the non-linearity of the dose-response association between the number of lost teeth and the risk of cardiovascular diseases among middle-aged adults. Methods: This retrospective cohort study, with over 5 years of follow-up, was based on medical claims and health check-up data. Participants were adults aged 40–64 in Japan. The outcome was the incidence of cardiovascular diseases. Exposure variables were the number of lost teeth, which was modeled using a restricted cubic spline. A Cox proportional hazards model was fitted to estimate hazard ratios (HRs) and 95% confidence intervals. Results: Among the 551,386 participants (mean age = 50.0 years [SD = 6.7], male = 52.0%), the incidence rate of cardiovascular diseases was 0.70 per 100 person-years. A significant non-linear dose-response association was observed between the number of lost teeth and cardiovascular disease risk (p = 0.004). Although the risk increased with greater tooth loss, the dose-response curve bent at around four lost teeth, with an HR of 1.09 (1.05–1.14) at four teeth lost and 1.21 (1.08–1.37) at 27 teeth lost (reference: “no tooth loss”). Conclusions: These findings suggest no clear threshold exists in the non-linear dose-response association between tooth loss and cardiovascular disease risk. Comprehensive public health strategies to prevent periodontal diseases and dental caries are essential throughout life to minimize tooth loss and its systemic consequences. Plain language summary: This retrospective cohort study of 551,386 middle-aged adults found a significant non-linear dose-response association between tooth loss and the risk of cardiovascular diseases. Cardiovascular disease risk increased as the number of lost teeth increased; however, the dose-response curve showed an inflection at around four lost teeth, with no clear threshold observed in the association between tooth loss and cardiovascular disease risk.

DOI： 10.1002/jper.70167

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記述言語：英語   出版者・発行元：Journal of the American Geriatrics Society  

Background: Evidence guiding first-line antihypertensive drug choice in adults aged 75 years or older is limited, despite widespread use of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) in late older age. Methods: We conducted a target trial emulation using a new-user design in a nationwide linked healthcare claims database in Japan. Adults aged ≥ 75 years who had no prescription of either drug class in the preceding 12 months and initiated an ARB (n = 10,037) or a CCB (n = 19,785) were followed from treatment initiation. The primary outcome was all-cause mortality; secondary outcomes included hospitalization for heart failure, myocardial infarction, stroke, and major adverse cardiovascular events (MACE). Intention-to-treat effects were estimated using inverse probability of treatment and censoring weighting with pooled logistic regression models. Results: Among 29,822 patients, median follow-up was 4.0 years. During follow-up, 3487 deaths occurred. ARB therapy was associated with lower all-cause mortality than CCB therapy (hazard ratio [HR], 0.885; 95% CI, 0.823–0.951). The estimated 5-year risk of death was 12.7% for ARB users and 14.8% for CCB users (absolute risk difference, −2.1 percentage points; 95% CI, −3.1 to −1.0). ARB therapy was also associated with lower risks of heart failure hospitalization (HR, 0.843; 95% CI, 0.774–0.918), myocardial infarction (HR, 0.867; 95% CI, 0.795–0.945), stroke (HR, 0.931; 95% CI, 0.869–0.998), and MACE (HR, 0.889; 95% CI, 0.848–0.931). Associations were consistent across age subgroups, including adults aged ≥ 85 years. Conclusion: In adults aged 75 years or older, ARB-based antihypertensive therapy was associated with lower risks of mortality and cardiovascular events compared with CCB-based therapy. These findings suggest that first-line antihypertensive drug choice may have prognostic implications in late older age.

DOI： 10.1111/jgs.70463

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Heart  

Background: Hypertension is highly prevalent among patients with chronic kidney disease (CKD) and contributes substantially to cardiovascular complications and progression of kidney disease. Although angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) are widely used antihypertensive agents in CKD, comparative evidence regarding their long-term effects on clinically important cardiorenal outcomes remains limited. Methods: We conducted a target trial emulation using nationwide-scale healthcare claims and health check-up data in Japan between April 2014 and September 2024. We emulated sequentially nested new-user trials and used a 1-month induction-period approach to compare ARB-based versus CCB-based antihypertensive treatment strategies. Intention-to-treat effects were estimated using discrete-time proportional hazards models with inverse probability of treatment and censoring weighting, accounting for competing risks. Results: Among 12 978 patients with CKD (4524 initiating ARB-based therapy and 8454 initiating CCB-based therapy), ARB-based strategies were associated with a directionally lower but not statistically significant risk of heart failure hospitalisation (HR 0.871, 95% CI 0.751 to 1.011). ARB-based therapy was also associated with lower risks of progression to end-stage renal disease (HR 0.533, 95% CI 0.317 to 0.898) and all-cause mortality (HR 0.825, 95% CI 0.706 to 0.963). No consistent differences were observed for myocardial infarction or stroke. Conclusions: In this nationwide target trial emulation, ARB-based antihypertensive strategies were associated with lower risks of kidney failure and all-cause mortality, with a directionally lower but statistically uncertain risk of heart failure hospitalisation. These findings suggest that ARB-based antihypertensive strategies may confer clinically relevant cardiorenal benefits compared with CCB-based strategies in patients with CKD, although causal interpretation remains limited by the observational design.

DOI： 10.1136/heartjnl-2026-328193

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本疫学会  

Medical claims data are increasingly used in epidemiological studies but are inadequately validated to ensure their reliability in identifying diseases. We developed the Claims data Learning & Enhancing for Algorithm Refinement (CLEAR) Study as a database platform to enable the systematic, low-cost implementation of validation studies in Japan. The CLEAR Study links routinely generated medical claims data from hospitals with diagnostic data (eg, laboratory data and diagnostic imaging reports) at the patient level. Using diagnostic data as the gold standard for disease identification, researchers can validate and refine their claims-based identification algorithms. Diagnostic data are collected as needed for each validation study, and data are linked using pseudonymized medical record numbers. Personal information is protected through the use of research identification numbers. To demonstrate the platform’s feasibility, we collected data on respiratory syncytial virus (RSV) infections and intussusception cases. Eight hospitals have agreed to participate in the CLEAR Study, and three have completed claims data provision. We obtained data for 5,022 RSV infection cases with 25,920 diagnostic tests, and 1,450 intussusception cases with 561,984 diagnostic tests. We also analyzed the initial diagnostic data for 39,212 RSV infection cases and 439,088 intussusception cases, demonstrating that the database can be used to validate algorithms for these diseases. The CLEAR Study is a newly developed database platform in Japan that facilitates validation studies of claims data for various diseases. By promoting validation studies, this platform will help to improve the reliability of claims-based epidemiological studies and drug risk assessments in Japan.

DOI： 10.2188/jea.je20250095

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Jdr Clinical and Translational Research  

Background: Administrative claims data are increasingly used in oral health research, but their validity for identifying denture use has not been established. Objective: To evaluate the accuracy of algorithms based on dental claims codes for identifying denture users, dentist-reported oral health screening records were used as the reference standard. Methods: We analyzed data from 4,053 adults aged ≥65 y in the Longevity Improvement and Fair Evidence (LIFE) Study in Japan. Twelve algorithms incorporating 56 denture-related diagnosis and procedure codes were developed from claims in the 12 mo preceding the screening. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sensitivity analyses used a 6-mo claims window. A post hoc bias analysis was also performed. Results: During screening, 59.9% of the participants were classified as denture users. Algorithms based solely on diagnosis codes showed very high specificity (98.3%–100%) but low sensitivity (1.4%–20.8%). Among the procedure-based definitions, oral rehabilitation codes (algorithm f; denture adjustment or instruction) had the highest sensitivity (63.6%). The combined algorithm using both diagnosis and procedure codes (algorithm C) achieved the best balance, with 65.3% sensitivity, 96.6% specificity, 96.6% PPV, and 65.1% NPV. Similar findings were observed using the 6-mo claims data. Bias analysis indicated that the risks for denture use could be underestimated by 26% to 59%, with algorithm C showing the least bias. Conclusions: Denture use can be identified from dental claims data with moderate accuracy. Algorithms combining denture-related diagnosis and procedure codes or using oral rehabilitation codes provide practical definitions for research on oral and systemic health outcomes. Knowledge Transfer Statement: The result of this validated study can be identified as denture use from dental claims with moderate accuracy. In combination with validated denture use and the number of remaining teeth, it can expand opportunities to assess oral health status and its relationship with systemic health outcomes in large-scale epidemiologic studies using claims data.

DOI： 10.1177/23800844261444341

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ajrccm/aamag162.1950

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of the American Medical Directors Association  

Objective Stroke is a leading cause of mortality and disability, significantly impairing quality of life. In Japan's aging society, premorbid functional decline is often already present at the time of illness or injury, potentially influencing prognosis, particularly long-term outcomes. This study aimed to investigate the association between long-term care insurance (LTCI) care need levels (CNLs) before admission and 3-year postdischarge mortality among older patients with stroke. Design Retrospective observational cohort study. Setting and Participants This study used health care and LTCI claims data from 15 Japanese municipalities participating in the Longevity Improvement & Fair Evidence (LIFE) study. Patients aged ≥65 years hospitalized for stroke were included. Methods Based on preadmission LTCI CNL, patients were categorized into 4 groups: no care needs, support level (SL) and CNL1 (lowest care level), CNL2-3, and CNL4-5 (highest care level). The primary outcome was 3-year all-cause mortality after discharge. Cumulative incidence rates were estimated using Kaplan-Meier methods. The association between baseline LTCI CNL and mortality was evaluated using a multivariable Cox regression model, with adjusted hazard ratios (aHRs) and 95% CIs calculated. Results Among 104,795 patients with stroke, 24,839 met the eligibility criteria for analysis. Compared to patients without care needs, the risk of all-cause mortality was higher in the other 3 groups and increased with higher baseline LTCI CNL (SL and CNL1: aHR 1.63, 95% CI 1.52-1.76; CNL2-3: aHR 2.59, 95% CI 2.38-2.81; CNL4-5: aHR 3.64, 95% CI 3.31-4.01; P for trend < .001). Conclusions and Implications Higher preadmission LTCI CNL was associated with an increased risk of all-cause mortality after discharge in older patients hospitalized for stroke. LTCI CNL may serve as a practical indicator for identifying patients at high mortality risk. Understanding how pre-stroke functional status influences long-term survival may provide valuable information for early clinical decision making in stroke treatment.

