Association between the interval of worksite dental check-ups and dental and medical expenditures: a single-site, 12-year follow-up study in Japan.

OBJECTIVES: The purpose of this study was to identify the effective intervals of worksite dental check-ups to reduce cumulative dental expenditures (CDEs) and cumulative medical expenditures (CMEs), based on 12 years of follow-up dental check-ups. SETTING, DESIGN AND PARTICIPANTS: A longitudinal study was conducted between 2002 and 2014 fiscal years. A total of 2691 full-time employees (2099 males and 592 females) aged 20-59 years in a manufacturing company in Japan were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES: Based on the follow-up of 12-year dental check-ups, the interval of dental check-ups visits was classified into the following categories: 'Once per year' as the regular group, 'At least once per 2 years' as the subregular group and others as the irregular group. CDEs and CMEs per capita were examined by the three groups of dental check-ups interval after adjustment for sex, age, occupation and total CMEs at baseline. For sensitivity analysis, decayed teeth, missing teeth and Community Periodontal Index were added as adjustment factors. RESULTS: Compared with the irregular group, the pooled CDEs (including dental check-ups fee) per capita in the subregular group (OR 0.91, 95% CI 0.85 to 0.98) and regular group (OR 0.87, 95% CI 0.81 to 0.93) were significantly lower overall. The younger adults in the subregular group and younger-aged and middle-aged adults in the regular group had significantly lower CDEs. Sensitivity analysis confirmed these findings. CONCLUSIONS: Our findings suggest that regular and subregular worksite dental check-ups were related to reduction of CDEs. It is important to promote a yearly interval between dental check-ups.

Impact and attribute of each obesity-related cardiovascular risk factor in combination with abdominal obesity on total health expenditures in adult Japanese National Health insurance beneficiaries: The Ibaraki Prefectural health study.

BACKGROUND: The aim of this study was to examine the attribution of each cardiovascular risk factor in combination with abdominal obesity (AO) on Japanese health expenditures. METHODS: The health insurance claims of 43,469 National Health Insurance beneficiaries aged 40-75 years in Ibaraki, Japan, from the second cohort of the Ibaraki Prefectural Health Study were followed-up from 2009 through 2013. Multivariable health expenditure ratios (HERs) of diabetes mellitus (DM), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), and hypertension with and without AO were calculated with reference to no risk factors using a Tweedie regression model. RESULTS: Without AO, HERs were 1.58 for DM, 1.06 for high LDL-C, 1.27 for low HDL-C, and 1.31 for hypertension (all P < 0.05). With AO, HERs were 1.15 for AO, 1.42 for DM, 1.03 for high LDL-C, 1.11 for low HDL-C, and 1.26 for hypertension (all P < 0.05, except high LDL-C). Without AO, population attributable fractions (PAFs) were 2.8% for DM, 0.8% for high LDL-C, 0.7% for low HDL-C, and 6.5% for hypertension. With AO, PAFs were 1.0% for AO, 2.3% for DM, 0.4% for low HDL-C, and 5.0% for hypertension. CONCLUSIONS: Of the obesity-related cardiovascular risk factors, hypertension, independent of AO, appears to impose the greatest burden on Japanese health expenditures.

Personal status of general health checkups and medical expenditure: A large-scale community-based retrospective cohort study.

BACKGROUND: We sought to clarify the association between the personal utilization of general health checkups (GHCs) and medical expenditures (MEs) in a middle-aged Japanese population. METHODS: A retrospective cohort study was conducted. Subjects were 33,417 residents (15,819 males and 17,598 females) aged 48 years or older in 2010 who were invited to undergo GHCs every year. Official records on GHCs from 2002 to 2007 and MEs from 2008 to 2010 were provided by Soka City, Saitama Prefecture, Japan. The utilization of GHCs was divided into zero times (non-utilizers), 1-3 times (low-frequency utilizers), and 4-6 times (high-frequency utilizers). Tweedie distributions in the generalized linear model were used to analyze the association between MEs and the subgroups of GHC utilization after adjustment for age and sex. RESULTS: Of the 33,417 subjects, 20,578 (61.6%) were non-utilizers, 5,777 (17.3%) were low-frequency utilizers, and 7,062 (21.1%) were high-frequency utilizers, based on the attendance to GHCs from 2002 to 2007. Compared with the non-utilizers, the high-frequency utilizers showed significantly higher outpatient MEs (JPY394,700 vs. JPY373,100). The low- and high-frequency utilizers showed significantly lower inpatient MEs (JPY224,000 and JPY181,500 vs. JPY309,300) and total MEs (JPY610,600 and JPY580,700 vs. JPY689,600) than the non-utilizers based on the pooled data from 2008 to 2010. CONCLUSIONS: This study suggests that the outpatient MEs rise when annual GHCs are increasingly attended (not including the GHC cost), but inpatient and total MEs are lower. To reduce MEs, increasing the rates of attendance at GHCs by the general public may be important.

