Association of social isolation and loneliness with chronic low back pain among older adults: A cross-sectional study from Japan Gerontological Evaluation Study (JAGES).

BACKGROUND: Per the biopsychosocial model, pain, especially chronic low back pain, which often presents with nonspecific pain, requires a comprehensive approach involving social factors. However, the association of social factors, including social isolation and loneliness, with this condition remains unclear. This study examined the cross-sectional association of social isolation and loneliness with chronic low back pain among older adults. METHODS: We recruited functionally independent older adults through a mail survey in 2019 from the Japan Gerontological Evaluation Study (JAGES). Chronic low back pain was defined as low back pain lasting more than three months. Social isolation was identified based on face-to-face and non-face-to-face interactions ("not isolated," "isolated tendency," and "isolated"). Loneliness was assessed using the UCLA Loneliness Scale ("not lonely," "lonely tendency," and "lonely"). RESULTS: Consequently, 21,463 participants were analyzed (mean age: 74.4 years; 51.5% females); 12.6% reported chronic low back pain. Multivariable Poisson regression analysis revealed that loneliness was significantly associated with the likelihood of chronic low back pain; compared with "not lonely", the prevalence ratio (PR) was 1.14 (95% confidence interval [CI]: 1.05-1.25) for "lonely tendency" and 1.40 (1.27-1.54) for "lonely." Social isolation was not associated; compared with "not isolated," the PR (95% CI) was 0.96 (0.88-1.05) for "isolated tendency" and 0.99 (0.89-1.10) for "isolated." A positive multiplicative interaction between social isolation and loneliness for chronic low back pain was found. CONCLUSIONS: Lonelier individuals were more likely to experience chronic low back pain, and those with loneliness and social isolation were synergistically more likely for this condition.

Development and validation of a rurality index for healthcare research in Japan: a modified Delphi study.

OBJECTIVES: Rural-urban healthcare disparities exist globally. Various countries have used a rurality index for evaluating the disparities. Although Japan has many remote islands and rural areas, no rurality index exists. This study aimed to develop and validate a Rurality Index for Japan (RIJ) for healthcare research. DESIGN: We employed a modified Delphi method to determine the factors of the RIJ and assessed the validity. The study developed an Expert Panel including healthcare professionals and a patient who had expertise in rural healthcare. SETTING: The panel members were recruited from across Japan including remote islands, mountain areas and heavy snow areas. The panel recruited survey participants whom the panel considered to have expertise. PARTICIPANTS: The initial survey recruited 100 people, including rural healthcare providers, local government staff and residents. PRIMARY OUTCOME MEASURES: Factors to include in the RIJ were identified by the Expert Panel and survey participants. We also conducted an exploratory factor analysis on the selected factors to determine the factor structure. Convergent validity was examined by calculating the correlation between the index for physician distribution and the RIJ. Criterion-related validity was assessed by calculating the correlation with average life expectancy. RESULTS: The response rate of the final survey round was 84.8%. From the Delphi surveys, four factors were selected for the RIJ: population density, direct distance to the nearest hospital, remote islands and whether weather influences access to the nearest hospital. We employed the factor loadings as the weight of each factor. The average RIJ of every zip code was 50.5. The correlation coefficient with the index for physician distribution was -0.45 (p<0.001), and the correlation coefficients with the life expectancies of men and women were -0.35 (p<0.001) and -0.12 (p<0.001), respectively. CONCLUSION: This study developed the RIJ using a modified Delphi method. The index showed good validity.

Health-Related Quality of Life during COVID-19 Pandemic: Assessing Impacts of Job Loss and Financial Support Programs in Japan.

This cross-sectional study examined the association between job loss during the coronavirus disease 2019 (COVID-19) pandemic and health-related quality of life (HRQOL) in the Japanese working population and whether universal financial support program has a protective influence on the HRQOL. Two self-reported internet surveys were used to determine job loss during the pandemic: one was conducted between February and March 2020, just before the COVID-19 emergency declaration by the Japanese government (April 2020), and the other was conducted between August and September 2020. For the dependent variable, we used the EQ-5D-5L utility score (QOL utility score), which was assessed between August and September 2020. The independent variables were job loss after the state of emergency was declared and two types of government financial support (either universal support or support targeting child-raising households). The Tobit regression model was applied, adjusting for covariates. Job loss during the pandemic was negatively associated with the QOL utility score in the fully adjusted model; the coefficient (95% confidence interval [CI]) for job loss during the pandemic was -0.07 (-0.11 to -0.03). For the government financial support variables, the universal financial support program was associated with a better QOL utility score of the coefficient (95% CI), 0.05 (0.03 to 0.08). Job loss during the COVID-19 pandemic is negatively associated with HRQOL, while universal financial support is positively associated with HRQOL. Our study results imply that universal financial support during the COVID-19 era has a protective influence on an individual's HRQOL. Supplementary Information: The online version contains supplementary material available at 10.1007/s11482-021-09918-6.