DOI： 10.1016/j.jamda.2026.106165

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Periodontology  

Background: This study aimed to investigate whether healthcare expenditures (HCEs) differed depending on whether the patients left periodontal disease (PD) untreated, despite the need for treatment. Methods: This study used public PD screening data from a municipality in Japan to identify adults aged ≥ 40 years who were found to require treatment of PD by dentists at PD screening. The presence or absence of periodontal treatment was determined by a dental visit within 180 days after the date of PD screening based on medical claims data. Annual HCE were calculated from cumulative expenditures over 2 years from the date of the presence or absence of periodontal treatment. A generalized linear model with a gamma distribution and log link function was used to calculate the relative cost ratios (RCRs) and 95% confidence intervals (95% CI), and a two-part model was used to predict annual HCEs and the difference in predicted HCEs based on dental treatment. Results: Among 652 people (mean age: 62.6 years [1 SD = 9.0], 65.5% women), 9.0% were untreated. After adjusting for the covariates, the RCR for medical, pharmaceutical, and dental costs in the untreated group compared with the treated group were 1.56 (95% CI: 1.02–2.38), 0.95 (95% CI: 0.53–1.70), and 0.14 (95% CI: 0.10–0.19), respectively. The differences in predicted HCEs were $593.5 (95% CI: –280.6, 1467.6) higher for medical, $79.9 (95% CI: –363.6, 523.4) higher for pharmaceutical, and $323.9 (95% CI: –397.3, –250.6) lower for dental. Conclusion: Leaving PD untreated was associated with increased HCEs, particularly medical expenditures. Plain language summary: This study looked at whether people who were told by a dentist that they needed care for periodontal disease actually received treatment, and how this affected their healthcare costs. The research followed more than 600 adults in Japan for 2 years, comparing the cumulative healthcare costs of those who received dental care with those who did not. The results showed that people who did not treat their periodontal disease ended up spending more on medical care, even though they spent less on dental care. On average, untreated individuals had medical expenses that were around $600 higher than those who received treatment. This suggests that avoiding dental care for periodontal disease might lead to more serious health problems down the line, which can increase overall healthcare costs. Although skipping dental visits may seem like a way to save money, it could actually lead to higher medical bills in the future. These findings highlight the importance of early dental treatment not just for oral health, but also for managing overall healthcare costs and preventing other health complications.

DOI： 10.1002/jper.70136

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Respiratory Research  

Background: Adherence and persistence for inhaled maintenance therapy markedly influence outcomes in chronic obstructive pulmonary disease (COPD). However, real-world data for single-inhaler triple therapy (SITT), including the effects of prior controller use and the selected regimen, have been limited. We here aimed to evaluate real-world adherence and persistence for SITT in COPD and to examine differences according to prior controller use and inhaler regimen. Methods: Using the population-based LIFE Study administrative claims database in Japan, we conducted a retrospective cohort study of patients with COPD who newly initiated budesonide-glycopyrronium-formoterol (BGF) or fluticasone furoate–umeclidinium–vilanterol (FUV) between April 2020 and March 2022. Medication adherence over 12 months was assessed according to the proportion of days covered (PDC), with good adherence defined as a PDC of ≥ 0.80. Multivariable-adjusted risk ratios (RRs) for good adherence were estimated by modified Poisson regression. Treatment persistence was evaluated as time to discontinuation determined by Kaplan-Meier analysis with inverse probability of treatment weighting (IPTW), and differences were quantified as restricted mean survival time (RMST) over 365 days. Results: Among 4077 individuals initiating SITT, only 36.4% achieved good adherence during the 12-month follow-up period. Controller-naïve patients were substantially less likely to achieve good adherence than patients with prior controller use (multivariable-adjusted RR, 0.37; 95% CI, 0.34–0.41). Treatment persistence was also worse for controller-naïve patients, with an IPTW-adjusted RMST that was 3.42 months shorter than that for patients with prior controller use (95% CI, − 3.67 to − 3.15 months). With respect to regimen, FUV was associated with a higher likelihood of good adherence compared with BGF (multivariable-adjusted RR, 1.40; 95% CI, 1.28–1.52) and showed longer treatment persistence (IPTW-adjusted RMST difference of 0.49 months; 95% CI, 0.22–0.76 months). Conclusions: Adherence and persistence for SITT were suboptimal among patients with COPD in real-world clinical practice, particularly among controller-naïve individuals. Although the once-daily FUV regimen was associated with better adherence and persistence than BGF, substantial gaps in treatment continuity persisted with both regimens. These findings highlight the need for enhanced support at treatment initiation and during early follow-up to optimize long-term SITT use in routine COPD care.

DOI： 10.1186/s12931-026-03658-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Plos One  

Outcomes related to health status and economic burden among patients who experienced critical COVID-19 remain insufficiently studied. We examined 180-day post-discharge mortality and total medical expenditures in COVID-19 patients according to their use of mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) during hospitalization. Using medical claims data from a Japanese municipality, this retrospective cohort study analyzed hospitalized COVID-19 patients who were discharged between April 1, 2020 and September 30, 2021. Patients were categorized into an MV/ECMO group (indicating severe disease) or a non-MV/ECMO group. Their differences in mortality and expenditures were compared using the χ² test and Mann–Whitney U test, respectively. A Cox regression analysis was performed to calculate the hazard ratios of MV/ECMO use for mortality, and a generalized linear model with gamma distribution was constructed to examine the association between MV/ECMO use and expenditures. The covariates included age, sex, comorbidities, and length of stay. The MV/ECMO group had significantly higher mortality (16.0% vs. 11.1%, p = 0.002) and expenditures ($8,732 vs. $3,460, p < 0.001) than the non-MV/ ECMO group. MV/ECMO use was significantly associated with higher mortality (hazard ratio: 1.66, 95% confidence interval: 1.27–2.15); other risk factors included age (1.06, 1.05–1.07), dementia (1.48, 1.10–1.99), and cancer (1.92, 1.56–2.36). MV/ECMO use was also significantly associated with higher expenditures (Exp[β]: 1.49, 95% confidence interval: 1.29–1.73); other risk factors included kidney disease (1.60, 1.29–2.01), cerebrovascular disease (1.74, 1.56–1.94), and cancer (1.28, 1.14–1.44). Survivors of severe COVID-19 who required MV or ECMO during hospitalization were associated with higher post-discharge mortality and expenditures, suggesting a need for targeted care to reduce their clinical and economic burden.

DOI： 10.1371/journal.pone.0345939

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Medicine  

Background: A fundamental public health goal is that all individuals have the opportunity to reach old age with adequate care and support. Japan is the global leader in longevity, and understanding whether this advantage exists primarily in healthy older adults or those relying on long-term care (LTC) can reveal if it stems from a healthier population or more extensive, and potentially higher-quality, healthcare provision. This study examined Japan’s mortality advantage by comparing life expectancy and death rates in Japan and Sweden across different levels of LTC. Methods: We included the entire population aged 75 + in Sweden (n = 858,595) and nine Japanese municipalities (n = 334,873), categorizing individuals into three groups: no care, home care, and care home residence. We compared age-specific death rates, remaining life expectancy, and expected time spent in each LTC state. Finally, we quantified how much of the overall mortality differences could be explained by LTC state-specific mortality difference. Results: Japanese older adults had lower death rates and longer life expectancy than Swedish counterparts, with more pronounced differences among individuals utilizing LTC. At age 75, total life expectancy was 12.0 vs. 11.7 years for men and 15.5 vs. 13.7 years for women in Japan and Sweden, respectively. Expected time without LTC was 9.8 vs. 9.6 years for men and 10.4 vs. 9.9 years for women. The difference (95% CI) in total life expectancy [men, 0.3 (0.2, 0.4); women, 1.8 (1.7, 1.9)] exceeded the difference in time without LTC [men, 0.2 (0.2, 0.3); women, 0.5 (0.4, 0.5)], particularly for women. Higher mortality in home care and care home populations in Sweden substantially increased Japan’s advantage. Conclusions: Our findings show that Japan’s longevity advantage in old age is primarily driven by lower mortality in the segment of the population utilizing LTC. This indicates that the overall advantage in life expectancy may not stem solely from a healthier population, but rather from more extensive, or possibly higher-quality, care, including life-sustaining treatments. However, since we were unable to control for differences in health status in the two populations, future studies should explore if the threshold for entering LTC is different in Sweden and Japan.

DOI： 10.1186/s12916-026-04786-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Experimental Gerontology  

BackgroundFrailty is an ageing-associated multidimensional condition linked to higher long-term care (LTC) needs, healthcare expenditures, and mortality. In Japan, the Questionnaire for Medical Checkup of Old-Old (QMCOO) is used to assess frailty, but its implementation is resource-intensive. Claims-based prediction models may offer a scalable alternative for early frailty identification.MethodsWe developed a machine learning model using administrative claims data from older adults to predict frailty status as defined by the QMCOO. In Phase 1, the model was trained and validated using data from a single municipality. In Phase 2, the model's prognostic utility for predicting all-cause mortality was evaluated using data from seven other municipalities. We applied the eXtreme Gradient Boosting algorithm, incorporating demographic variables, LTC use, comorbidities, procedures, and medical device use. Model performance was assessed mainly using the area under the receiver operating characteristic curve (ROC-AUC). Mortality risk was estimated using Kaplan–Meier method and Cox regression models.ResultsIn Phase 1, a total of 74,148 individuals were included (development cohort: 60,930, validation cohort: 13,218). The model achieved an ROC-AUC of 0.780 in internal validation and 0.728 in external validation. In Phase 2, external validation was conducted in a new cohort of 354,815 individuals. Frailty classification was associated with significantly higher mortality in both the development (hazard ratio: 7.03, 95% confidence interval: 6.47–7.63) and validation (6.75, 6.62–6.89) cohorts.ConclusionThis claims-based frailty prediction model showed reasonable performance and prognostic value. It may support efficient, population-level frailty screenings where questionnaire-based assessments are impractical.

DOI： 10.1016/j.exger.2026.113050

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Alzheimer S and Dementia Diagnosis Assessment and Disease Monitoring  

Introduction: Lecanemab, an anti-amyloid-beta antibody, is approved in over 40 countries. Patient demographic data exist for the US but are limited elsewhere. This study examined early real-world lecanemab use in Japan. Methods: Using claims data from 18 municipalities, we identified patients prescribed lecanemab between December 2023 and September 2024. The study outcome was the discontinuation rate, with discontinuation defined as a ≥42-day prescription gap. Covariates included age, sex, long-term care certification, municipality size, comorbidities, Mini-Mental State Examination (MMSE) score, and Clinical Dementia Rating (CDR). Results: We identified 123 lecanemab recipients (median age: 76 years, interquartile range: 73–79 years; women: 73.2%). Most had mild impairment: 60.9% with MMSE ≥24 and 79.3% with CDR 0.5. The discontinuation rate was 1.04/100 person-months, with most occurring within 1.5 months. Discussion: In this first Asian report, lecanemab was mainly prescribed to older women with milder cognitive impairment. Early discontinuation may reflect cautious adoption in Japan.

