Influence of Occupational Background on Smoking Prevalence as a Health Inequality Among Employees of Medium- and Small-Sized Companies in Japan.

Tobacco smoking is a major public health problem. In addition, the influence of socioeconomic status on health inequalities has received great attention worldwide. The authors used insurance data of beneficiaries employed in medium- and small-sized Japanese companies to investigate the influence of occupational background on smoking prevalence as a health inequality among workers in Japan. Participants were aged 35-74 years and underwent health examinations in 2015. Smoking prevalence was estimated for each occupational group according to sex, age, and income. Logistic regression analysis was used to assess the association between smoking status and occupational groups. A total of 385,945 participants were included. Overall smoking prevalence was 36.3%, higher than average in Japan. Smoking prevalence was lowest among workers in the education and learning support category; all other occupational groups had significantly high prevalence, with the highest for transport and postal services (odds ratio 2.69, 95% confidence interval 2.53-2.86). There were few differences in smoking prevalence at higher income levels among female participants, but differences were remarkably significant at lower income levels. For health inequalities related to smoking, occupational background was associated with smoking prevalence. In particular, there was high smoking prevalence in workplaces not covered by smoke-free policies. These results also demonstrated differences between the sexes; smoking prevalence among female workers with lower income levels was strongly associated with occupational background whereas there were no large differences among male workers by income. These findings suggest that the government should encourage companies to adopt smoke-free policies in the workplace.

Investigation into the causes of indwelling urethral catheter implementation and its effects on clinical outcomes and health care resources among dementia patients with pneumonia: A retrospective cohort study.

There is a possibility that unnecessary treatments and low-quality medical care, such as inappropriate indwelling urethral catheter use, are being provided to older Japanese individuals.The aim of this study was to investigate contextual effects relating to indwelling urethral catheters in older people with dementia and to clarify the effects of indwelling urethral catheter use on patients' mortality, length of stay (LOS), and health care spending. This retrospective cohort study involved 4501 male and female Japanese participants. Those who were aged 75 or older with dementia and had a primary diagnosis of acute lower respiratory disease with antibiotics administered during hospitalization were eligible for inclusion. Patient mortality, LOS, and total charge during hospitalization were the main study outcomes. This study showed that indwelling urethral catheter use was significantly associated with higher mortality, longer LOS, and higher total charge for hospitalization. The pattern of indwelling urethral catheter use was clustered by care facility level. Physician density was significantly associated with indwelling urethral catheter use; the relationship was not linear but U-shaped, such that the approximate median had the lowest rate of urethral catheter use and this increased gradually toward both lower and higher physician densities. Our study found considerable variation in indwelling urethral catheter use between care facilities in older people with dementia. Additionally, indwelling urethral catheter use was related to poor outcomes. Based on these findings, we consider there to be an urgent need for constructing a framework to measure, report on, and promote the improvement of care quality for older individuals in Japan.

Investigation of the Existence of Supplier-Induced Demand in use of Gastrostomy Among Older Adults: A Retrospective Cohort Study.

The aim of this study is to clarify whether there is small area variation in the use of gastrostomy that is explained by hospital physician density, so as to detect the existence of supplier-induced demand (SID).The study design is a retrospective cohort using claim data of Fukuoka Late Elders' Health Insurance, submitted from 2010 to 2013. Study participants included 51,785 older adults who had been diagnosed with eating difficulties. We designated use of gastrostomy as an event. Multilevel logistic analyses were then used to investigate the existence of SID.After controlling for patient factors, we found significant regional level variance in gastrectomy use (median odds ratio [MOR]: 1.72, 1.37-2.51). Hospital physician density was significantly positively related with gastrostomy (adjusted OR of hospital physician density: 1.75, 1.25-2.45; P < 0.001). MORs were largely reduced for the input variable of hospital physician density.We found that the small area variation in use of gastrostomy among older adults could be explained by hospital physician density, which might indicate the existence of SID.