Pre-pandemic social isolation as a predictor of the adverse impact of the pandemic on self-rated health: A longitudinal COVID-19 study in Japan.

Many studies have found adverse effects of the coronavirus disease pandemic on health. Irrespective of being infected by the coronavirus, lockdowns and other measures to restrict mobility have worsened an individual's subjective health assessment. Unlike previous studies, this study examined how pre-pandemic social isolation (in the form of no interaction with others and having no social support) affected the impact of the pandemic on self-rated health in Japan. To this end, we estimated fixed-effects models using 4172 observations of 2086 individuals obtained from a three-wave Internet nationwide survey conducted in January/February 2019 and February 2020 (before the pandemic), in March 2021 (when the pandemic-related state of emergency was effective in four prefectures and just after it was lifted in six prefectures), and in October/November (a full month after the state of emergency was lifted in all prefectures). The state of emergency raised the probability of reporting poor health by 17.8 (95% confidence interval [CI]:1.9-33.8) percentage points among the participants who had not interacted with others before the pandemic, compared with only 0.7 (95% CI: -3.1-4.5) percentage points among other participants. Similar results were obtained in the absence of social support prior to the pandemic. In conclusion, pre-pandemic social isolation was detrimental to health, suggesting that policy measures are needed to avoid social isolation to increase the resilience of public health to external shocks.

Evolutions of Self-Rated Health and Social Interactions during the COVID-19 Pandemic Affected by Pre-Pandemic Conditions: Evidence from a Four-Wave Survey.

The Coronavirus disease 2019 (COVID-19) pandemic has affected individuals' self-rated health (SRH) and social interactions, but their evolution during the pandemic needs further investigation. The present study addressed this issue using longitudinal data from 13,887 observations of 4177 individuals obtained from a four-wave nationwide, population-based survey conducted between January and February 2019 (before the pandemic) and November 2022. We compared the evolutions of SRH and social interactions during the pandemic between individuals who interacted with others before the pandemic and those who did not. Three noteworthy findings were obtained. First, deterioration in SRH in response to the declared state of emergency was concentrated on individuals with no pre-pandemic interaction with others. Second, SRH generally improved during the pandemic, although the improvement was more remarkable among previously isolated individuals. Third, the pandemic has promoted social interactions among previously isolated individuals and reduced such chances among those who previously interacted with others. These findings underscore the importance of pre-pandemic social interactions as key determinants of responding to pandemic-related shocks.

Association between having a primary care physician and health behavioral intention in Japan: results from a nationwide survey.

INTRODUCTION: Introducing a primary care physician (Kakaritsuke-I: KI) system to improve the efficiency of the health care system has been controversial in Japan. This study aimed to determine the relevance of KI to an individual's health behavioral intentions. METHODS: We used data from a nationwide, population-based internet survey (N = 5,234) to conduct a cross-sectional regression analysis. Additionally, we used a propensity score matching method to mitigate the potential endogenous biases inherent in the decision to have a KI. RESULTS: KI was positively associated with various behavioral intentions. For example, the probabilities of intending to eat a well-balanced diet and engaging in moderate exercise were 12.8 (95% confidence interval [CI]:9.5-16.1) percentage points and 7.2 (95% CI: 3.9-10.4) percentage points higher, respectively, among those with a KI than among those without a KI. A KI equally increased the likelihood of getting vaccinated against coronavirus (in November 2021) by 7.5 (95% CI: 5.2-9.8) percentage points. CONCLUSIONS: Although further analysis is needed to examine the effect of KI on health, the results of this study suggest the potential benefits of policy measures to promote the KI system.

At Which Area Level Does COVID-19 Infection Matter Most for an Individual's Self-Rated Health? A Multilevel Fixed-Effects Model Analysis in Japan.

Several studies have reported the adverse impacts of the COVID-19 pandemic on health outcomes. However, little is known about which area of COVID-19 infection matters most for an individual's subjective health outcomes. We addressed this issue in the present study. We used the longitudinal data of 2260 individuals obtained from a two-wave internet-based nationwide survey conducted in Japan. We estimated the multilevel regression models, which controlled for fixed effects at the individual and prefecture levels, to explain an individual's self-rated health (SRH) based on the reported number of new COVID-19 infection cases at different area levels: prefecture, group of neighboring prefectures, and regional bloc. We found that SRH was highly associated with the average and maximum number of new infection cases among neighboring prefectures or in the regional bloc, but not with those at the prefecture level, if used jointly as explanatory variables. The results suggest that inter-prefectural coordination is needed not only to contain COVID-19 but also to reduce its adverse impact on the subjective health outcomes of residents.