DOI： 10.1002/dad2.70273

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ Open  

Objectives This study aimed to investigate the effects of long-term and habitual physical activity on mortality and long-term care insurance (LTCI) certification among cancer survivors using a population database. Design 5-year retrospective study. Setting 13 Japanese municipalities participated in the Longevity Improvement & Fair Evidence study. Participants Among 471 511 participants who underwent health check-ups, 39 435 met the following eligible criteria: documented in the cancer claims database without a suspected diagnosis and participated in a health check-up at least once in a 12-month period, had no missing exercise data and had already been certified for LTCI. Main outcome measures Outcomes were new LTCI certification and all-cause mortality. LTCI certification was assigned by a trained local government official through a systematic process (involving various items—physical function, daily activity function, cognitive function, behavioural disorders, adjustment to social life and daily use of medical services—as well as overall consideration of computer-based and specialist team assessments), and the LTCI severity level correlates with the Barthel index. LTCI certification reflects some impairment in activities of daily living. All-cause mortality was defined based on claims data. Results Three physical activity categories, ‘exercise and walking’, ‘exercise or walking’ and ‘no physical activity’, were used. Among survivors aged 65–74 years, the ‘no physical activity’ group had a higher risk of mortality and LTCI certification than the ‘exercise and walking’ group (adjusted model HR: 1.72, 95% CI 1.52 to 1.94). Among survivors aged ≥75 years, the low physical activity groups had a higher risk of mortality and LTCI certification than the ‘exercise and walking’ group (adjusted model: ‘exercise or walking’, HR: 1.51, 95%CI 1.29 to 1.85; ‘no physical activity’, HR: 1.66, 95%CI 1.43 to 1.92). The effects of physical activity differed according to cancer type. Conclusions Habitual physical activity had positive effects on cancer survivors. These effects differed according to age and cancer type.

DOI： 10.1136/bmjopen-2025-104102

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Cancer  

Depression and anxiety are common among cancer patients and are associated with poorer treatment adherence, quality of life, and survival outcomes. While the prevalence of these conditions has been widely reported, less is known about their incidence and temporal trends. This study aimed to clarify the incidence and temporal patterns of depression and anxiety following cancer diagnosis using claims data from 14 Japanese municipalities. The study cohort comprised 22,863 newly diagnosed cancer patients from April 2018 to March 2021. During a follow-up period of up to 24 months after diagnosis, we identified depression and anxiety using recorded diagnoses in the claims data. We calculated crude incidence rates, and then Poisson regression was used to visualize monthly incidence rates and temporal trends for all patients, as well as according to sex, age, treatment modality, and cancer type. The overall crude incidence rates were 3.36 and 3.11 per 1000 person-months for depression and anxiety, respectively. Depression incidence peaked around the second month following cancer diagnosis, while anxiety incidence peaked in the month of cancer diagnosis. Female sex and chemotherapy were associated with higher incidence rates for depression and anxiety. Pancreatic cancer showed the highest incidence rates for both disorders. These findings provide valuable insights into the burden and timing of mental disorders among cancer patients in Japan and emphasize the need for targeted interventions during high-risk periods.

DOI： 10.1002/ijc.70118

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記述言語：英語   出版者・発行元：Age and Ageing  

Background Consistent antihypertensive treatment reduces cardiovascular risk, but older adults requiring long-term care (LTC) due to functional impairment may have a diminished ability to adhere to treatment. Objective To examine antihypertensive medication adherence among older adults requiring LTC in Japan and to identify its associated factors. Design Retrospective cohort study. Setting 11 municipalities. Participants Individuals aged ≥65 years requiring LTC and diagnosed with hypertension between April 2016 and March 2020. Methods Medical claims data, LTC claims data and LTC certification data were analysed. The study outcome was antihypertensive medication adherence (proportion of days covered >0.8) over 1year. Using logistic regression analysis, we assessed the associations between adherence and the following factors: care needs levels, paralysis, visual function, hearing function, swallowing function, cognitive function and need for medication intake assistance. Results The study cohort comprised 69200 participants (nonadherent: 17523; 25.3%). At LTC certification application, most participants lived at home (78.3% adherent vs. 64.1% nonadherent). Adherence was negatively associated with high care needs levels (odds ratio: 0.241, 95% confidence interval: 0.222–0.263), bilateral upper limb paralysis (0.605, 0.565–0.648), bilateral lower limb paralysis (0.837, 0.803–0.873), left upper limb paralysis (0.820, 0.746–0.921), moderate visual impairment (0.738, 0.675–0.808), severe hearing impairment (0.683, 0.549–0.853), severe swallowing impairment (0.199, 0.169–0.234), severe cognitive impairment (0.652, 0.621–0.684) and need for full medication intake assistance (0.296, 0.279–0.315). Conclusions Over 25% of older adults requiring LTC were nonadherent to antihypertensive treatment. These findings may help to identify high-risk individuals who could benefit from targeted interventions to support medication management.

DOI： 10.1093/ageing/afag018

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Children  

Highlights: What are the main findings? Receipt of at least two doses of an ancestral monovalent COVID-19 vaccine was associated with a lower incidence rate of COVID-19-associated hospitalization among children and adolescents (adjusted IRR 0.429; 95% CI: 0.198–0.930). Only 4.3% of COVID-19-associated hospitalizations required oxygen administration, whereas 36.6% involved diagnoses related to vomiting, diarrhea, hypovolemia, or hypoglycemia, indicating that gastrointestinal symptoms and dehydration were common reasons for hospitalization. What are the implications of the main findings? The results provide real-world evidence that pediatric COVID-19 vaccination was associated with a lower incidence rate of COVID-19-associated hospitalization in Japan during the Omicron-dominant period. Expanding COVID-19 vaccine uptake among eligible pediatric populations may reduce the future burden of severe disease. Background/Objectives: Evidence regarding the impact of COVID-19 vaccination on children and adolescents remains limited, particularly in Japan. Thus, this study aimed to estimate incidence rates of COVID-19-associated hospitalization by vaccination status and evaluate the association between COVID-19 vaccination and COVID-19-associated hospitalization among individuals aged 6 months to <18 years in Japan. Methods: We conducted a retrospective, population-based cohort study using linked health insurance claims data and municipal COVID-19 vaccination registry records from nine Japanese municipalities between 1 January 2022, and 31 March 2023, when the Omicron variant was dominant nationwide. Incidence rates of COVID-19-associated hospitalization were estimated among unvaccinated individuals and those who had received one dose (partially vaccinated) or at least two doses of an ancestral monovalent COVID-19 vaccine (fully vaccinated). Incidence rate ratios (IRRs) were calculated, adjusting for age group, sex, presence of underlying medical conditions, municipality, and calendar month. Results: Among 163,305 individuals, 93 COVID-19-associated hospitalizations were identified. Crude incidence rates were 4.5 (95% confidence interval [CI]: 3.6–5.6), 3.2 (95% CI: 0.1–18.0), and 2.3 (95% CI: 1.1–4.2) per 100,000 person-months in unvaccinated, partially, and fully vaccinated groups, respectively. The adjusted IRR for the fully vaccinated group was 0.429 (95% CI: 0.198–0.930). Among hospitalized patients, 30.1% had underlying medical conditions, and only 4.3% required oxygen administration during hospitalization. Conclusions: Receiving at least two doses of COVID-19 vaccine was associated with a lower incidence rate of COVID-19-associated hospitalization among children and adolescents during the Omicron-dominant period in Japan. Expanding vaccine uptake among eligible pediatric populations may help reduce the burden of severe disease.

DOI： 10.3390/children13020183

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：公益社団法人 日本医師会 / 日本医学会  

DOI： 10.31662/jmaj.2025-0078

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Vaccine  

Background: In Japan, the proactive recommendation of human papillomavirus (HPV) vaccination was suspended in 2013 and resumed in 2022, with the HPV vaccination coverage rate slow to recover following this 9-year pause. The purpose of this study was to calculate the prevalence of diverse symptoms (DS) similar to adverse events following HPV vaccination in unvaccinated individuals. Methods: This population-based descriptive study utilized data from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study database, which links National Health Insurance claims and immunization registries in four Japanese municipalities. Unvaccinated persons aged 10–19 years with claims from April 2017 to March 2022 were included. DS were defined using ICD-10 codes for 27 symptoms previously identified in the literature, with persistence exceeding 3 months considered indicative of onset. Cases with identifiable underlying disease were excluded by consensus review of pediatricians. Prevalence of DS was calculated by the fiscal year, age group, and sex. Results: DS occurred in 1891 cases. The overall prevalence of DS was 0.15 %, and prevalence was slightly higher in females than males. The most common symptoms were skin problems (in males aged 10–14 years, 0.83 %), sleep disorders (females aged 15–19 years, 0.44 %), headache (females aged 10–14 years, 0.40 %), and menstrual irregularities (females aged 15–19 years, 0.38 %). No substantial variations in prevalence were observed across municipalities or during the COVID-19 pandemic. Conclusions: Our results provide objective evidence of DS even in Japanese adolescents who have not received the HPV vaccine. These results could help support improving HPV vaccine coverage in Japanese adolescents.

DOI： 10.1016/j.vaccine.2025.128020

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掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digital Health  

Objective: This study aimed to examine whether sleep maintenance efficiency (SME) and total sleep time (TST), measured by wristband devices tracking both movement and heart rate patterns, are associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods: This cross-sectional study was conducted using data from 72 individuals who participated in a Japanese municipality's project for improving sleep quality. Fitbit-derived sleep data were linked with health checkup and claims data. Linear regression analyses were conducted with SBP or DBP as the dependent variable, and SME or TST as the independent variable. We constructed simple and multivariable models that adjusted for age, sex, body mass index, smoking, alcohol consumption, exercise habit, restful sleep, and antihypertensive medication use. Results: SBP significantly decreased with higher SME in the simple model (B = −1.92 mmHg, p = 0.01) and the multivariable model (B = −1.87 mmHg, p = 0.02). When SME was analyzed as quartile groups in the multivariable model, the lowest group had a significantly higher SBP (B = 8.51 mmHg, p = 0.04) than the highest group. This negative association was also observed in sensitivity analyses with bootstrapping that focused on participants without antihypertensive medication use and participants with normotensive SBP. SME showed no association with DBP, and TST showed no association with SBP or DBP. Conclusion: SME was associated with SBP, whereas TST showed no clear association. Sleep quality assessments using wearable devices may provide useful insights that support the prevention of blood pressure elevation and population health monitoring.