Intensity of community-based programs by long-term care insurers and the likelihood of frailty: Multilevel analysis of older Japanese adults.

The World Health Organization (WHO) argues that governments can postpone declining capacity of older adults by providing sufficient support. Yet, to our knowledge, no study has focused on the role of local governments for realizing healthy ageing. This study examined the association between the intensity of community-based programs for frailty postponement by long-term care insurers (as municipalities) and the likelihood of frailty. We analyzed repeated cross-sectional data of three waves (2010-11, 2013, and 2016) from the Japan Gerontological Evaluation Study (JAGES). Participants included 375,400 older adults aged 65 years or older (M = 74.1) living in a total of 81 regions covered by insurers in Japan. Frailty was assessed by a governmental standardized index, the Kihon Check List (KCL; a basic function check list in Japanese). Estimations were obtained using a multilevel logistic model with random slopes. We found that every social activity per hundred older people organized by a long-term care insurer was significantly associated with an 11% reduction of the likelihood of frailty (Odds ratio = 0.89; 95% credible interval = 0.81, 0.99). Although the main effect of educational events was not significant, the point estimate was slightly larger for people with lower levels of education than for those with higher education. The results also suggested that insurer-organized social activities could be more beneficial in communities with few opportunities for civic participation. The variation in intensity of community-based programs by long-term care insurers may explain part of a disparity in the likelihood of frailty between municipalities.

Change in Municipality-Level Health-Related Social Capital and Depressive Symptoms: Ecological and 5-Year Repeated Cross-Sectional Study from the JAGES.

Prevalence of depressive symptoms is lower in communities with greater social capital (SC). However, it is unclear whether a prevalence of depressive symptoms will decrease in communities where SC has increased. We investigated the relationship between the changes in municipality-level SC and depressive symptoms by using 5-year repeated cross-sectional data from the Japan Gerontological Evaluation Study. In 2010 and 2016, self-reported questionnaires were mailed to functionally independent residents aged 65 years or older living in 44 municipalities; valid responses were received from 72,718 and 84,211 people in 2010 and 2016, respectively. All scores were aggregated at the municipality level. The dependent variable was the change in the prevalence of depressive symptoms that were diagnosed with a 15-item Geriatric Depression Scale. Independent variables were the score of change in health-related SC indicators, e.g., social participation, social cohesion, and reciprocity. A multiple regression analysis was employed. The average prevalence of depressive symptoms decreased from 28.6% in 2010 to 21.3% in 2016. The increases in the percentages of sports group participation (B, -0.356), and reciprocity scores (B, -0.597) were significantly associated with the decrease in the prevalence of depressive symptoms after adjusting for potential confounding variables. Our findings suggest that community SC might be an intervention for protecting depressive symptoms in municipalities.

Income and education are associated with transitions in health status among community-dwelling older people in Japan: the JAGES cohort study.

BACKGROUND: Health inequalities are an emerging issue in ageing societies, but inequalities in pre-frailty, which is suffered by almost half of older people, are mostly unknown. OBJECTIVE: This study aimed to determine the association between the socio-economic status (SES) and changes across pre-frailty, frailty, disability and all-cause mortality. METHODS: We conducted a prospective cohort study across 23 Japanese municipalities between 2010 and 2013. Functionally independent community-dwelling older adults aged ≥65 years (n = 65 952) in 2010 were eligible for the study. The baseline survey was conducted from 2010 to 2012, and the self-reporting questionnaires were mailed to 126 438 community-dwelling older adults [64.8% (81 980/126 438) response rate]. The follow-up survey was conducted in 2013. Overall, 65 952 individuals were followed up [80.4% (65 952/81 980) follow-up rate]. The health status was classified into five groups: robust; pre-frailty; frailty; disability and death. We conducted three multinomial logistic regression models stratified by the initial disability status. Educational attainment and equivalized household income were separately added to the models as exposures after adjusting for covariates. RESULTS: Participants with the lowest educational level were less likely to recover from pre-frailty to robust compared with those with the highest level [odds ratio (OR) (95% confidence interval (CI)) = 0.84 (0.76-0.93)]. The participants with the lowest income level were also less likely to recover from pre-frailty to robust compared with those with the highest level [OR (95% CI) = 0.80 (0.69-0.91)]. CONCLUSIONS: Older individuals with a lower SES were less likely to recover from a pre-frailty status.

Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases-meta-analytic assessment.