Non-work-related personal events contribute to depressive symptoms in Japanese discretionary workers.

In Japan, the number of workers with depressive symptoms has increased recently, and long working hours are considered one of the main contributing factors. Currently, the number of workers engaging in discretionary work is small but is expected to increase, as a diverse method of employment is believed to contribute to workers' well-being. However, the factors related to discretionary workers' depressive symptoms are unclear. This study aimed to identify the factors associated with depressive symptoms in discretionary workers. The subjects were 240 male discretionary workers in a Japanese insurance company. A cross-sectional study was performed using a questionnaire that includes demographic characteristics, living and working conditions, work-related and non-work-related stressful events, and the Center for Epidemiologic Studies Depression Scale (CES-D). Depressive symptoms were assessed as more than 16 points on the CES-D. Multiple logistic regression models were employed to estimate odd ratios (OR) with 95% confidence intervals (95% CI) of depressive symptoms in relation to possible factors. Thirty-six subjects (15.5%) showed depressive symptoms. The depressive symptoms were significantly related to age (p = 0.04), presence of child(ren) (p = 0.02), and length of employment (p = 0.01), but unrelated to working hours. Subjects who reported "financial matters" (OR = 4.50, 95% CI = 1.89-10.72) and "own event" such as divorce or illness (OR = 2.93, 95% CI = 1.13-7.61) were more likely to show depressive symptoms. In conclusion, mental health measures for discretionary workers should focus on addressing financial difficulties and consultations and assistance in personal health and family issues.

Changes of subjective stress and stress-related symptoms after a merger announcement: a longitudinal study in a merger-planning company in Japan.

To investigate the influences of a merger on employees in a Japanese company, changes of subjective stress and stress-related symptoms after a merger announcement in a major Japanese financial company were explored using longitudinal study surveys. Seventy-one participants responded to the first and second questionnaires, consisting of stress and symptoms, personal characteristics, lifestyle, medical examination, and work-related factors. After the merger announcement, the prevalence of subjective stress, anxiety, and impatience increased significantly from 46.5% to 78.9%, 18.3% to 40.8%, and 15.9% to 29.0%, respectively. The study suggests that subjective stress and stress-related symptoms may increase after a merger announcement. To reduce the negative impact of mergers, employers are expected to provide mental health-promotion programs in a merger-planning company.

Characteristics of lifestyle and health status of workers in small-scale enterprises in Japan.

This study was conducted to clarify the characteristics of small-scale enterprises (SSEs) with fewer than 50 workers, which employ 62.2% of all Japanese workers. Subjects were 71,183 workers employed at 1,761 workplaces in Tochigi, Japan, in 2002. Frequencies of abnormal lifestyle and health check-up data were described according to the category of the enterprise. Adjusted odds ratios (ORs) of the abnormal findings were calculated by logistic regression analysis. Dose-response relationships were calculated by trend tests. The frequency of abnormal findings was higher in SSEs than in other categories of enterprises. The ORs of work intensity, alcohol consumption, current smoker, and the Brinkmann index were higher in SSEs than in large-scale enterprises (LSEs) and were also significant in trend tests. The ORs of audiometry, hypertension, glucose in urine and ECG in males and females, BMI, liver function, lipid metabolism, and blood sugar in females, chest X-ray, and anemia in males were higher in SSEs. Audiometry, hypertension, anemia, ECG in both males and females; chest X-ray, and glucose in urine in males, and liver function, lipid metabolism and blood sugar in females showed significant results in trend tests. Overall health and healthy lifestyle in SSEs were worse than in LSEs.