DOI： 10.1177/20552076261420875

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その他リンク： https://journals.sagepub.com/doi/full-xml/10.1177/20552076261420875

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本疫学会  

<p><b>Background</b></p><p>Previous studies on foreign body airway obstruction (FBAO) have primarily focused on patients who received prehospital or emergency department care. The epidemiological features of FBAO in the broader population, including cases managed outside emergency departments, remain unknown. We aimed to determine the incidence and characteristics of clinically managed FBAO using Japanese medical claims data.</p><p><b>Methods</b></p><p>This retrospective observational study was conducted using claims data from public health insurance enrollees across 16 municipalities. FBAO cases were identified from April 2020 to March 2024. The age-stratified and age-adjusted incidence rates of FBAO were calculated using the number of publicly insured individuals in the participating municipalities as the denominator.</p><p><b>Results</b></p><p>During the four-year observation period, a total of 1,123 FBAO cases (median age: 84 years) were identified. There were 518 (46.1%) cases in cardiac arrest on arrival and 516 (45.9%) deaths in the same month as the FBAO event. Age-stratified analyses showed that FBAO incidence rates steadily increased with advancing age, with individuals aged ≥95 years exhibiting an approximately 17-fold higher incidence than those aged 65–69 years. The age-adjusted incidence rate was 6.68 per 100,000 person-years.</p><p><b>Conclusion</b></p><p>This large-scale claims-based observational study indicated that the risk of FBAO occurrence is disproportionately high among individuals of advanced age, underscoring the need for FBAO prevention and management strategies targeting highly aged populations.</p>

DOI： 10.2188/jea.je20260264

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本疫学会  

<p><b>Background</b></p><p>There is limited evidence on the relationship between educational attainment and health markers in Japan. This study examined the associations of education level with cardiometabolic markers and health behaviors in a large Japanese population.</p><p><b>Methods</b></p><p>This cross-sectional study used health-related data (medical claims and health checkup results) from public health insurance enrollees linked with national census data between April 2020 and March 2021 from 16 municipalities. Participants were categorized according to education level: low (junior high school graduates or lower), middle (high school graduates), and high (vocational school graduates or higher). The study outcomes were cardiometabolic markers (waist circumference, body mass index, systolic blood pressure, diastolic blood pressure, HbA1c, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) and health behaviors (smoking habit, drinking habit, restful sleep, and regular exercise). Linear regression and modified Poisson regression analyses were performed to analyze the associations between education levels and the outcomes. The analyses were also conducted according to sex and age (39-64 and 65-75 years).</p><p><b>Results</b></p><p>The study cohort comprised 61,684 participants. Higher education levels were generally associated with better cardiometabolic markers, but were also linked with higher low-density lipoprotein cholesterol levels. In addition, higher education levels were associated with better health behaviors. The magnitude of association was more pronounced in women and middle-aged persons.</p><p><b>Conclusions</b></p><p>These findings provide a broad overview of the associations between educational attainment and health markers in a large Japanese population, and deepen our understanding of health disparities.</p>

DOI： 10.2188/jea.je20250683

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記述言語：英語   出版者・発行元：一般社団法人日本衛生学会  

Background: Hypertension is prevalent and is influenced by modifiable factors. Increasing attention has focused on community-based health promotion. However, studies on the relationship between neighborhood characteristics and hypertension prevalence are limited. This study combined medical claims and geographic information system data to identify neighborhood characteristics associated with hypertension. Methods: The study population included participants enrolled in the National Health Insurance or Medical Care System for the Elderly in both 2017 and 2021, and their 2021 data were aggregated at the elementary school district level. Hypertension was defined using the International Statistical Classification of Diseases and Related Health Problems-10 codes I10–I15. Neighborhoods were defined by elementary school districts. For each school district, hypertension prevalence, the proportions of participants aged <65 years, 65–74 years, and ²75 years, and the proportion of men were calculated. Neighborhood characteristics included college graduation rate, area deprivation index, annual average temperature, annual total precipitation, average slope angle, number of destination types, and densities of public places. Quasi-Poisson regression analyses were conducted with the number of hypertension cases as the dependent variable, neighborhood characteristics as explanatory variables, the proportions of participants aged 65–74 years and ²75 years, and the proportion of men (in the overall analysis) as covariates, and the number of participants as an offset term. For the quasi-Poisson regression analyses, a Bonferroni-adjusted p-value < 0.05 was considered statistically significant. Results: The study covered 424 elementary school districts across 14 municipalities in five prefectures in western Japan. The mean number of participants per district was 2,248 (men: 946, women: 1,302), with an average age of 67 years (men: 66; women: 68). The mean hypertension prevalence was 51% (men: 53%; women: 50%). In the combined and female-only analyses, the neighborhood proportion of university graduates and green space coverage were significantly negatively associated with hypertension prevalence. In the male-only analysis, the proportion of university graduates, green space coverage, and park density showed significant negative associations. Conclusions: Neighborhood socioeconomic and physical environmental characteristics were associated with hypertension prevalence in Japan, particularly educational attainment and green space coverage, suggesting that social and physical environmental attributes may contribute to community-level cardiovascular health.

DOI： 10.1265/ehpm.26-00095

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記述言語：英語   出版者・発行元：Clinical Microbiology and Infection  

Objectives In Japan, seasonal influenza vaccination is recommended for older adults between October and mid-December; however, the optimal vaccination timing remains unclear owing to waning immunity and variable epidemic patterns. In this study, we aimed to assess the effectiveness of different vaccination strategies in reducing influenza-related outcomes in older adults. Methods Using data from the vaccine effectiveness, networking, and universal safety study, we conducted a target trial emulation including adults aged ≥65 years across four influenza seasons (2016/2017, 2017/2018, 2018/2019, and 2019/2020). We applied a cloning, censoring, and weighting approach. Each individual was cloned and assigned to one of seven vaccination strategies at the start of October: no vaccination, vaccination during October, October–November, October–December, November, November–December, or December. Outcomes included influenza, influenza-related hospitalization, and all-cause mortality. Risk ratios (RRs) and risk differences, relative to no vaccination, were estimated at the end of March for each season based on standardized cumulative incidence. Results Annual cohorts included 131 178–138 438 individuals (meanage: 76–77 years; male sex: 40.7–41.0%). The influenza incidences and RRs varied by season. Delayed vaccination was associated with the lowest influenza incidence in the 2017/2018 and 2018/2019, but not in the other seasons. Influenza-related hospitalizations showed seasonal trends similar to those of influenza. In contrast, early vaccination strategies generally led to reduced all-cause mortality across all seasons. The RRs were 0.80–0.93, 0.80–0.95, 0.82–1.00, and 0.81–0.96 in the 2016/2017, 2017/2018, 2018/2019, and 2019/2020 seasons, respectively. The risk differences were larger for mortality than for the influenza-related outcomes. Conclusions The effectiveness of each timing strategy varied depending on the outcome and season. Although delayed vaccination was associated with a lower influenza incidence in some seasons, early vaccination generally reduced all-cause mortality.

DOI： 10.1016/j.cmi.2026.07.025

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人日本衛生学会  

Background: Few studies have investigated the association between ambient temperature and the risk of mental disorders in Japan. In this study, we investigated a short-term association between the risk of hospitalizations for mental disorders and ambient temperature using municipal health insurance data. Methods: We used the data of the Longevity Improvement & Fair Evidence Study in Japan, and the data of 17 municipalities were employed in the analysis. The daily number of hospitalizations for schizophrenia, depressive disorders, and anxiety disorders was used as the outcome variable. The time-stratified case-crossover design was employed in this ecological time-series study, and a distributed-lag non-linear model using a conditional quasi-Poisson regression model was employed to investigate an association between ambient temperature and hospitalizations for the abovementioned mental disorders. The model was applied to each municipality, and a multivariate meta-analysis was conducted to pool the results of municipalities. In addition, subgroup analyses by sex and age groups were conducted, and temperature-related attributable fractions of the mental disorders were also calculated. Results: The results of the overall cumulative effect of ambient temperature on hospitalizations for mental disorders indicated that the risk ratio (RR) tended to increase with an increase in temperature regardless of the type of mental disorder. An analysis by sex indicated that the RR tended to increase with an increase in temperature regardless of sex. In addition, an analysis by age group indicated that an increase in RR with increasing temperature was more evident in persons aged <65 years compared to those aged ²65 years regardless of mental disorders, and that the temperature-related attributable fractions were also higher in persons aged <65 years. Conclusions: Higher temperatures were associated with a higher risk of hospitalization for mental disorders in Japan, while the degree of the association differed by age group.

DOI： 10.1265/ehpm.25-00377

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Human Vaccines and Immunotherapeutics  

Maternal Coronavirus disease 2019 (COVID-19) vaccination during pregnancy enables transplacental antibody transfer; however, data on clinical effectiveness in infants are limited. We evaluated the BNT162b2 and mRNA-1273 vaccine effectiveness (VE) of maternal second and third doses against COVID-19 in infants during Omicron predominance. This population-based cohort study in a Japanese municipality included infants born between January and August 2022. Maternal vaccination status at delivery was classified as unvaccinated, second dose before pregnancy, second dose during pregnancy, or third dose during pregnancy. Follow-up for COVID-19 outcomes–primary (infection) and secondary (hospitalization)–began at delivery and ended at the infant’s 6-month birthday or September 25, 2022, whichever came first. Adjusted hazard ratios (HRs) were estimated using Cox regression, comparing the second dose during pregnancy with no vaccination and comparing the third dose during pregnancy with the second dose before pregnancy. VE was calculated as (1−adjusted HR) × 100%). We identified 613 infants: 234, 72, 181, and 126 whose mothers were unvaccinated, received the second dose before pregnancy, received the second dose during pregnancy, and received the third dose during pregnancy, respectively. Fifty-one infants developed an infection. Three hospitalizations occurred only among infants in the unvaccinated and second-dose-before-pregnancy groups. VE of the second and third doses against infection was 1% (95% confidence interval [CI]:−87% to 47%) and 71% (95% CI:−7% to 92%), respectively. This study indicates that a third dose during pregnancy may be effective in protecting infants from COVID-19 infection during Omicron predominance, while a second dose limited effectiveness.