BACKGROUND: It is well known that the incidence of developing hepatocelluler carcinoma (HCC) is increased in liver cirrhosis of different etiologies. However, comparison of HCC incidence in various liver diseases has not yet been estimated. We surveyed this comparison. METHODS: The PubMed database was examined (1989-2017) for studies published in English language regarding the prospective follow-up results for the development of HCC in various liver diseases. A meta-analysis was performed for each liver disease. RESULTS: The annual incidence (%) of HCC in the non-cirrhotic stage and cirrhotic stage, and the ratio of HCC incidence in the cirrhotic stage/non-cirrhotic stage were as follows. (a) hepatitis B virus liver disease: 0.37%→3.23% (8.73-fold), (b) hepatitis C virus liver diseases: 0.68%→4.81% (7.07-fold), (c) primary biliary cholangitis (0.26%→1.79%, 6.88-fold), (d) autoimmune hepatitis (0.19%→0.53%, 2.79-fold), and (e) NASH (0.03%→1.35%, 45.00-fold). Regarding primary hemochromatosis and alcoholic liver diseases, only follow-up studies in the cirrhotic stage were presented, 1.20% and 2.06%, respectively. CONCLUSIONS: When the liver diseases advance to cirrhosis, the incidence of HCC is markedly increased. The development of HCC must be closely monitored by ultrasonography, magnetic resonance imaging, and computed tomography, irrespective of the different kinds of liver diseases.

Socioeconomic inequalities in low back pain among older people: the JAGES cross-sectional study.

BACKGROUND: Low back pain is an important public health issue across the world. However, it is unclear whether socioeconomic status (SES) is associated with low back pain. This study determines an association between SES and low back pain among older people. METHODS: We used cross-sectional data derived from the year 2013 across 30 Japanese municipalities. The survey was conducted between October 2013 to December 2013. Functionally independent community-dwelling older adults aged 65 and above (n = 26,037) were eligible for the study. Multilevel Poisson regression analysis with a robust variance estimator was used to examine the association between SES and low back pain. Self-reported low back pain in the past year was used as a dependent variable. Educational attainment, past occupation, equivalized household income, wealth, and subjective economic situation represented SES and were separately analyzed as independent variables, adjusted for covariates including age and sex. RESULTS: The prevalence of low back pain was 63.4%. Overall, lower SES were more likely to suffer from low back pain compared with that for the highest. First, as for the educational attainment, the prevalence ratio (PR) (95% credible interval (CI)) for the lowest level was 1.07 (1.02-1.12). Second, as for the past occupation, the PR (95% CI) for the blue-collared workers compared with professionals was 1.06 (1.01-1.11). Third, as for the equalized household income, the PRs (95% CI) for lower middle and the lowest income levels were 1.08 (1.02-1.13) and 1.16 (1.10-1.23), respectively. Fourth, as for the wealth, the PRs (95% CI) for lower middle and the lowest wealth levels were 1.11 (1.04-1.19) and 1.18 (1.11-1.27), respectively. Fifth, as for the subjective economic situation, the PRs (95% CI) for lower middle and the lowest financial conditions were 1.18 (1.10-1.26) and 1.32 (1.22-1.44), respectively. CONCLUSIONS: Significant socioeconomic inequalities were observed in low back pain among older individuals in Japan. Policymakers and clinicians must understand the nature of these inequalities.

The development of a scale for social participation among community-dwelling frail older adults: a preliminary survey.

AIM: The aim of our study was to draft a scale measuring the social participation of community-dwelling frail older adults. METHODS: A questionnaire consisting of 37 items was prepared based on the findings of previous studies. We recruited community-dwelling older adults ≥65 years of age living in Mitaka City, Tokyo. The inclusion criteria were as follows: native speakers of Japanese; not being covered as support and care level; support level 1; support level 2; care level 1; and care level 2. In total, 328 individuals were investigated. The selected individuals were categorized into the following six groups, according to a Japanese frailty scale and the Japanese Long-term Care Insurance System: non-frail, frail and at high-risk of requiring long-term care, support level 1, support level 2, care level 1, and care level 2. We then randomly selected individuals adjusted for age and gender in each group. The Rasch model was used to select items and to examine the validity. Cronbach's α was calculated to examine reliability. RESULTS: We analyzed 170 subjects. Of the 37 items, 22 were considered based on the Rasch model for inclusion in a draft scale of social participation. The Cronbach's α for these items ranged from 0.86-0.87. CONCLUSIONS: We conducted a preliminary survey to develop a scale describing social participation among community-dwelling frail older adults. The construct validity and reliability were adequate for this scale. Based on the findings of this preliminary survey, we will investigate a larger sample size to enhance the scale.