DOI： 10.1080/21645515.2025.2585595

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of the Neurological Sciences  

Background: There is a growing need for alternative imaging measures to better understand the neurodegenerative pathology of Parkinson's disease and related conditions, such as drug-induced Parkinsonism. This study investigated the link between optic nerve morphology, specifically, the cup-to-disc ratio, a known neurodegenerative marker, and the presence of Parkinson's disease and drug-induced Parkinsonism in a large-scale, population-based study. Methods: A total of 14,280 participants aged 40–64 years with available fundus photographs and health data were included from a community-based database of the Longevity Improvement & Fair Evidence (LIFE) Study in Japan. The cup-to-disc ratios were analyzed through deep learning techniques using fundus photographs. Participants were categorized into quartiles based on these measurements. Parkinson's disease and drug-induced Parkinsonism were identified using International Classification of Diseases, 10th Revision codes and prescription records. Odd ratios (ORs) and 95 % confidence intervals (CIs) were estimated using logistic regression models. Results: Among the participants, 131 (0.9 %) had Parkinson's disease, and 152 (1.1 %) had drug-induced Parkinsonism. After adjusting for potential confounders, participants in the highest quartile of cup-to-disc ratio had a significantly higher likelihood of Parkinson's disease compared with those in the lowest quartile (OR = 1.74, 95 % CI = 1.07–2.86, p = 0.02). No significant association was found between cup-to-disc ratio and drug-induced Parkinsonism. Conclusions: These findings suggest that optic nerve morphology information derived from deep learning analysis of fundus photographs—a noninvasive, convenient, and reproducible method—may help assess specific neurogenerative processes in Parkinson's disease.

DOI： 10.1016/j.jns.2025.123751

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Blood Cancer Journal  

Autoimmune diseases (AIDs) are associated with an increased risk of lymphoma. Although treatment strategies have changed substantially in AIDs, recent evidence regarding this association is lacking. Particularly, the impact of novel immunosuppressive/immunomodulatory agents and the cumulative effect of multiple medication use on lymphoma risk have not been well investigated. To address these, we used the LIFE Study database, which contains health care claims data from 2014 to 2023 in 15 municipalities in Japan. Of 2,229,423 individuals, 211,592 had AIDs and 530 subsequently developed lymphoma. Overall, AID cases had a significantly higher incidence of lymphoma than non-AID cases (hazard ratio [HR] 1.9). Among 23 AIDs, lymphoma risk was significantly elevated in 14, including Takayasu arteritis (6.6) and adult-onset Still’s disease (4.7). Among immunosuppressive/immunomodulatory agents, calcineurin inhibitors, iguratimod, or methotrexate were associated with higher lymphoma risks. Importantly, the use of two or more medications strongly increased lymphoma risk (HR 2.7) in AID cases. Lymphoma subtype-specific analysis revealed novel associations, including T/NK-cell lymphoma in systemic lupus erythematosus. Our large-scale cohort study reveals an increased risk of lymphoma in AID patients, particularly those receiving multiple immunosuppressants/immunomodulators, underscoring the need for careful monitoring in these patients.

DOI： 10.1038/s41408-025-01422-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ  

Introduction

Human papillomavirus (HPV) vaccination coverage in Japan is among the lowest worldwide (&lt;1% in 2019). In April 2022, the Japanese government resumed proactive recommendations for routine HPV vaccination after an 8-year suspension and initiated a catch-up vaccination programme. This study aimed to assess the impact of this change in the vaccination policy on HPV vaccination rates in Japan.

Methods

We used data from the resident and vaccination registries of one municipality in Japan collected from January 2019 to June 2023. We estimated the cumulative vaccination rates for each female cohort born in the 2003–2011 fiscal years (FYs, 1 April–31 March). We also assessed the impact of the change in governmental policy by estimating the changes in the level and trend of first vaccination rates among girls eligible for routine vaccination using a segmented Poisson regression with an interrupted time series (ITS) design.

Results

We identified 13 376 girls eligible for routine HPV vaccination (born between FY2003 and FY2011) during the study period. The FY2006 birth cohort had the highest cumulative vaccination rates for the first, second and third doses in June 2023 (33.6%, 30.2% and 27.0%, respectively). The ITS analysis shows that the level change was 1.53 (95% CI 1.24 to 1.91), which means that the first vaccination rate increased by 53% in April 2022. The trend change was 0.97 (95% CI 0.95 to 1.00), indicating that the trend of the first HPV vaccination remained almost unchanged before and after April 2022.

Conclusions

The resumption of the proactive recommendation of HPV vaccination by the Japanese government promoted HPV vaccinations. However, the changes in HPV vaccination rates and trends remain insufficient when compared with the WHO’s target of achieving 90% full vaccination coverage among girls by age 15 years. Additional efforts are required to encourage and promote vaccination in the Japanese population.

DOI： 10.1136/bmjph-2024-000982

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1182/blood-2025-2718

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAMA Health Forum  

Importance: In Japan, the public assistance (PA) system for low-income individuals provides medical aid that covers all health care costs (no cost sharing). However, little is known about how health care service utilization changes after PA certification. Objective: To examine the trajectories of outpatient medical and dental care utilization among PA recipients before and after PA certification. Design, Setting, and Participants: Longitudinal data from a municipality in Japan participating in the Longevity Improvement Fair Evidence Study from 2017 to 2022 were used. Generalized estimating equations were used to calculate absolute differences and relative ratios in health care service utilization before and after PA certification. An interrupted time-series analysis (ITSA) was performed to examine the trends in health care service use based on monthly panel data. The elasticity of each health care service was also calculated. The participants were individuals who switched from National Health Insurance to PA and were 20 years and older. The analysis was performed in 2024. Exposure: PA certification. Main Outcomes and Measures: Outpatient medical and dental care expenditures, visits, and unit costs per month from 1 year before to 1 year after PA certification. Results: Overall, 2893 study participants were analyzed (mean [SD] age, 54.2 [15.3] years; 1501 women [51.9%]). For outpatient medical care, the mean (SD) expenditures per month before and after PA certification were ¥16565 (¥53159) and ¥22442 (¥53443), respectively (converting to US dollars using the rate of ¥100 = $0.68 based on 2025 rates). For outpatient dental care, the mean (SD) expenditures per month before and after PA certification were ¥1727 (¥3726) and ¥3978 (¥6894), respectively. The ITSA showed significant increases in outpatient expenditure immediately after PA certification: ¥2681 (95% CI, 317-5046) and ¥2330 (95% CI, 1896-2764) in medical and dental care, respectively. Conclusions and Relevance: This study found that eliminating cost sharing under a PA system was associated with increased outpatient health service use, particularly for dental care. These findings highlight financial barriers to care among low-income populations and suggest that no cost-sharing policies can improve access but may require policy measures to address overuse.

DOI： 10.1001/jamahealthforum.2025.3713

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：公益社団法人 日本医師会 / 日本医学会  

<p><b>Introduction:</b> High salt intake has been linked to various diseases. However, measuring an individual's salt intake level may be challenging. This study aimed to identify the characteristics of individuals with high salt intake using a salt intake check sheet.</p><p><b>Methods:</b> This is a cross-sectional study that used data from the Longevity Improvement & Fair Evidence (LIFE) Study. Participants were individuals who underwent a specific medical examination between April 2023 and March 2024 and also completed a salt intake check sheet. Individuals with missing data from the health examinations or the salt intake check sheet were excluded from the study. Individuals taking antihypertensives were also excluded.</p><p>Exposure factors were defined as participant sex, age range (40-64 and 65-74 years old), smoking, alcohol consumption, regular exercise, body mass index (BMI; <25 kg/m² or ≥25 kg/m²), and the presence of hypertension during specific health examinations (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg). The salt intake level of participants, based on scores from the salt intake check sheet, was evaluated as the outcome in this study. Using these scores, participants were categorized into two groups: the low salt intake group (0-13 points) and the high salt intake group (>14 points). To evaluate the factors related to salt intake, the salt intake levels (high or low) of participants were set as the response variable, while the exposure factors were set as the explanatory variables. Modified Poisson regression analysis was then conducted.</p><p><b>Results:</b> This study comprised 5,157 participants, with 3,745 in the low salt intake group (72.6%) and 1,412 in the high salt intake group (27.4%). Results from the modified Poisson regression analysis conducted to evaluate the correlation between individual salt intake levels and exposure factors showed statistically significant correlations between the following factors and high salt intake: smoking (relative risk [RR] = 1.35, 95% confidence interval [CI]: 1.21-1.50, p < 0.001); alcohol consumption (RR = 1.19, 95% CI: 1.09-1.30, p < 0.001); and BMI >25 kg/m² (RR = 1.32, 95% CI: 1.19-1.47, p < 0.001). Conversely, participants in the low salt intake group were at lower risk for hypertension compared to those in the high salt intake group; however, the difference was not statistically significant (RR = 0.92, 95% CI: 0.85-1.01, p = 0.08).</p><p><b>Conclusions:</b> The results of this study showed that smoking, alcohol consumption, and having a BMI of ≥25 kg/m² were related to high salt intake.</p>

DOI： 10.31662/jmaj.2025-0150

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：公益社団法人 日本医師会 / 日本医学会  

DOI： 10.31662/jmaj.2025-0027

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記述言語：英語   出版者・発行元：Journal of Human Hypertension  

The American Heart Association’s Life’s Essential 8 is a set of modifiable lifestyle habits and risk factors used to assess cardiovascular health (CVH). However, little is known about the potential impact of non-ideal statuses in these metrics on hypertension risk. This study aimed to clarify the associations between the total number of non-ideal CVH metrics and incident hypertension in a Japanese population. This retrospective cohort study was conducted using data from 10 Japanese municipalities participating in the LIFE Study. We identified National Health Insurance enrollees who had undergone health checkups between April 2017 and March 2018. Participants were categorized into 7 groups (0, 1, 2, 3, 4, 5, and 6–7 metrics) based on their total number of non-ideal CVH metrics (excluding blood pressure). The hazard ratio of each group (reference: 0 metrics) for new-onset hypertension was estimated using Cox proportional hazards models. During a mean follow-up period of 1405 days, 22 826 (24.5%) participants developed hypertension. Hypertension risk significantly increased with higher numbers of non-ideal CVH metrics (hazard ratios ranged from 1.067 for 1 metric to 1.609 for 6–7 metrics). Additionally, all non-ideal CVH metrics except for blood lipids were found to be significant predictors of hypertension. Higher numbers of non-ideal CVH metrics in Life’s Essential 8 were consistently associated with a higher incidence of hypertension. Multicomponent lifestyle modification strategies that improve overall CVH status may help to prevent hypertension.

DOI： 10.1038/s41371-025-01059-9

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記述言語：英語   出版者・発行元：Journal of the American Heart Association  

BACKGROUND: Hypertension is the principal risk factor for intracerebral hemorrhage (ICH), and blood pressure control is reliant on consistent adherence to antihypertensive treatment. This study examined the association between antihypertensive treatment discontinuation and ICH occurrence in Japanese patients with hypertension. METHODS: This nested case–control study was conducted using claims data from the LIFE (Longevity Improvement & Fair Evidence) study from residents of 4 Japanese municipalities enrolled in public medical insurance or public assistance programs. The participants comprised people with hypertension between April and October 2017 and were followed up from November 2017 to March 2022 to identify ICH occurrence. Cases with ICH were matched with controls without ICH in a 1:10 ratio based on sex and age. Participants without any claims data for hypertension care for ≥4months were regarded as discontinuing antihypertensive treatment. Conditional logistic regression was performed to examine the association between treatment discontinuation and ICH occurrence. Covariates included atrial fibrillation and flutter, diabetes, Charlson Comorbidity Index score, antithrombotic, and statin use. RESULTS: Of 62674 patients with hypertension, 5699 (9.1%) developed ICH during follow-up. Participants who discontinued antihypertensive treatment had significantly higher odds for developing ICH (odds ratio, 3.77 [95% confidence interval, 3.43–4.14]; P<0.001) than treatment-adherent participants. In addition, the male sex and younger age (<40years) were significant risk factors for antihypertensive treatment discontinuation. Cases with ICH had significantly higher medical expenditure than controls without ICH. CONCLUSIONS: Antihypertensive treatment discontinuation significantly increased the risk of developing ICH in Japanese patients with hypertension. Regular medical visits and treatment adherence may help to prevent ICH development in these patients, thus reducing their clinical and economic burden.

DOI： 10.1161/JAHA.125.042523

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：国立保健医療科学院  

目的:2024年度から腹囲2cm・体重2kg減を達成すれば特定保健指導の介入量を問わず特定保健指導終了とする新たなアウトカム評価が導入された.本研究では基準達成群,未達成群,脱落群を比較し,短期的アウトカムと中長期的アウトカムの新規発症の差の有無を明確にする.方法:本研究は,LIFE Studyの15自治体における2012年度～2022年度の国民健康保険加入者の医療レセプトデータおよび特定健康診査・特定保健指導データを用いた.特定保健指導後の腹囲2cmかつ体重2kg減少の達成群,未達成群,保健指導途中終了の脱落群の3群に分類し,短期的アウトカム(高血圧,糖尿病,脂質異常症の発症)および中長期的アウトカム(虚血性心疾患,脳血管疾患の発症)を評価した.Kaplan-Meier法を使用し生存曲線を描き,Log-rank検定を行った.3群間における交絡因子の影響を調整するためCox比例ハザードモデルによる多変量解析を行った.さらに,自治体のクラスターを考慮し標準誤差を補正した感度分析を実施した.結果:短期的アウトカムの発症率は,達成群88人(22.8%),未達成群423人(36.3%),脱落群647人(30.3%),中長期的アウトカムは達成群23人(6.0%),未達成群84人(7.2%),脱落群116人(5.4%)であった.Kaplan-Meier法による生存時間分析とLog-rank検定では,短期的アウトカムにおいて3群間で有意差を認めた.ハザード比は,短期的アウトカムで未達成群1.50(1.19-1.89),脱落群1.23(0.98-1.54),中長期的アウトカムでは,未達成群0.98(0.62-1.57),脱落群0.77(0.49-1.21)であった.自治体のクラスターを考慮した感度分析の結果,短期的アウトカムは未達成群1.50(1.29-1.75,p<0.001)と有意差を認め,中長期的アウトカムでは有意差が認めなかった.結論:短期的アウトカムでは,達成群と比較した未達成群のみ統計的な有意差を認めた.自治体間の影響を考慮した感度分析においても,同様の結果であった.一方,中長期的アウトカムでは,統計的有意差は認められなかった.動脈硬化性疾患の進行は長期間を要するため,今後の特定保健指導においては特定健康診査を継続的に受診し,減量効果を維持することが重要である.(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Periodontology  

Background: To investigate the differences in health care expenditure (HCE) due to the comorbidity status of periodontal disease (PD) and diabetes mellitus (DM). Methods: This cohort study used health care claims and oral health screening data to identify participants with PD or DM and followed them for 1 year to assess their HCE. PD and DM were determined based on PD screening and medical claims data, respectively. The study participants were divided into four groups: participants without PD and DM (PD−/DM−), participants with PD and without DM (PD+/DM−), participants without PD and with DM (PD−/DM+), and participants with PD and DM (PD+/DM+). Covariates included age, sex, smoking status, and Charlson Comorbidity Index (CCI) score. A generalized linear model (GLM) with a gamma distribution and log link function was used to examine the association between comorbidity and annual HCE, and a two-part model was used to assess the differences in annual HCE. Results: In total, 790 participants (mean age: 63.1, 30.3% male) were included. Compared with the PD−/DM− group, the relative cost ratio (RCR) for the PD+/DM+, PD−/DM+, PD+/DM− groups were 1.31 (95% confidence interval [CI]: 1.06–1.62), 1.27 (95% CI: 0.99–1.64), 1.01 (95% CI: 0.89–1.14) times higher, respectively. The adjusted mean annual HCE for the PD+/DM+, PD−/DM+, PD+/DM− groups were ¥59,328 (95% CI: 14,171–104,484), ¥50,228 (95% CI: −15,801–116,256), ¥-2,162 (95% CI: −24,598–20,274) higher than the PD−/DM− group, respectively. Conclusion: This study provides a significant contribution of PD to the increase in HCE, particularly in individuals with DM. Plain Language Summary: The association between periodontal disease (PD) and diabetes mellitus (DM) has commonly been described in previous literature, but the health expenditure incurred when PD and DM coexist is not clear. This study investigates the differences in health care expenditure (HCE) due to the comorbidity status of PD and DM. HCE is calculated from medical, dental, and pharmacy-dispensing expenditures from the claims data. PD was defined by periodontal pocket scores, and DM was determined based on medical records. Study participants were divided into four groups based on whether they had PD, DM, both, or neither. The results showed that people with both PD and DM had higher HCE compared with those without PD and DM. These findings may suggest the importance of cooperation between medical and dental professionals in the treatment of DM in terms of HCE.

DOI： 10.1002/JPER.24-0496

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Hepatology Research  

Aim: To estimate the risks of coronary artery and cerebrovascular diseases in metabolic dysfunction-associated fatty liver disease (MAFLD) using different fatty liver index (FLI) cut-off values in a Japanese population. Methods: We analyzed insurance claims and health checkup data from public medical insurance enrollees aged ≥40 years in seven Japanese municipalities who had undergone a health checkup between April 2015 and March 2022. The MAFLD cases were identified as hepatic steatosis (defined as FLI ≥60 or ≥37) with overweight/obesity, diabetes, or lean/normal weight with metabolic dysregulation. Cox proportional hazards models estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for MAFLD (reference: non-MAFLD) regarding incident coronary artery and cerebrovascular diseases. Covariates included age, sex, smoking habit, low-density lipoprotein cholesterol level, and statin use. Results: The study was undertaken using 163 834 individuals. The HRs of MAFLD for coronary artery disease were 1.44 (95% CI, 1.24–1.67) for FLI ≥ 60 and 1.49 (95% CI, 1.32–1.68) for FLI ≥ 37. The HRs of MAFLD for cerebrovascular disease were 1.58 (95% CI, 1.22–2.05) for FLI ≥ 60 and 1.41 (95% CI, 1.15–1.74) for FLI ≥ 37. In women, neither FLI cut-off was associated with coronary artery disease, and only FLI ≥ 60 was associated with cerebrovascular disease. Conclusions: The MAFLD cases identified using the two FLI cut-off values were at higher risk for coronary artery and cerebrovascular diseases. Asian-specific FLI cut-offs may better identify hepatic steatosis in Japan than Western-specific cut-offs, but there is a need to consider sex differences when determining at-risk subgroups for targeted health interventions.

DOI： 10.1111/hepr.14185

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本臨床疫学会  

<p><b>BACKGROUND</b></p><p>The post-authorization safety study of a vaccine is an important public health task, and its results contribute to the decisions about whether to recommend a vaccination by estimating not only the risk ratio but also the risk difference. There are few reports of adjusted risk differences. We evaluated the statistical performance of the adjusted risk difference and its variance under a post-authorization safety study’s settings (rare events, large sample, extreme exposure frequency).</p><p><b>METHODS</b></p><p>Adjusted risk differences were estimated using ordinary least squares estimators in a linear regression model with a binary outcome, and their variances were estimated using the standard error from ordinary least squares and four types of robust variance. In a simulation, we evaluated the risk differences’ performances using bias, coverage, and power and using data from the Vaccine Effectiveness, Networking, and Universal Safety study as an example of an actual post-authorization safety study.</p><p><b>RESULTS</b></p><p>The adjusted risk difference using ordinary least squares was not biased. Compared to the ordinary least squares’ standard error, the robust variance achieved more appropriate coverage and higher power. With actual data, including 2 × 2 tables of exposure and outcome with zero, both the ordinary least squares and robust variance could be estimated.</p><p><b>CONCLUSIONS</b></p><p>In post-authorization safety study settings, the estimation of the risk difference using ordinary least squares and robust variance showed better performance than the typical ordinary least squares. These findings may prove beneficial for reporting risk difference in extreme settings such as post-authorization safety studies.</p>

DOI： 10.37737/ace.25007

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Jdr Clinical and Translational Research  

Introduction: A public oral health screening, periodontal disease screening, has been implemented in Japan, but it remains unclear whether screening encourages subsequent regular dental visits. This study aimed to examine whether people who underwent periodontal disease screening were more likely to regularly visit dentists after undergoing the screening than before using a difference-in-differences (DID) approach. Methods: This study used health care claims data of municipality residents who underwent periodontal disease screening in 2017 or 2018. For each screening recipient, 4 individuals were extracted from those who did not undergo screening as controls. In the DID analysis, we assessed the change in the proportion of dentist visits at least once every 180 d after undergoing screening. Results: A total of 4,050 participants were included in the analysis. The proportion of participants visiting dentists was consistent throughout the study period (approximately 45%) among the participants who did not undergo the screening. However, among the participants who underwent the screening, while the proportion who visited dentists was consistent before screening (approximately 60%), the proportion was higher after screening (1–180 d after, 81.2%). DID analysis indicated that the proportion increased by 12.9% after the screening. In addition, the age-subgroup DID estimates were higher in the younger population (aged 20–35 y, 13.9%; 40–55 y, 12.8%; 60 y, 12.6%). Conclusions: Among people who underwent periodontal disease screening, a higher proportion visited dentists after undergoing the screening than before, suggesting that periodontal disease screening was associated with an increase in subsequent regular dental visits. Knowledge Transfer Statement: Our results provide evidence that a public oral health screening could increase regular dental visits, which has the potential to improve and maintain people’s oral health, especially in the younger population.

DOI： 10.1177/23800844241275859

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その他リンク： https://journals.sagepub.com/doi/full-xml/10.1177/23800844241275859

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(公社)日本小児科学会  

BCGワクチン接種後有害事象(AEFI)能動的解析における診療報酬明細書(レセプト)情報の有用性および課題について検討を行った。マッチドコホート研究デザインの対象は2015年-2020年の出生児のうち接種者678名(男児53%:接種時日齢中央値173日)、未接種者678名(男児49%:基準日中央値214日)、自己対照ケースシリーズSCCSデザインの対象集団は161名(男児57%、接種時日齢中央値163日)とした。その結果、マッチドコホート研究デザインで観測可能なのは予防接種後副反応のみであったが、SCCSデザインではBCGワクチン接種と一部のAEFIとの関連を認め有用であると考えられた。課題として専門家による診療録を使用した評価体制の構築、レセプト情報の妥当性評価、安定した症状調査集団の確保などが挙げられた。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Age and Ageing  

Background: Both osteoporosis and dementia have emerged as important public health challenges in Japan's aging population. This study aimed to investigate the impact of low bone mineral density (BMD) on the subsequent risk of dementia in older Japanese women aged ≥65 years, given the overlapping demographics of individuals affected by these two conditions. Methods: This cohort study was conducted using osteoporosis screening data and insurance claims data from a municipality. We identified 8618 women (median age: 73 years) who underwent osteoporosis screening between April 2019 and March 2021. Participants with a BMD <80% of the young adult mean were assigned to a low-BMD group (n = 2297), whereas those with a BMD ≥80% were assigned to a control group (n = 6321). The study outcomes were new-onset all-cause dementia and Alzheimer's disease (AD). To estimate the risk of low BMD on these outcomes, we constructed Cox proportional hazards models that adjusted for covariates (age, care needs, year of cohort entry, comorbidities and medications) using inverse probability of treatment weighting. Results: The low-BMD group had a significantly higher risk of developing both all-cause dementia (adjusted hazard ratio: 1.58, 95% confidence interval: 1.20-2.08) and AD (1.61, 1.11-2.36) than the control group over approximately 30 months of follow-up. Conclusion: These findings suggest that low BMD is associated with medium-term onset of dementia. Osteoporosis screenings could be useful not only for the secondary prevention of osteoporosis, but also for the primary prevention of dementia.

DOI： 10.1093/ageing/afaf058

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Pediatric Infectious Disease Journal  

Background: Respiratory syncytial virus (RSV) is a major cause of pediatric respiratory tract infections. In Japan, children with specific underlying conditions are eligible to receive palivizumab to prevent severe RSV disease. However, the association between palivizumab eligibility and RSV infection severity remains unclear. This study examined RSV infection severity and hospitalization outcomes in Japanese infants and children according to palivizumab eligibility and identified their associated factors. Methods: Using insurance claims data from 12 municipalities, we identified RSV cases in children ≤24 months of age between April 2017 and March 2022. The patients' characteristics and hospitalization status were analyzed according to the presence of palivizumab-indicated underlying conditions. Regression models were used to identify factors associated with hospitalization, length of stay (LOS), and hospital expenditures. Results: We analyzed 1025 first-time RSV cases (860 infants <12 months and 165 children 12-24 months old). There were 777 (90.3%) palivizumab-ineligible infants and 83 (9.7%) palivizumab-eligible infants. Only 13 (15.7%) palivizumab-eligible infants had received palivizumab in the month before RSV infection, and 8 required hospitalization. RSV hospitalization was significantly associated with age (odds ratio: 0.84, 95% confidence interval: 0.79-0.88), palivizumab-indicated underlying conditions (1.82, 1.13-2.89), and non-indicated high-risk conditions (4.87, 2.28-10.99). These factors were also associated with LOS. Hospital expenditures were associated with age, high-risk conditions and LOS. Conclusions: Palivizumab-indicated underlying conditions, high-risk conditions, and younger age are risk factors for RSV hospitalization. Most hospitalized patients did not receive palivizumab in the month before RSV infection despite being eligible, suggesting that some hospitalizations were preventable through appropriate palivizumab use.

DOI： 10.1097/INF.0000000000004543

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Geriatric Psychiatry  

Objectives: Anticholinergic drugs can cause cognitive impairment. The risk of dementia associated with anticholinergics compared to beta-3 agonists (mirabegron and vibegron) has not been extensively investigated in the super-aging society of Japan. This study evaluated the association between the dementia risk and anticholinergics compared to beta-3 agonists in older adults with overactive bladder in Japan. Methods: This study had 1,493,202 participants from the Longevity Improvement & Fair Evidence Study, which includes claim data in Japan from 2014 to 2022. The participants included 13,448 anticholinergic drug users and 24,669 beta-3 agonist users diagnosed with overactive bladder and aged ≥ 65 years. The Cox proportional hazards regression model was used to calculate hazard ratios and 95% confidence intervals being adjusted for confounding variables to evaluate the impact of anticholinergic drugs compared to beta-3 agonists prescribed at index date to patients with overactive bladder. Results: Among the beta-3 agonist and anticholinergic drug users, the mean (standard deviation) age was 78.9 (6.7) and 78.8 (7.0) years, and the percentage of men was 47.2% and 39.7%, respectively. In the beta-3 agonist group, 2130 participants were newly diagnosed with dementia during the 51,605 person-years of follow-up from the index date, whereas in the anticholinergic drug group, 1826 participants were diagnosed during the 34,929 person-years of follow-up. In the Cox proportional hazard regression model, there was an increased risk of dementia in the anticholinergic drug group compared to the beta-3 agonist group (adjusted hazard ratio [aHR] = 1.22; 95% confidence interval [CI], 1.15–1.30). The increased risk remained identical when Inverse Probability Weighting (IPW) model was used for the analysis (aHR = 1.19; 95% CI, 1.11–1.28). Conclusions: Compared to beta-3 agonists, anticholinergic drugs are associated with an increased risk of dementia in older adults with overactive bladder, in Japan. These findings suggest that beta-3 agonists may have a lower risk of dementia than anticholinergics and have potential to be a good alternative opinion for older people with OAB, which warrants further study.

DOI： 10.1002/gps.70036

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Vaccine  

Introduction: Post-COVID-19 conditions have emerged as a global health challenge. This study examined the long-term effects of COVID-19 vaccination on the incidence and risk of post-COVID-19 conditions in Japan. Methods: This retrospective cohort study was conducted using a database comprising medical claims, COVID-19 case information, and vaccination records of persons residing in four Japanese municipalities. The cohort included COVID-19 cases diagnosed between August 2020 and December 2022. Participants were classified according to the duration between their most recent COVID-19 vaccination and COVID-19 occurrence (≥365 days, 150–364 days, and 14–149 days). The incidences of 36 post-COVID-19 conditions were monitored for 3, 5, and 8 months after infection. Cox proportional hazards models were used to calculate the risk of developing each post-COVID-19 condition within 8 months after infection according to vaccination status. Results: From among 84,464 participants, 9642 (11.4 %) developed post-COVID-19 conditions over 8 months. The 8-month risks of developing 28 (including various respiratory conditions, cardiovascular conditions, inflammatory and immune diseases, physical conditions, psychiatric conditions, and endocrine disorders) of the 36 target conditions were significantly lower when individuals had been recently vaccinated (14–149 days) before infection. Conclusions: COVID-19 vaccination can reduce the incidence and risk of post-COVID-19 conditions if administered within 5 months before infection. Despite having the highest mean age and prevalence of comorbidities, individuals who were most recently vaccinated had a lower risk of developing post-COVID-19 conditions. These results provide important evidence for future COVID-19 vaccination strategies.

DOI： 10.1016/j.vaccine.2024.126497

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Clinical Parkinsonism and Related Disorders  

Background: The association between care needs level (CNL) and functional outcomes after diagnosis in older patients with Parkinson's disease (PD) is unclear. Methods: Using health insurance claims and the Japanese Long-Term Care (LTC) data from 12 municipalities in Japan, PD patients aged ≥ 65 years old were identified between April 2014 and March 2022. CNL was classified as no care needed (NCN), support level (SL), CNL1 (low level), CNL2-3, and CNL4-5 (fully dependent) based on the total estimated daily care hours as defined by the national standard criteria. The primary outcomes were changes in CNL and all-cause death one year after PD diagnosis by baseline CNL at diagnosis. Results: Of the 11,270 PD patients, 39.8% had NCN, 27.6% SL&CNL1, 18.8% CNL2-3, and13.9% CNL4-5 at PD diagnosis. One-year after diagnosis, there were NCN 28.2%, SL&CNL1 24.9%, CNL2-3 19.2%, CNL4-5 17.6% (i.e., 61.7% required care need), and all-cause death 10.1%. Compared with NCN patients at diagnosis, patients with SL&CNL1, CNL2-3, and CNL4-5 had an increased risk of all-cause death one-year after diagnosis (adjusted hazard ratio [95% confidence interval]: 1.58 [1.29–1.93], 2.83 [2.32–3.46], and 5.80 [4.76–7.06]), assessed by using Cox proportional hazard models. Conclusions: Baseline CNL in older Japanese patients was associated with all-cause death even one-year after PD diagnosis, and high CNL was associated with a high risk of all-cause death.

DOI： 10.1016/j.prdoa.2025.100375

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：国立研究開発法人 国立国際医療研究センター  

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

DOI： 10.35772/ghmo.2024.01007

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CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本疫学会  

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

DOI： 10.2188/jea.je20230323

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掲載種別：研究論文（学術雑誌）  

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掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Pharmacoepidemiology and Drug Safety  

Purpose: We validated claims-based algorithms using the International Classification of Diseases, Tenth Revision (ICD-10) to identify patients with the first-ever coronavirus disease (COVID-19) onset between May 2020 and August 2022. Methods: The study cohort was comprised of residents of one municipality enrolled in a public insurance program. This study used data provided by the municipality, including residents' insurer-based medical claims data linked to the Health Center Real-time Information-Sharing System (HER-SYS). The HER-SYS data included positive results from COVID-19 tests and were used as reference standards. Claims-based algorithms #1 and #2 were U07.1, B34.2, with and without suspicious diagnoses, respectively. Claims-based algorithms #3 and #4 were U07.1 with and without suspicious diagnoses, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each algorithm. Results: The study cohort included 165 038 residents, including 13 402 residents were the reference standard. For the entire period, the sensitivity, specificity, PPV, and NPV were 55.7% (95% confidence interval: 54.8%–56.5%), 65.4% (65.2%–65.6%), 11.5% (11.3%–11.8%), and 98.9% (98.8%–99.0%) for Algorithm #1, and 67.0% (66.2%–67.8%), 88.1% (87.9%–88.3%), 31.6% (31.1%–32.2%), and 97.8% (97.7%–97.8%) for Algorithm #2, and 52.9% (52.0%–53.7%), 67.1% (66.9%–67.3%), 11.5% (11.2%–11.8%), and 98.3% (98.3%–98.4%) for Algorithm #3, 62.6% (61.8%–63.4%), 88.5% (88.3%–88.7%), 30.9% (30.3%–31.4%), and 97.3% (97.2%–97.4%) for Algorithm #4, respectively. Conclusions: Our study showed that the validity of claims-based algorithms consisting of COVID-19-related ICD-10 codes to identify patients with first-onset COVID-19 is limited.

DOI： 10.1002/pds.70032

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Open Forum Infectious Diseases  

This retrospective matched cohort study investigated the protective effects of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against pneumonia mortality and all-cause mortality in Japanese adults aged ≥65 years. We analyzed claims data, vaccination records, and death certificate records between October 2016 and December 2019 from 55 509 PPSV23-vaccinated individuals and 55 509 unvaccinated individuals. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of PPSV23 vaccination for mortality. The results showed that PPSV23 vaccination was significantly associated with a reduction in all-cause mortality (adjusted HR, 0.52; P < .001) but not pneumonia mortality (adjusted HR, 0.70; P = .374).

DOI： 10.1093/ofid/ofae530

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Hypertension Research  

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

DOI： 10.1038/s41440-024-01768-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Critical Care  

Background: The post-discharge prognosis of patients with sepsis remains a crucial issue; however, few studies have investigated the relationship between pre-sepsis health status and subsequent prognosis in a large population. This study aimed to examine the effect of the pre-sepsis care needs level on changes in care needs and mortality in patients with sepsis 1 year post-discharge. Methods: This was a population-based retrospective cohort study including twelve municipalities in Japan that participated in the Longevity Improvement & Fair Evidence study between April 2014 and March 2022, with a total of 1,491,608 persons. The pre-hospitalization levels of care needs (baseline) were classified from low to high, as no care needs, support level and care needs level 1, care needs levels 2–3, and care needs levels 4–5 (fully dependent). The outcomes were changes in care needs level and mortality 1 year post-discharge, assessed by baseline care needs level using Cox proportional hazard models. Results: The care needs levels of 17,648 patients analyzed at baseline were as follows: no care needs, 7982 (45.2%); support level and care needs level 1, 3736 (21.2%); care needs levels 2–3, 3089 (17.5%); and care needs levels 4–5, 2841 (16.1%). At 1 year post-discharge, the distribution of care needs were as follows: no care needs, 4791 (27.1%); support level and care needs level 1, 2390 (13.5%); care needs levels 2–3, 2629 (14.9%); care needs levels 4–5, 3373 (19.1%); and death, 4465 (25.3%). Patients with higher levels of care needs exhibited an increased association of all-cause mortality 1 year post-discharge after adjusting for confounders [hazard ratios and 95% confidence intervals: support level and care needs level 1, 1.05 (0.96, 1.15); care needs levels 2–3, 1.46 (1.33, 1.60); and care needs levels 4–5, 1.92 (1.75, 2.10); P for trend < 0.001]. Conclusions: Elevated care needs and mortality were observed in patients with sepsis within 1 year post-discharge. Older patients with sepsis and higher baseline levels of care needs had a high association of all-cause mortality 1 year post-discharge.

DOI： 10.1186/s13054-024-05080-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Brain Communications  

The association between statin use and the risk of Parkinson’s disease remains inconclusive, particularly in Japan’s super-ageing 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 claim 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 (9397 cases and 46 789 controls), 53.6% were women. The inverse association between statin use and Parkinson’s disease risk was significant after adjusting for multiple variables (odds ratio: 0.61; 95% confidence interval: 0.56–0.66). Compared with non-users, the dose analysis revealed varying odds ratios: 1.30 (1.12–1.52) for 1–30 total standard daily doses, 0.77 (0.64–0.92) for 31–90 total standard daily doses, 0.62 (0.52–0.75) for 91–180 total standard daily doses and 0.30 (0.25–0.35) for >180 total standard daily doses. Statin use among older Japanese adults was associated with a decreased risk of Parkinson’s disease. Notably, lower cumulative statin doses were associated with an elevated risk of Parkinson’s disease, whereas higher cumulative doses exhibited protective effects against Parkinson’s disease development.

DOI： 10.1093/braincomms/fcae195

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本疫学会  

Background: 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). Methods: 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%. Results: 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. Conclusion: BNT162b2 was highly effective against infection, symptomatic infection, and hospitalization in Japan’s older adult population aged ≥65 years during the Delta-predominant period.

DOI： 10.2188/jea.je20230106

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：IJID Regions  

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

DOI： 10.1016/j.ijregi.2024.03.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Psychiatric Research  

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

DOI： 10.1016/j.jpsychires.2024.04.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Gerodontology  

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

DOI： 10.1111/ger.12703

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Plos One  

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

DOI： 10.1371/journal.pone.0299849

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Hypertension  

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

DOI： 10.1097/HJH.0000000000003661

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Brain Behavior and Immunity  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Infectious Diseases  

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%. 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% (95% confidence interval [CI]: 20.8, 44.3%) more effective than receiving no vaccination, and 18.2% (95% CI: 9.4, 26.0%) 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% (95% CI: 9.9, 26.5%) additional protection among those vaccinated with ≥ 2 monovalent doses, in the absence of a previous infection history. However, we did not find sufficient evidence of effectiveness of bivalent vaccines among previously infected older adults. Conclusions: Bivalent vaccines are effective against COVID-19 infections among older adults without a history of infection.

DOI： 10.1186/s12879-024-09035-3

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その他リンク： https://link.springer.com/article/10.1186/s12879-024-09035-3/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Vaccine  

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

DOI： 10.1016/j.vaccine.2023.12.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Alzheimer S Disease  

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

DOI： 10.3233/JAD-230806

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Antimicrobial Chemotherapy  

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

DOI： 10.1093/jac/dkad340

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>

DOI： 10.1002/gps.6029

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CiNii Research

掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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その他リンク： https://academic.oup.com/ofid/article-pdf/10/10/ofad475/52304770/ofad475.pdf

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Open Forum Infectious Diseases  

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 <50 years old. Conclusions: No increased risk of HZ was found after BNT162b2 vaccination in the overall study population. However, an increased risk was observed in the younger subgroup.

DOI： 10.1093/ofid/ofad274

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その他リンク： https://academic.oup.com/ofid/article-pdf/10/7/ofad274/51009557/ofad274.pdf

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Vaccine  

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

DOI： 10.1016/j.vaccine.2023.03.059

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cancer Epidemiology  

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

DOI： 10.1016/j.canep.2023.102335

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of the American Geriatrics Society  

Background: An increased risk of fracture has been reported in older adults taking hypnotics. However, few studies have reported the comparative safety of hypnotics with different mechanisms of action. We examined the risk of fracture in older adults initiating suvorexant compared to those initiating Z-drugs. Methods: We conducted a retrospective cohort study using a claims database within a longevity improvement and fair evidence (LIFE) study in Japan (1.5 million beneficiaries). People aged ≥65 years were included in this study. Exposure was defined as the initiation of either suvorexant or Z-drugs (eszopiclone, zolpidem, or zopiclone). The evaluated outcomes were hip fracture and all-cause fracture requiring hospitalization. We used inverse probability of treatment weights to adjust for confounding and followed the incidence of the outcome for three different periods: 30, 90, and 365 days. Cox proportional hazards models were fitted to the weighted population to estimate hazard ratios (HRs). Sensitivity analyses were performed with narrowed outcome definitions and inverse probability of censoring weights. Results: We identified 16,148 suvorexant new users and 54,327 Z-drugs new users. During the 30-day follow-up, 21 (16.6 events per 1000 person-years) and 53 hip fractures (12.2 events per 1000 person-years) were identified among suvorexant and Z-drugs new users, respectively (HR: 1.01, 95% confidence interval [CI]: 0.58–1.76). The analysis for all-cause fracture showed an HR of 1.03 (95% CI: 0.78–1.36). Extended follow-up (90 and 365 days) showed similar results for both outcomes. Sensitivity analyses showed consistent results except for an increased risk of all-cause fracture requiring surgery (HR: 1.41, 95% CI: 0.87–2.29) during the 30-day follow-up. Conclusions: This is the first study to show that suvorexant has a generally comparable risk of fracture as compared to Z-drugs. Further research is needed to investigate the potential short-term increased risk of all-cause fracture requiring surgery among suvorexant initiators.

DOI： 10.1111/jgs.18068

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jgs.18068

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Alzheimer S Disease  

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

DOI： 10.3233/JAD-230471

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Infectious Diseases  

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% (95% confidence interval [CI]: 80.5–94.7%) during the Delta-predominant period and 21.2% (95% CI: 11.0–30.3%) during the Omicron-predominant period. The effectiveness of a third dose against symptomatic infection was 71.8% (95% CI: 60.1–80.1%) during the Omicron-predominant period. Conclusion: Vaccine effectiveness against symptomatic infection decreased during the Omicron-predominant period but was maintained by a third dose.

DOI： 10.1016/j.ijid.2022.10.001

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PubMed

掲載種別：研究論文（学術雑誌）  

Web of Science

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of the American Medical Directors Association  

Objectives: As more countries are implementing measures to address Alzheimer's disease (AD), it is essential to update the available knowledge on the relationship between economic status and mortality in patients with AD. This study examined the influence of economic status on mortality in Japanese individuals with AD using a medical claims dataset. Design: This was a retrospective cohort study. Setting and Participants: Medical claims data from April 2014 to March 2019 were obtained from 13 local cities participating in the Longevity Improvement and Fair Evidence study. The inclusion criteria were patients aged 65 years and older who were newly diagnosed with AD during the study period. Methods: The outcome was death during the follow-up period. We assessed economic status by household income (middle to high income and low income); data were obtained from the use of the Medical Expenditure Ceiling Application and Standard Copayment Reduction Card (fee reduction card) when receiving an AD diagnosis, as an indicator of low-income status. We performed multivariate Cox proportional hazards analyses to examine the relationship between economic status and mortality; the model was adjusted for age, sex, the Charlson comorbidity index, and antidementia drug use. Results: We identified 39,081 newly diagnosed patients with AD from the Longevity Improvement and Fair Evidence study database (mean age, 83.6 years; female, 67.1%). Of these, 3189 individuals were identified as having a low-income status. After adjusting for possible confounders, low-income status was associated with mortality (hazard ratio, 1.95; 95% confidence interval, 1.84–2.07). Conclusions and Implications: Low-income status was associated with substantially poorer prognoses in new AD cases, indicating a need for a thorough examination of medical and nursing care services utilized by low-income individuals with AD and to explore improvement strategies.

DOI： 10.1016/j.jamda.2021.08.025

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Alzheimer S Disease  

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

DOI： 10.3233/JAD-220200

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PubMed